relationship with yourself

For many of us, our addiction is filled with thoughts and behaviors that cause harm to ourselves and those around us. Part of the difficulty we face getting sober is that often we beat ourselves up for our behavior, past and present. We are incredibly harsh on ourselves, sometimes treating ourselves worse than we would ever treat others. Although it is beneficial to push ourselves to grow, we must find a way to change our relationship to ourselves. Our habits of self-resentment and self-blame can cause quite a bit of suffering in our lives, and bringing forgiveness, compassion, and acceptance into our sober lives can help us recover.

The Blame Game

We often play the blame game in our using and early recovery. Unfortunately, the nature of addiction is that we often hurt those we care about, including ourselves. These realities can be hard to face when our minds clear and we don’t have drugs or alcohol to subdue the thinking mind. Whether we are recovering from an addiction, a mental disorder like depression, or a co-occurring disorder

Self-Forgiveness

Self-forgiveness is one of the first steps toward a healthy relationship with ourselves. Self-forgiveness is the ability to let go of resentment toward ourselves for something in the past. Perhaps Lily Tomlin said it best when she said, “Forgiveness means giving up all hope for a better past.” Forgiveness is allowing ourselves to move forward. The Vietnamese Buddhist monk and author Thich Nhat Hanh reminds his students the forgiveness requires us to forgive ourselves for not being perfect.

“Forgiveness means giving up all hope for a better past.”
-Lily Tomlin

It’s important to note that forgiveness is not an act of giving ourselves permission to behave poorly in the future. We can forgive ourselves for causing harm without endorsing the behavior or allowing it to happen again. When we work on forgiveness, it becomes a constant attitude, not just a one-time effort. Developing a working attitude of forgiveness can be greatly beneficial in our recovery. A 2005 study by Romero, et. al. investigated self-forgiveness in women with breast cancer and found that an attitude of forgiveness toward self was linked to less mood disturbances and better quality of life.

So how do we jump into a state of self-forgiveness? It takes time. We can’t suddenly change the way our minds work just by making a decision. However, we can start on the path of forgiveness right away. Try noticing how you’re talking to yourself during the day. What happens when you think of your past or when you make a mistake? You don’t need to push down any harsh thoughts. Instead, just notice them and try to bring a little bit of kindness to the thoughts. You don’t have to buy into each and every thought you have!

Self-Compassion

This is likewise a powerful way in which we can change our relationship with ourselves. Humans, especially those struggling with addiction, have a tendency to dislike unpleasant emotions and experiences. Rather than feeling what is present, we push the feeling down or take ourselves away from the situation. Of course, this can be beneficial if we are in serious danger. However, we often respond with aversion when we are actually rather safe.

Maybe you have a painful thought about some harm you caused a loved one. In the past, you may have taken a drink or used drugs to keep this thought away. Without substances to push these thoughts down, we may turn to process addictions, sleeping, or any number of other behaviors. Instead of finding another way to not feel, we can try responding with some self-compassion. By caring about our pain, we can learn to be with our experience without needing to use drugs or other experiences to run away. A 2007 study by Neff, et. al. found that increased self-compassion led to increased psychological well-being, suggesting there is some truth the power of compassion.

Like we may do with self-forgiveness, self-compassion takes repeated effort. It is not our habit to respond to pain with care and attention, so we may benefit from letting go of expectations. We can forgive ourselves for not being perfectly compassionate! Here’s a practice to try: When you notice that you’re having an experience of pain, offer yourself a phrase of kindness such as “I love you” or “I care about you.” This simple act of trying to care about ourselves can really help retrain the mind to respond with care when we’re in pain.
relationship with yourself

Self-Appreciation

It feels sometimes like we’re so often focusing on the difficult experiences when we get sober. We do an inventory in twelve-step programs, talk about difficulties in therapy, and have to deal with some wreckage of our past. These are all incredibly useful pieces of recovery, but we mustn’t forget to tune into the happy moments as well. When we experience joy in early recovery, we glaze right over it or feel unworthy. Dr. Mario Martinez has done research on this, finding that joy releases cortisol, the stress hormone, in the brain. If we feel unworthy of the joy, the body physically becomes stressed when happiness is present.

To grow happier, we have to learn to be with the moments of happiness and appreciate the joy we experience. In any given day we go through a number of emotions, pleasant and unpleasant. We unfortunately tend to focus on the unpleasant experiences, and they stick in our minds with more weight. Bestselling author Dr. Rick Hanson points out that we can help ourselves by pausing when joy is present and really taking it in. Whether you’re noticing a beautiful sunset, grateful to be sober, or proud of yourself for the work you’re doing, take a moment and really allow yourself to appreciate yourself and your joy!

The journey away from self-hatred and toward self-love isn’t easy. It takes time and persistence. We don’t just wake up one day with unconditional kindness toward ourselves. What we can do is hold the intention to respond with more forgiveness, compassion, and appreciation, and make an effort to take action to cultivate these new states of being.

Honesty In Recovery

In twelve step programs and other recovery programs as well, there are sets of principles which serve as a guiding force for the addict or alcoholic newly entering recovery. Behind each step, or monumental outline services a principle or a description as to what value the action or notion holds universally. In the 12 step program, the first step, “we admitted we were powerless over our addiction and that our lives had become unmanageable,” correlates with the principle of honesty. The notion of honesty is more than simply telling the truth. When carefully considered, it can reveal itself to be a powerful sentiment and strongly loaded word. To live an honest life is more than keeping your word or not lying, it’s almost an oath for righteousness without the thoughts of being righteous.

What is Honesty?

The most common definitions of honesty are that it implies a refusal to steal; a quality of being fair; a straight forwardness of conduct; a refusal to deceive in any way. Perhaps the most insightful is the refusal to deceive in any way. Many times in early recovery, we like to utilize the skill of omission. Omission is different than a normal lie because rather than offering information or an explanation that isn’t truthful, we preserve the integrity of our secrets by leaving out parts that might shed light into an area of our conduct that we wouldn’t want to be discovered. In taking up an honest lifestyle, it becomes apparent fairly quickly that honesty and transparency are words that should be synonymous with one another, if we are going to be anything close to happy in recovery from substances.

