Studies indicate that between forty and seventy percent of those with bipolar disorder also have a current or previous history of substance abuse. Compared with those without a co-occurring disorder, those with co-occurring illnesses may derive less benefit from treatment for their mood disorder, recover more slowly from episodes, spend more time in hospitals and have higher risks for suicide than those without a dual diagnosis.
These facts demonstrate the importance of considering both the bipolar disorder and any substance use disorder when determining the best treatment and management strategy.
What Is Bipolar Disorder?
Bipolar disorder is a mental illness that causes dramatic mood swings that can go from elated and joyful to sad and hopeless, often with normal mood periods in between. The periods of highs and lows are called episodes of mania and depression. Along with these mood swing episodes, bipolar disorder also causes severe changes in energy and behavior.
The symptoms of bipolar disorder can be quite severe, and they are not the same as normal ups and downs that everyone experiences from time to time. For those dealing with bipolar disorder, the symptoms make it very difficult to engage in everyday life. This can result in damaged relationships, diminished performance at school or work and even suicide.
Bipolar Disorder and Substance Abuse
It is difficult to explain the high rate of substance abuse and among individuals suffering from bipolar disorder, and there are numerous factors involved.
One contributing factor may be that many individuals attempt to self-medicate to reduce the troubling symptoms of their bipolar disorder. Rather than experience anxiety, depression, sleeplessness and pain, some turn to drugs and alcohol to temporarily escape.
An individual’s age and gender may also play a role, according to some research. For example, based on a study published in the journal Bipolar Disorders, drug abuse is more common in young men with bipolar than in females or older age groups. However, alcoholism is seven times higher among women with bipolar disorder than among the general population.
Clinical researchers are studying additional factors that influence both mental illness and substance abuse, including the effects of brain chemistry on both.
In individuals with bipolar disorder, there are often abnormal levels of serotonin, dopamine and norepinephrine. These chemicals affect numerous bodily functions and directly contribute to one’s mood and emotions. Drugs and alcohol further interfere with the how the brain processes these chemicals, causing even more severe emotional instability, erratic energy levels and depression.
It is unclear whether the mental disorder is causing people to turn to drugs or alcohol out of an unconscious need to stabilize their moods, or whether the substance abuse is triggering or intensifying the symptoms of the disorder. But whatever the precise nature of the link, substance abuse has a detrimental effect and makes the symptoms of bipolar disorder worse.
Regardless of which came first, bipolar disorder or substance abuse, effective treatment necessarily involves addressing both problems. There are varying approaches to treating a dual diagnosis, depending upon the specific needs of the individual. According to Mayo Clinic, finding an effective treatment may include:
- Initial treatment. It is vital to work with a doctor or other professional who can prescribe medications to balance your moods. Once the symptoms of bipolar are under control, you’ll be better able to determine the best long-term treatment.
- Ongoing treatment. Because of the underlying causes of bipolar disorder, it requires lifelong treatment, even when you’re feeling better. Maintenance treatment may involve medications, psychological counseling and education or support groups.
- Substance abuse treatment. If there are problems with alcohol or drugs, substance abuse treatment is essential. In some cases, this issue must be dealt with first, before effective treatment of bipolar disorder is possible.
- Hospitalization. If your symptoms are particularly severe, hospitalization may be recommended. This is important if you’re behaving dangerously, feel suicidal or become detached from reality. Psychiatric treatment can help keep you safe while stabilizing your mood.