Bipolar Disorder and Addiction

Many people who have mental health disorders also develop addictions to drugs or alcohol. When this occurs, it is known as having co-occurring disorders or a dual diagnosis. The prevalence of addictions that co-occur with bipolar disorder is particularly high, with about 60% of those with bipolar disorder developing addictions.

What Is Bipolar Disorder?

Bipolar disorder, formerly known as manic depression, is characterized by drastic mood swings, going from extreme emotional highs to intense lows. These episodes may last days to weeks, with the frequency of episodes varying widely by person.

People with bipolar disorder may experience four different types of episodes.

1. Manic episodes: Extreme happiness or hostility that may last for a week or more, sometimes requiring hospitalization.
2. Hypomanic episodes: The same as manic episodes but shorter and less severe.
3. Major depressive episodes: Extreme feelings of sadness or hopelessness with a loss of interest in activities lasting for two weeks or more.
4. Mixed episodes: Experiencing symptoms of all three other types of episodes.

Two types of bipolar disorder have been defined.

• Bipolar !: People with bipolar ! experience more manic episodes followed by major depressive episodes. Bipolar ! is considered the most severe type.
• Bipolar !!: Characterized by more major depressive episodes followed by hypomanic episodes.

The causes of bipolar disorder may be genetics, chemical brain imbalances, or past trauma.

Symptoms of Bipolar Disorder

The symptoms of bipolar disorder are different for manic episodes and depressive episodes.

Manic Episode Symptoms

• Hyperactivity
• Heightened sense of self-confidence
• Decreased need for sleep
• Extreme talkativeness
• Racing thoughts
• Short attention span
• Risky behavior
• Preoccupation with doing a specific task

Depressive Episode Symptoms

• Feeling sad or hopeless most of the day
• A sense of worthlessness
• Weight loss or gain
• Restlessness
• Insomnia or sleeping too much
• Loss of interest in once enjoyable activities
• Fatigue
• Extreme feelings of guilt
• Lack of concentration
• Thoughts of death or suicide

The Relationship Between Bipolar Disorder and Addiction

The relationship between bipolar disorder and addiction is complex. No single explanation can be given for why people with bipolar disorder are so prone to addiction, but it’s thought in part to be due to the fact that addiction and bipolar disorder have common risk factors, including genetics, environment, and past trauma.

The other explanation is that people with bipolar disorder turn to drugs or alcohol to relieve their symptoms. However, this only provides temporary relief. Using drugs or alcohol over time will actually cause the bipolar symptoms to become worse. This leads to continued use of substances to try to relieve the worsened symptoms, which leads to addiction. It’s a vicious circle.

Interestingly, in some cases, addiction may induce bipolar disorder by affecting parts of the brain that control mood, leading to bipolar symptoms. In these cases, once sobriety is achieved, the bipolar symptoms may disappear over time as the brain resets itself.

Diagnosing Bipolar Disorder When Addiction Is Present

Diagnosing bipolar disorder in someone with an addiction can be difficult since the effects of drugs and alcohol can be similar to the symptoms of bipolar disorder. For example, cocaine can make someone manic.

Only a mental health professional can make the diagnosis. They will evaluate the person’s symptoms and history, and may interview friends and family about their behaviors and emotional state.

Treating Bipolar Disorder and Addiction Concurrently

When bipolar disorder and addiction co-occur, both must be treated at the same time for treatment to be effective. When entering a treatment program for addiction, the person will be fully evaluated for mental health disorders so that a personalized treatment program can be developed.

The first line of treatment for bipolar disorder is generally medication. Medications may include:

• Anticonvulsants
• Antipsychotics
• Lithium
• Benzodiazepines

Therapy is also used to treat both bipolar disorder and addiction. Fortunately, the types of therapies used for each are similar and may include:

• Motivational Interviewing: This approach involves helping the person to set personal goals for recovery, and to build motivation to achieve those goals. It works by exploring how substance abuse has disrupted their life, and what will drive them to get better, whether it’s their children, their health, or some other aspect of their life.
• Cognitive Behavioral Therapy (CBT): CBT focuses on changing negative or irrational thought patterns into positive, reality-based thoughts. It also teaches healthy coping strategies.
• Dialectical Behavioral Therapy (DBT): DBT is similar to CBT but focuses on accepting negative emotions and learning skills to change negative behaviors. It involves learning mindfulness, emotional regulation, and distress tolerance.
• Relapse Prevention Therapy: This approach involves identifying specific relapse risks and triggers, meaning situations and emotions that put the person at risk of relapse. It teaches them how to handle those risks, both with thoughts, and with specific behaviors.

Much of this therapy occurs in a group therapy format, which is very effective in treating co-occurring disorders.

The Structure of Treatment for Bipolar Disorder and Addiction

The best course of treatment is a comprehensive treatment program that involves both inpatient and outpatient treatment. Three stages of treatment are usually recommended.

1. Inpatient Treatment Program: Inpatient treatment will start with a period of detox, keeping the person safe as they experience withdrawal. During this time medications for the bipolar disorder may be started. These medications may be adjusted until an effective combination and dosage is found. Then individual and group therapy will continue throughout the inpatient stay, which may last for 30 to 90 days.
2. Partial Hospitalization Program (PHP): A partial hospitalization program (PHP) allows the person to live at home while attending treatment for four to six hours per day, usually five days a week. The program may last anywhere from four weeks to ten weeks. The treatment consists of therapy similar to that of inpatient treatment, both in groups and individually.
3. Intensive Outpatient Program (IOP): An intensive outpatient program (IOP) consists of two to three hours of therapy several days a week for eight to twelve weeks. Often, sessions are held in the evenings so that the person can still go to work or attend school. Treatment, again, involves individual and group therapy.

Treatment should be followed with some kind of ongoing support, such as attending support groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).

In Closing

Bipolar disorder and addiction often occur together and must also be treated together. If you have bipolar disorder and addiction, help is available. At Bridges of Hope we offer treatment options for co-occurring disorders that can help you get on the road to recovery. We are committed to providing comprehensive, personalized care. Give us a call today to learn more.