Honest Without Words

There’s an example that is sometimes used of a car without fuel. When the car is completely without fuel, it isn’t possible for it to go anywhere without refueling. There’s a similar notion in recovery, with a loss of energy and a loss of interest in many things. Feelings of being overwhelmed or even “burnt out,” are fairly common and can make it difficult to consider whether or not inertia comes from a place of exhaustion or simply refusal. Considering the automobile, we can honestly ask ourselves if we are putting in the best effort in our recovery and the tasks that are asked of us. Sometimes, admitting that the answer is “no,” can be a great example of honesty within ourselves. As honesty becomes much like a new language, it starts with our own understanding of ourselves and our capabilities. Many times, it can be misunderstood that unwilling and dishonest go hand in hand, however a truthful admission of our own unwillingness can be one of the more complementary steps we take in our quest for honesty. Much like the definition, this can be an important “straight forwardness of conduct,” and through this growth can absolutely be attainable.

Deception

For many addicts and alcoholics, something as simple as “dressing the part,” can be a dishonest method used for surviving uncomfortable and questionable situations. When we enter into early recovery, our dishonesty may be attached to a certain role we have been playing through our active addictions and a sense of an authentic self might seem to fall short of our expectations for who we must be or appear to be to survive. It’s important to realize that this sense of self is skewed through living a lifestyle that was not only dishonest, but ultimately wasn’t beneficially for bettering ourselves or finding true happiness. In recovery, we can see where we are being dishonest through our actions and appearances. With learning not to omit anything, and being straight forward about our conduct, we begin to learn that the best way to live an honest life is to simply step out into the world as we are and embrace the truth, for all it is worth.

We will live longer and happier lives if we can cultivate a sense of honesty that allows us to take refuge in the idea that we are no longer hiding from the world. Whether it’s through admitting a relapse, admitting a mistake, or being honest about our feelings in a certain situation, we can grow as recovering addicts and alcoholics if we find the faith necessary to allow ourselves to be honest with those who are closest to us. Through our trial and error, it becomes obvious that the only person we had hurt with our dishonest was ourselves. It is through faith in a process that we allow ourselves to show those who are closest to us our real selves; having shown them our real selves, we begin to heal as the people we were truly designed to be.

Faith comes in many forms, and although many of us are skeptical, we find we can not build trust without allowing a small bit of it in the first place. Through a recovery program, a mentor, a friend, a therapist or a loved one, we can begin allowing ourselves to build trust by being honest, little by little, with those who are closest to us. Through time we will see that in our honesty, others begin to gradually trust us, and the connections that are built through sincerity are those that are built to last a lifetime.

 

Fulfill Your Basic Needs

If you have ever taken a psychology class you have probably learned at least something about Maslow’s Hierarchy of Needs. In case you can’t remember or need a little refresher, here is what it’s all about: you need to fulfill your basic needs before you can fulfill your more complex needs. He created a pyramid with the most basic needs being at the bottom and the more complex needs at the top. Here is what they are (going from bottom to top)

  • Physiological
  • Safety
  • Love or Belonging
  • Esteem
  • Self-Actualization

While I am sure that many of us would like to skip to the top and go straight to self-actualization, that is not how it works. We have to make an effort to meet the needs at the bottom of the pyramid before we can work our way up.

Many people who struggle with addiction have a very difficult time meeting these basic needs. Often addiction takes over all of the other things we would usually do to take care of ourselves. Behaviors that seems so fundamental like eating and sleeping fall away. For people in early recovery it is vital to re-establish these healthy self-care behaviors. Here are some ways you can start to meet those basic needs so that you can start to move up that pyramid.

Eat Well

Eating well can mean different things to different people. There is no blanket diet that is good for all people. However, there are some basics that have been researched. The NIH (https://www.nhlbi.nih.gov/health/educational/lose_wt/eat/calories.htm) recommends emphasizing vegetables, fruits, and whole grains. It can also be beneficial to eat lean meats and proteins. You should try to limit sugar intake and control portion sizes in general. Following these simple recommendations can help you get your diet back on track. Dietary counseling has become common at many holistic treatment centers, as it’s a crucial piece to investigate if we are going to recover.

Drink Water

Contrary to what many bottled water companies would like you to believe, you don’t need to drink a ridiculous amount of water in order to stay hydrated. In fact, research has shown that just 2 cups of water per day can be enough for healthy adults. It is of course important to meet this minimum so that you aren’t dehydrated. Drinking water can help reduce stress, help us focus, and of course keeps our physical bodies running smoothly.

 

Get Your Sleep

Sleep needs tend to change for people over the course of the lifetime. For anyone who is chronically sleep deprived you probably know first-hand the negative effects it can have on the body. People who are sleep deprived tend to have worse concentration and memory. Sleep deprivation has also been linked to obesity and cardiovascular disease. Just like the water tip above, you do not need some crazy amount of sleep in order to meet your needs. But, if you are feeling tired you probably could use some more. Listen to your body and investigate for yourself what the right amount of sleep is for you.

Exercise Regularly

Exercise has been linked to a whole host of positive outcomes. According to the CDC it will boost mood and has positive mental health benefits as well as being beneficial for your physical body. Getting even a little exercise regularly will be hugely beneficial. Exercise has proven effective in increasing mood, helping treat depression, and helping people focus more on daily tasks.

Go to the Doctor

When we are kids most of us go to the doctor pretty regularly because our parents take us. For many young adults they don’t get to the doctor as often as they probably should. People struggling with addiction sometimes avoid seeing doctors for fear that their addiction might be found out. For people in early recovery it is crucial to get back into the habit of seeking medical help regularly and as needed. Duke Health recommends that healthy people under 30 get a physical every 2 or so years. They also recommend that women who are sexually active get see a gynecologist regularly. Taking care of your physical health in this way can really help your mental health.

Practice Meditation

This might seem like one of those things that isn’t a “basic need”. However, meditation can really help you meet some of your most basic needs for mental health. Meditation has been shown to reduce cortisol levels thereby reducing stress levels (https://www.ncbi.nlm.nih.gov/pubmed/23724462). Being that stress is one of the biggest triggers for most mental health issues this can be truly foundational to well-being. If you are looking to start a regular meditation practice there are a number of easy apps and breathing techniques that can be done regularly with very little time commitment.

Speak up for Yourself

This tip is one that moves from Maslow’s bottom tier of physiological needs up to safety. It can be really difficult for people to ask for their needs to be met. It can also be very difficult for people who are newly sober or trying to get sober to ask for help when it is needed. Speaking up for yourself even when it is hard can be a great way to increase your sense of safety. Doing so will allow you to lean on others for support and safety and have you needs met by the people close to you.

Establish Good Boundaries

This tip also addresses your basic need for safety. Part of addiction is very blurry boundaries. This might mean people who are enabling or codependent, it can also mean having people around who are too demanding. One of the best ways to start keeping yourself safe in recovery is to establish good boundaries with the people around you. Sometimes this means cutting off friends who just enable using or saying “no” to people who demand too much.

Remember to Have Fun

It is hard to meet your basic needs if there isn’t some time for breaks and fun. It is important in early recovery to start to care for yourself in all of these ways but also to be gentle with yourself and enjoy the process. The best way to motivate yourself to meet your basic needs is to enjoy the time you spend doing it. Maybe you pick one of these like exercise or nutrition that becomes a hobby for you. Whatever you do, remember that it is hard to meet complex needs like happiness and friendship when you aren’t being taken care of in basic ways.

bipolar and alcohol

While the association between a mood disorder and co-occurring alcoholism is well established, the most prevalent dual diagnosis is the one involving bipolar disorder and alcohol. Although the science behind this particular comorbidity isn’t yet clear, what is known is that alcohol abuse compounds the severity of the bipolar disorder and complicates treatment.

Bipolar disorder is a complex mental health condition that features extreme mood swings that vacillate between depressive and manic states, with some intermittent normal periods between these. There are four types of bipolar disorder, with bipolar I being the most serious. Individuals who suffer with bipolar disorder may gravitate toward alcohol use in an effort to soften the effects of the mental health disorder.

Gaining a better understanding of the relationship between bipolar and alcohol abuse allows us to improve the response time for getting someone much needed treatment for either or both of these conditions. Fortunately, both bipolar disorder and alcohol use disorder can be effectively managed through medication and psychotherapy.

What is Bipolar Disorder?

Mental illness can result in deep disturbances to all aspects of daily life, and bipolar disorder is particularly difficult to endure. Bipolar disorder, formerly referred to as manic-depression, features extreme mood swings. The characteristic shifts in mood and energy levels make it hard to complete basic tasks that others can so easily accomplish. According to the National Institute of Mental Health, bipolar disorder afflicts about 2.8% of the adult population in the U.S. Among those diagnosed with bipolar disorder, 82% are classified as severe.

The 4 types of bipolar disorder include:

Bipolar I Disorder. Bipolar I is the most common and most severe form of bipolar disorder, characterized by manic episodes that last for at least seven days or with manic symptoms so severe that acute stabilization in a hospital setting is often necessary.

Bipolar II Disorder. Bipolar II is defined by a pattern of manic and depressive episodes, but not to the same severity of Bipolar I.

Cyclothymic Disorder. Cyclothymic Disorder, or cyclothymia, is features repeated periods of manic symptoms and depressive symptoms lasting at least two years, however the symptoms do not reach the diagnostic criteria for manic or depressive episodes.

Unspecified Bipolar Disorders. This category includes those who experience bipolar disorder symptoms that do not fit into the above categories.

Symptoms of bipolar vary depending on the type of the disorder, but may include:

Depressive symptoms

  • Low mood that persists
  • Loss of interest in everyday life activities
  • Fatigue
  • Sleep problems
  • Inability to concentrate or make decisions
  • Feelings of guilt or worthlessness
  • Restlessness or slowed behaviors
  • Weight loss or gain that is unintended
  • Thoughts of suicide

Manic symptoms

  • Racing thoughts
  • Rapid speech, very talkative
  • Euphoric, hyperactive behavior
  • Increased activity and energy
  • Reduced sleep
  • Easily distracted, difficulty finishing tasks
  • Engages in high risk behavior
  • Poor decision-making

The Effects of Bipolar Disorder

Bipolar disorder can be dangerous to one’s physical health as well. Often the individual with bipolar will fixate on their own death, even obsessing about suicide. Also, many who struggle with bipolar disorder will engage in self-harming behaviors, such as the practice of “cutting” or other forms of self-mutilation, as an outlet for feelings of frustration and self-loathing.

Relationships are hard hit by bipolar disorder. People battling bipolar disorder often isolate themselves, withdrawing socially because they feel misunderstood. The isolating behaviors only worsen interpersonal relationships and can negatively impact employment stability.

Substance abuse is common among those with bipolar disorder, particularly alcohol abuse, further complicating the symptoms and exacerbating high-risk behaviors. Other comorbidities may include anxiety disorder, psychosis, eating disorders, and ADHD.

The Link Between Bipolar and Alcohol Use Disorder

The connection between bipolar disorder and alcohol use disorder has been the subject of research. It has been found that 46.2% of individuals with bipolar I disorder also have a comorbid alcohol use disorder, although it has yet to be discovered exactly why there is such a high prevalence of this dual diagnosis. Some of the possible causes for these comorbid disorders are posed in an article, “Bipolar Disorder and Alcoholism,” [Sonne and Brady]:

  • That bipolar disorder may be a risk factor for substance use
  • That symptoms of bipolar may emerge during alcohol withdrawals
  • That individuals with bipolar may use alcohol to mitigate mania
  • That bipolar disorder and alcoholism affect neurotransmitters the same way
  • That there is a genetic component with family history of both disorders

Unfortunately, alcohol abuse only enhances the symptoms of bipolar disorder. Although someone suffering from the relentless mood swings attempts to find relief in alcohol use, this strategy only worsens the disease and can lead to alcohol dependence or addiction.

The Warning Signs of Alcohol Use Disorder

The telltale signs and symptoms of alcohol use disorder (AUD) include behavioral, physical, and psychological elements. The DSM-5 established a list of criteria that helps to diagnose the severity of an alcohol problem. The more symptoms that are present, the higher the severity of the AUD. Mild AUD is indicated when 2-3 criteria are present, moderate AUD when 4-5 criteria are met, and severe AUD is diagnosed when 6 or more criteria are met.

The diagnostic criteria include:

  • Higher levels of alcohol consumption or drinking over a longer period of time than was intended
  • Persistent unsuccessful attempts to cut down or control alcohol use
  • Significant time spent obtaining, drinking, and recovering from the effects of alcohol.
  • Alcohol cravings
  • Recurrent alcohol use leading to failure to fulfill major role obligations at work, school, or home
  • Recurrent use of alcohol, despite having mounting interpersonal problems caused or worsened by alcohol
  • Giving up or missing important social, occupational, or recreational activities due to alcohol use
  • Recurrent alcohol use in high risk situations
  • Increased tolerance markedly increases levels of alcohol consumption to get desired effect
  • Withdrawal symptoms when alcohol is withheld

Dual Diagnosis Treatment for Bipolar and Alcoholism

According to statistics provided by the National Alliance on Mental Illness, approximately 9.2 million Americans struggle with a dual diagnosis, such as bipolar and alcohol addiction. When layering alcoholism over an existing mental health disorder, the individual’s condition becomes more serious. The resulting co-occurring disorders leaves individuals with mounting negative life consequences and deteriorating mental and physical health.

It is essential to seek help for comorbid disorders at a residential recovery program that specializes in treating a dual diagnosis. These programs are staffed appropriately with the psychiatric expertise necessary to prescribe medication, design a customized treatment plan for co-occurring disorders, and to effectively manage the unique mental health challenges that may emerge in the treatment setting.

It is essential that someone with both bipolar disorder and an AUD obtain treatment for both disorders simultaneously. Treatment will be multi-pronged, including medication, psychotherapy, holistic elements, and recovery support. These treatment elements include:

Detox and withdrawal.  Initially the individual must first eliminate the chemical toxins from the body through an alcohol detoxification process. This typically takes 5-7 days and is best undergone in an inpatient medically supervised detox program that is trained to identify dangerous withdrawal symptoms.

Medication: Mood stabilizing medications, such as antipsychotics and antidepressants, are the most commonly prescribed drugs for treating bipolar disorder. The specific type of bipolar disorder will dictate the medications. Lithium is the predominant medication prescribed for controlling bipolar disorder, in addition to anticonvulsants and SSRIs. Some may benefit from medication-assisted treatment for the alcoholism. Naltrexone is a non-narcotic drug that can help individuals maintain sobriety by reducing the cravings that lead to relapse.

Psychotherapy: Thoughts can influence behaviors, and negative thoughts can lead to self-destructive behaviors. Cognitive behavioral therapy (CBT) is the most commonly used form of psychotherapy for treating bipolar disorder. CBT therapists will guide the individual to identify thought distortions or triggers that lead to the disruptive behaviors, and help them change these destructive thought patterns. CBT is also effective for individuals in addiction recovery, providing them with essential coping skills.

Interpersonal and social rhythm therapy.  IPSRT provide life skills that helps the patient learn how to better predict and manage the bipolar episodes. This therapy focuses on the importance of maintaining a consistent daily routine, in addition to improving interpersonal relations and stress management.

Holistic: Experiential and holistic therapies can aid in regulating bipolar symptoms and promote overall wellness. These activities might include massage therapy, yoga, deep-breathing techniques, mindfulness meditation, art therapy, guided imagery, and aromatherapy.

Lifestyle: Because establishing a healthy routine is essential in managing bipolar disorder, residential programs will counsel patients on nutrition and exercise. Improving sleep quality, getting regular exercise, eating a nutritious diet, and managing stress are all intrinsic to achieving emotional stability and reducing the probability of a relapse.

Recovery support groups.  Success in recovery does not end with completion of a dual diagnosis program. Aftercare is an important aspect of recovery and should be included in the comprehensive dual diagnosis treatment planning. Aftercare includes regular participation in a recovery community, such as a 12-step or non 12-step program, ongoing outpatient group and individual counseling, and possibly transitional housing for a few months in sober living.

Elevation Behavioral Health Provides Dual Diagnosis Treatment

Elevation Behavioral Health is an upscale private residential mental health program in Los Angeles. Elevation is committed to providing leading dual diagnosis treatment for individuals who struggle with both bipolar disorder and alcohol use disorder. Our expert staff ensures that each individual in our care receives compassionate and respectful care, along with the most up to date evidence-based treatment measures. Our beautiful, serene setting provides a soothing and supportive environment for healing and new beginnings. For more information, please reach out to the Elevation team at (888) 561-0868.

Bipolar Disorder and Addiction

Bipolar disorder is a serious mood disorder that’s characterized by alternating episodes of extremely high and very low moods. According to the Depression and Bipolar Support Alliance, bipolar disorder affects around 5.7 million adult Americans each year, and it’s the sixth leading cause of disability in the world.1

Bipolar disorder is the sixth leading cause of disability in the world.

Bipolar disorder commonly co-occurs with substance use disorders. Results of the U.S. National Comorbidity Survey found that 71 percent of people with bipolar disorder reported at least one lifetime substance use disorder.2 Alcohol dependence was reported by 61 percent of respondents, and 40.7 percent reported drug dependence.

How Substance Abuse Affects Bipolar Disorder

According to an article published in the journal Science & Practice Perspectives, people with bipolar disorder who abuse alcohol had an earlier onset of symptoms, more frequent hospitalizations and more mental illnesses.3

Those who suffer from bipolar disorder and a co-occurring substance use disorder are also the highest risk group for suicide. This is largely due to the combination of risk-taking behaviors and major depressive episodes that characterize bipolar disorder and the loss of inhibition and a deepening of despair that often characterize intoxication.

If you or someone you love suffers from co-occurring bipolar disorder and a substance use disorder, then the sooner treatment begins, the better the outcome is likely to be. Each disorder worsens the other, and left unchecked, co-occurring disorders can lead to devastating disability.

That said, even severe cases of co-occurring bipolar disorder and addiction can be successfully treated, as long as an individual remains committed to treatment and fully engaged in the treatment plan.

Even severe cases of co-occurring bipolar disorder and addiction can be successfully treated as long as an individual remains committed to treatment and fully engaged in the treatment plan.

Signs and Symptoms of Bipolar Disorder

Bipolar disorder is characterized by four types of mood episodes. These are mania, hypomania, depression and mixed episodes. Each type of episode can last for weeks or months, especially when left untreated, and each has its own set of signs and symptoms. Signs of bipolar episodes are those that others may notice, while symptoms are those that an individual with bipolar will feel.

Mania

Signs and symptoms of a manic episode include:

  • Feelings of grandiosity and self-importance
  • Talking rapidly
  • Alternating moments of incredible elation and intense pessimism
  • A reduction in hours of sleep per night
  • Engaging in risk-taking behaviors
  • Impaired judgment
  • Irrational thoughts and behaviors
  • Hallucinations

Hypomania

Psychotic symptoms are absent during periods of hypomania, which has symptoms that are similar to but far less intense than those of the manic phase. During hypomania, a person will likely:

  • Be capable of managing day-to-day activities
  • Feel happier, more energetic or more irritable than usual
  • Need less sleep
  • Feel capable of taking on more responsibility at work or school
  • Be more likely than usual to engage in high-risk behaviors, including substance abuse
  • Feel like the bipolar disorder is under control

Depression

The depressive phase of bipolar disorder is marked by severe lows and includes signs and symptoms such as:

  • Feelings of hopelessness, helplessness and sadness
  • A loss of interest in activities you once enjoyed
  • Fatigue and sleepiness
  • Appetite changes or changes in weight
  • Feelings of guilt and self-hatred
  • Thoughts of death or suicide

Mixed Episodes

Bipolar symptoms aren’t always cut and dry. A mixed episode is a combination of symptoms for mania and depression.

Five types of bipolar disorder are commonly diagnosed:

  • Bipolar I Disorder is the most severe form of the disorder and is characterized by one or more mixed or manic episodes and one or more major depressive episodes.
  • Bipolar II Disorder is characterized by lower highs than bipolar I disorder. Bipolar II is diagnosed after one or more major depressive episodes and at least one hypomania episode.
  • Bipolar Not Otherwise Specified doesn’t follow a pattern. For example, you may have very rapid swings between manic and depressive episodes, or you may experience recurring hypomanic episodes without any depressive episodes.
  • Cyclothymia is a mild form of bipolar disorder that’s characterized by alternating hypomanic episodes and milder episodes of depression. These alternating episodes must last for at least two years to be diagnosed as cyclothymia.
  • Bipolar with Rapid Cycling is characterized by having four or more depressive, manic or hypomanic episodes in a 12-month period. Rapid cycling can occur with any of the types of bipolar.

Substance Use Disorders: Addiction and Dependence

Addiction is characterized by continuing to use a psychoactive substance even though it’s causing problems in your life. Addiction affects the structures and functions of the brain and is widely considered to be a diagnosable, treatable and preventable brain disease. If you’re addicted to drugs or alcohol, a number of psychological and physiological mechanisms are likely at work, including learned, reinforced behaviors and changes in the way the chemicals in your brain function.

Signs and symptoms of addiction include:4

  • Using drugs or alcohol despite negative consequences to your health, relationships, finances or legal status
  • A loss of control over the frequency of using drugs or alcohol, the duration of use and the amount consumed
  • A loss of interest in hobbies and activities you once enjoyed
  • Increasingly neglecting your responsibilities at home, work or school
  • Taking serious risks as a result of drug-seeking or drug-taking behaviors
  • Hiding the extent of your drug use from family and friends
  • Problems in your relationships with family, friends or coworkers
  • Neglecting personal hygiene

Dependence is characterized by changes in brain function that reach a tipping point at which the brain now needs a psychoactive substance in order to function “properly.” When the substance is withheld from the body, withdrawal symptoms set in as your brain’s way of telling you it can’t operate normally without the substance of abuse present. Withdrawal symptoms are the main indication that physical dependence has occurred.

Why Bipolar Disorder Commonly Co-Occurs with a Substance Use Disorder

A number of theories attempt to explain the high prevalence of bipolar disorder co-occurring with a substance use disorder.3

Self-Medication

One theory proposes that having a mood disorder increases the risk of developing a substance use disorder, and vice versa. The effects of a mood disorder often lead to self-medication with drugs or alcohol. Substance use may seem to reduce symptoms initially, but almost always worsens a mental disorder.

Someone with bipolar disorder may try to suppress feelings of rage or anger with an opiate like oxycodone; someone else may try to lift a depressed mood with cocaine or another stimulant. In many cases, chronic substance abuse causes mild symptoms of mental illness to worsen to a clinically significant level, due to changes in already-abnormal neurotransmitter activity. As such, it can be difficult to determine which occurred first: the substance abuse or the bipolar disorder.

It can be difficult to determine which occurred first: the substance abuse or the bipolar disorder.

Kindling

Kindling occurs when repeated disruptions sensitize brain cells and lead to symptoms that become more frequent and severe over time. Some substances, like alcohol and cocaine, sensitize neurons, and this makes them more easily disrupted. This may help explain the progression of a substance use disorder from chronic abuse to addiction, and it may explain why mood disorders often progress as well, with symptoms worsening over time and increasingly shorter periods of remission occurring between episodes.

Genetics

Both substance use disorders and mood disorders have genetic risk factors, and some genetic influences may increase the risk of developing both bipolar disorder and an addiction. This may occur in three ways:

  • The genetic variable makes an individual vulnerable to a mood disorder, which that person may then self-medicate, leading to addiction.
  • The genetic variable causes the brain to respond to drug exposure in a way that leads to chronic abuse, which then causes changes that lead to or uncover the mood disorder.
  • The genetic variable causes the brain to develop in a way that makes it vulnerable to both addiction and bipolar through mechanisms like sensitized neurons and kindling.

Diagnosing Co-Occurring Bipolar and Addiction: Integrated Screening and Assessment

The Substance Abuse and Mental Health Services Administration has developed a best-practices protocol for the integrated screening and assessment of co-occurring disorders.5 Individuals who seek treatment for a mental health issue will be screened for a substance use disorder as a matter of course, and those who seek treatment for a substance use disorder will be screened for mental illness. The screening process serves to answer the question of whether a co-occurring disorder may be present.

If the screening is positive, a detailed and thorough assessment will take place, and if the presence of a co-occurring disorder is established, this assessment will serve as the basis for an individualized treatment plan.

According to the Substance Abuse and Mental Health Services Administration’s 10 Guiding Principles of Recovery, there is no single way to treat addiction, because nobody responds to the same treatments in the same way. Every individual has a unique combination of issues, needs and preferences when it comes to treatment, and these must be addressed through a unique, personalized treatment plan.6

Every individual has a unique combination of issues, needs and preferences when it comes to treatment, and these must be addressed through a unique, personalized treatment plan.

Why Integrated Treatment is Essential for Co-Occurring Disorders

If you suffer from co-occurring bipolar and substance use disorders, choosing a dual diagnosis treatment program is crucial for improving your chances of long-term recovery from each disorder.

Treating only the bipolar disorder won’t address the issues underlying the substance use disorder, which will typically continue to worsen the bipolar symptoms. Conversely, treating only the substance use disorder won’t help curb the self-medicating and risk-taking behaviors that are associated with bipolar disorder, which will likely contribute to relapse very quickly.

Integrated treatment for co-occurring disorders is a meaningful collaboration among the treatment teams for both disorders, each of which is treated in the context of the other. An enormous body of research shows that specialized, dual diagnosis treatment for co-occurring disorders has a far better outcome than stand-alone treatments for a substance use disorder and other mental illness.

Integrated treatment for co-occurring disorders is a meaningful collaboration among the treatment teams for both disorders.

It is important to find an evidence-based integrated treatment program if you have a co-occurring disorder.7 This type of treatment involves treatment specialists who are trained to treat both substance use disorders and serious mental illnesses. These specialists:

  • Strive to meet all of the various unique needs of people with co-occurring disorders
  • Use treatment interventions that are appropriate for an individual’s particular stage of recovery
  • Administer treatment therapies in group, individual and family settings
  • Involve the individual in the development of a treatment plan
  • Integrate medication services with other treatment protocol

Using a combination of behavioral therapies and medication is the most effective way to treat a co-occurring disorder. A holistic approach to treatment is essential and should include both traditional and complementary treatment therapies that address issues of the body, mind and spirit.

Medications Used for Treating Bipolar Disorder

Bipolar disorder can be successfully managed with a variety of medications, depending on the symptoms.8

  • Mood stabilizers help control manic and hypomanic episodes and include drugs like lithium and lamotrigine.
  • Antipsychotics like risperidone and aripiprazole help control symptoms that other medications have been unable to affect.
  • Antidepressants effectively treat depression, but since these medications can trigger a manic episode, they’re usually taken with a mood stabilizer or antipsychotic. Common antidepressants include fluoxetine and citalopram.
  • Combination medications are those which contain both an antidepressant and a mood stabilizer.
  • Anti-anxiety medications in the benzodiazepine family may be prescribed for short-term use to reduce anxiety and improve sleep.

Treatment Therapies for Co-Occurring Bipolar Disorder and Addiction

Psychotherapy, or talk therapy, helps individuals learn to change their way of thinking and behaving. Research shows that psychotherapy is highly effective for treating both bipolar disorder and substance use disorders.

Group Therapy

Peer groups are valuable sources for developing coping skills and strategies. Sharing similar experiences provides a strong sense of belonging to people who may otherwise feel disenfranchised. Group members hold each other accountable and help one another evaluate their thoughts and behaviors. The opportunity to help others itself can also help bring about meaningful change.

Family Therapy

Family therapy is essential for restoring function to the household and improving communication among family members. Both bipolar and addiction take a major toll on the functioning of the family system, and fostering a healthy home environment goes a long way toward preventing relapse.

Family therapy is essential for restoring function to the household and improving communication among family members.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy helps you learn to identify and evaluate self-destructive thoughts, beliefs and attitudes and replace them with healthier ways of thinking and behaving. It also helps you cope with symptoms and recognize the signs that point to a mood shift. Research shows that cognitive-behavioral therapy is highly effective for treating those with bipolar disorder.9

Dialectical Behavior Therapy

A 2013 study found dialectical behavior therapy to be a promising treatment for bipolar disorder, according to an article published in Psychiatric Times.10 Originally developed to treat people with suicidal thoughts and actions, dialectical behavior therapy involves teaching participants four sets of essential behavior skills:

Mindfulness – the practice of being aware and present in the moment

Distress tolerance – how to tolerate, rather than eliminate, painful situations

Interpersonal effectiveness – how to say no to people and ask for what you want in a way that promotes healthy relationships and a high level of self-respect

Emotional regulation – how to control your emotions and change those you want to change

Interpersonal Therapy

Bipolar disorder and addiction both have a strong influence on your interactions with others. Interpersonal therapy addresses your various relationships and explores how your interactions with others affect your disorders and vice versa.

Social Rhythm Therapy

Keeping a routine and getting adequate sleep are both crucial for recovering from co-occurring disorders. The body’s circadian rhythms are deeply affected by bipolar disorder. Resetting and stabilizing your biological clock for better sleep, daily functioning and overall mental health can make a big difference in your recovery.

Challenges in Recovery from Bipolar Disorder and Addiction

Recovery from a substance use disorder can be particularly challenging if you have bipolar disorder. The nature of manic and depressive episodes, such as the prevalence of risk-taking behaviors during a manic episode and the feelings of hopelessness that characterize a depressive episode, can lead to disengagement with your treatment plan. This can quickly lead to a relapse.

Although research shows that people with bipolar disorder recover more slowly when alcohol abuse or addiction co-occurs, with the right dual diagnosis program and a high level of engagement in treatment, many people can and do recover from bipolar disorder and addiction.

With the right dual diagnosis program and a high level of engagement in treatment, many people can and do recover from bipolar disorder and addiction.

Choosing a Recovery Program

If you have bipolar and a substance use disorder and you’re ready to get the help you need to recover from both disorders, choosing a residential dual diagnosis treatment program is essential for the best possible outcome. Residential treatment programs enable you to focus solely on recovery, and they offer an enormous amount of support during treatment. Components in choosing a treatment program include:

  • State accreditation. Make sure the facility is accredited by the state it’s in.
  • Licensing. Ensure the mental health professionals and addiction specialists are fully licensed and well trained.
  • Research-based treatment protocol. Find out whether the program uses a research-based, best-practices treatment protocol and adheres to the National Institute on Drug Abuse’s Principles of Effective Treatment.11
  • Statistics. Ask about the program’s outcome statistics. Treatment programs should have readily available statistics concerning their success rates, and they should be forthcoming with that information.
  • Personal preferences. Make sure the program and the facility are a good match for your personal preferences. For example, if you’re vegetarian, are meatless options available for meals?
  • Are the residential facilities clean and comfortable? Does the facility feel like a hospital or a home?
  • A holistic approach. High-quality treatment programs will offer a number of holistic, research-based complementary therapies like yoga, art therapy, acupuncture or nature therapy.
  • Insurance. Does the facility accept your insurance? Keep in mind that under the Mental Health Parity and Addiction Equity Act of 2008, insurance companies must offer the same level of benefits for mental health and addiction recovery services that they do for standard medical treatments.12

Recovering from a co-occurring disorder isn’t easy, but the hard work pays off in a dramatically higher quality of life and sense of self-efficacy and well-being. Hope is the foundation of recovery, which is a process of change that occurs from the inside out and leads to better health and wellness and a self-directed life.13 As long as you have hope for a better future in which you’re able to strive to reach your full potential, there’s always a high potential for long-term recovery.

Sources:

  1. Bipolar Disorder Statistics. (n.d.). Retrieved from http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_bipolar_disorder
  2. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005, June). Prevalence, Severity, and Comorbidity of Twelve-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847357/
  3. Quello, S. B., Brady, K. T., & Sonne, S. C. (2005, December). Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Science & Practice Perspectives, (3)1, 13-21. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/
  4. About Addiction: Signs and Symptoms. (2015, July 25). Retrieved from https://ncadd.org/about-addiction/signs-and-symptoms/signs-and-symptoms
  5. Substance Abuse Treatment for Persons with Co-Occurring Disorders. (2005). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64196/
  6. SAMHSA’s Working Definition of Recovery: 10 Guiding Principles of Recovery. (2012). Retrieved from https://store.samhsa.gov/shin/content/PEP12-RECDEF/PEP12-RECDEF.pdf
  7. Integrated Treatment for Co-Occurring Disorders. (2009). Retrieved from http://store.samhsa.gov/shin/content//SMA08-4367/Brochure-ITC.pdf
  8. Bipolar Disorder: Treatment & Drugs. (2015, February 10). Retrieved from http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/treatment/con-20027544
  9. Psychotherapies. (n.d.). Retrieved from http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml
  10. Duerr, H. A. (March, 2013). DBT Holds Promise for Patients With Bipolar Disorder. Retrieved from http://www.psychiatrictimes.com/bipolar-disorder/dbt-holds-promise-patients-bipolar-disorder
  11. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
  12. Implementation of the Mental Health Parity and Addiction Equity Act. (2016, March 18). Retrieved from http://www.samhsa.gov/health-financing/implementation-mental-health-parity-addiction-equity-act
  13. Recovery and Recovery Support. (2015, October 5) Retrieved from http://www.samhsa.gov/recovery
depression and alcohol

There are many reasons why individuals suffer from alcoholism, and genetics, environmental factors and mental health issues are just a few explanations. Co-occurring disorders occur when an individual suffers from both a mental health issue and an addiction such as depression and alcohol. Though they are completely treatable, co-occurring disorders are especially delicate and require integrated clinical therapy to achieve lasting results. >/p>

Depression Statistics

Nearly a third of individuals who suffer from major depressive disorder also suffer from alcoholism. Though it can be hard to determine with certainty, in many cases the depression is present before the addiction takes place.

These numbers are compounded by the fact that 10 percent of Americans experience depression, yet more than 80 percent of those who deal with depression go undiagnosed and untreated. In the absence of professional treatment, it’s not uncommon for those suffering in silence to deepen their relationship with alcohol.

Negative Feedback Loops

Whether alcoholism is caused by depression or vice versa varies on a case-by-case scenario, but what remains the same is the impact that the two have on one another. For an individual struggling with alcoholism and depression, the negative feedback loop is self-perpetuating.

A person drinks in an attempt to feel better, only to find that the relief is merely temporary, if at all. This may lead to further attempts to self-medicate by drinking larger amounts with more frequency. Through this process, depression compounds these factors, leading the individual to quickly descend into addiction.

Social Consequences

The seemingly endless cycle of addiction has residual social repercussions as well. Many times people find themselves not caring about anything outside of their addiction. They may be unwilling to speak with others, show up at work or do anything that might interfere with their drinking routine. The inability to listen to reason, combined with disconnection from the world around them, produces a potent fertilizer in which depression, anxiety and addiction can grow.

Dual Diagnosis Treatment

Quitting cold turkey can not only be ineffective, it can be dangerous. Receiving help from certified professionals through a medically supervised detox program will greatly increase chances of recovery and decrease the dangers that come along with detoxing.

Trained specialists look at the root of the addiction and mental health issue and treat them both from the very start—healing both mind and body. Peoplecan learn new ways to cope with their mental health issues and begin to discover the potential that they may have thought was gone forever.

Types of Therapy

Many dual-diagnosis treatment facilities go beyond conventional individual and group therapy, giving individuals the chance to get to know themselves again through activities like art, yoga, exercise and music. When administered effectively and adhered to, therapy can help resolve co-occurring disorders and give people suffering from addiction the tools they need to overcome obstacles in a healthy and positive way.

Anyone who is suffering from alcoholism or who may be developing a drinking problem shouldn’t wait to treat these issues. The more time that passes, the more difficult it will be to break the negative feedback loop.

Role of Environment in Addiction

Drug and alcohol addiction impacts 23.5 million Americans each year. The sad truth is, though, that only around 11.2 percent of those people seek professional treatment. There are numerous factors that can contribute to addiction—trauma, mental illness, peer pressure—but out of all of the possible causes, there is one that affects every single person: environment.

Environment and the Brain’s Reward System

A person’s social interactions with others and their personal circumstances impact the risk of developing an addiction. When someone lives in an environment that does not challenge their mind or that makes them feel bad due to rocky relationships with loved ones, they are not stimulating the reward system in their brain. That lack of stimulation means that they are more likely to abuse drugs or alcohol in an effort to improve the way that they feel.

Poor social stimulation includes:

  • Poor relationships with family
  • A boring job situation
  • Poor interactions with co-workers
  • A lack of friends
  • Lack of respect at work or at home
  • Conflict in any relationship

Trauma or Abuse

Almost 50 percent of women and 60 percent of men experience traumatic situations at least once in their lifetime. That’s more than half of the country’s population. How do so many people cope with these stressful and painful memories? Many of them drink or do drugs. The reality is, though, that using only makes things worse. It might mask the pain for a moment, but it doesn’t resolve it. Instead, the symptoms compound into ugly globules of depression, anger and self-hatred. Soon they’ll have no choice but to feed their addiction, even though substance abuse is no longer covering up the pain.

Peer and Family Influences

A person’s quality of life, peer interactions and family influences greatly impact the way that they view the world—including their decisions regarding drugs or alcohol . If they work in a job that encourages alcohol consumption, then they are subconsciously influenced by the behavior of their peers and co-workers. Or if a loved one takes a prescription medication and leaves it in a location that they can access easily, they might be tempted by its presence and know where to turn if a conflict arises.

These influences make it almost impossible to stop using once a person becomes addicted. It’s time for them to take back control, and the first step is separating from anyone who pressures them into using or who uses around them.

Finding the Help They Need

It’s no secret that addiction is harmful to a person’s life, their relationships and their health. In order to find the help they need, it is important to look past what their peers are doing and look into themselves. They should make their own decisions. Many times those decisions include entering into a new, encouraging environment and surrounding themselves with others who will support them and help guide them back to sobriety.

Each person’s situation is unique. Their story is their own. Finding a treatment facility that fits a person perfectly can be a challenge, but it is vital to their success. A high-quality program will look into past traumas and living environments in order to pinpoint the root cause of their addiction. From there, they will finally be able to heal and grow into the person they want to be.

is addiction a disease or a choice

Is addiction a disease or a choice? That question has fueled countless debates over the years. Though there is solid evidence supporting both sides, the scientific and biological proof that drives the concept of addiction as a disease is paramount.

What causes a person to first pick up a bottle or take a few pills may be a choice, but the deeper issue of addiction is anything but. Like other diseases, addiction is the product of a series of environmental, psychological and biological factors baked together into a dangerous concoction.

What is the Disease Theory?

The disease theory of addiction essentially looks at addiction as a medical illness that can’t be controlled without ongoing treatment. Addiction has been classified as a physical disease due to the cycles of cravings and withdrawal symptoms it produces. It changes the way the brain functions, leading people to do things against their expressed will. This is where choice ends and chronic illness begins.

Addiction and the Brain

Drugs tap into the brain’s communication system and physically change the way the brain processes information. This causes the brain’s reward system to be flooded with feel-good chemicals, sending the user into a state of euphoria. The overstimulated reward system of the brain reinforces the behavior of drug use, leading to the desire to use again.

These pathological changes in the brain result in overpowering urges to use. Even if a person expresses a sincere desire to quit using, they’re drawn to take whatever steps are necessary to obtain their drug of choice. The disease completely overwhelms them—their thoughts, feelings and actions—until the only thing they’re able to focus on is using, as though their life depends on it.

Addiction and Survival Instincts

The survival instinct drives people to seek out resources that will trigger the brain’s reward sensors, i.e., when people eat, they feel full and satisfied. As time passes and behaviors are positively and consistently rewarded, a body begins to make the connection between the act and the feeling of pleasure it produces. Eventually, people start to crave the behavior more and more until it becomes an automated routine.

Addictive drugs evoke patterns of behavior similar to those prompted by natural rewards. As the user falls deeper into addiction, though, that single behavior starts to take precedence over all other instincts, including eating, sleeping, working or even caring for children. Addiction becomes their dominant survival instinct, which is one reason giving it up is so challenging. Their body yearns for it and feels the need to fulfill its instinctual goal.

Treating Addiction as a Disease

It is no secret that treatment can help people quit using, avoid relapse and successfully recover, but finding a treatment center that focuses on treating addiction as a disease may be the most effective option. It focuses on mental health as a whole, digging into a person’s past and exposing events that may have triggered them to start using in the first place . This allows people to heal from the inside out, removing the baggage that has held them down for so long.

Types of treatments used to heal mind and body include:

  • Individual therapy
  • Meditation
  • Art therapy
  • Yoga
  • Group therapy