What is the relationship between bipolar disorder and addiction?

Background

The coexistence of bipolar disorder and addiction is the rule rather than the exception. As many as 60 percent of people with bipolar disorder also will abuse an addictive substance during their lifetime, according to the National Alliance on Mental Illness.

The person in the manic phase of bipolar disorder may turn to alcohol or drugs to try to stabilize their condition. An addiction to alcohol or drugs might come about because the person is trying to slow down his or her thought processes long enough to get some rest. Addiction may be the result of, and not the reason for, the manic phase of the illness.

In the depressive stage of the illness, a person is vulnerable to addiction because he or she is looking for something that will help with feelings of hopelessness, isolation, and worthlessness. Alcohol or drugs may be considered a type of anesthetic to help the person escape from these kinds of feelings.

Causes

Persons with bipolar disorder are subject to overwhelming forces that are largely beyond their conscious control, which explains why so many persons with the disorder turn to drugs and alcohol for support and relief. Often, persons with bipolar disorder will use alcohol or drugs to numb their painful and difficult symptoms and to help them cope with their intense feelings. This can lead to a pattern of abuse that can quickly spiral into dependency and addiction.

People suffering with bipolar disorder are three to seven times more likely than others to abuse alcohol or drugs, such as sleeping pills and stimulants (including cocaine and methamphetamines). Drugs and alcohol are abused to increase the natural high of the mania and to self-medicate during depressive episodes.

Symptoms

Bipolar disorder is characterized by drastic mood swings—extreme highs and devastating lows. Some of the symptoms exhibited during manic episodes include an extremely elated, happy mood or an extremely irritable, angry, unpleasant mood; increased physical and mental activity and energy; racing and uncontrolled thoughts; increased talking (speech more rapid than normal); ambitious, often grandiose plans; inflated self-esteem; risk taking; and impulsive activity such as spending sprees; sexual indiscretion; and decreased sleep without experiencing fatigue.

Symptoms of depressive episodes include loss of energy; prolonged sadness; decreased energy and activity; restlessness and irritability; inability to concentrate or make decisions; increased worry and anxiety; less interest or participation in, and less enjoyment of, activities normally enjoyed; feelings of guilt and hopelessness; change in appetite; change in sleep patterns; and thoughts of suicide.

People with bipolar disorder often have difficulty in the workplace. Many of their symptoms can interfere with their ability to show up for work, to do their job, and to interact productively with others.

The consequences of addiction for persons with bipolar disorder are many and include taking drugs or consuming alcohol to regulate, stabilize, or improve their mood. Drugs and alcohol can provide temporary symptom relief, but in time, they worsen the symptoms, resulting in ever-increasing drug or alcohol use. Alcohol and drugs can reduce the effectiveness of bipolar medications and can reduce compliance for bipolar treatment. Stimulant drugs, such as cocaine or methamphetamines, can induce mania and then deep depression, exacerbating symptoms. Withdrawal symptoms can worsen depression.

Screening and Diagnosis

A diagnosis for substance abuse that occurs in persons with bipolar disorder is known as a dual diagnosis. In such cases, the substance abuse can occur during both the manic and the depressive phases.

No diagnostic laboratory tests exist for bipolar disorder. Thus diagnosis occurs through standardized diagnostic criteria to rate and evaluate the person’s behavior.

Treatment and Therapy

Treatment for addiction includes psychiatric care and medication. Because bipolar disorder and alcohol and drug addiction often appear together, the symptoms of each disorder overlap, making it difficult to recognize the coexistence of both. The two conditions must be treated in tandem, making dual diagnosis critical to the recovery process.

Effective in treating co-occurring disorders is a residential substance abuse treatment program. This treatment typically includes individual and group counseling, cognitive-behavior therapy, dialectical behavior therapy, twelve-step programs, and other mental health services. Research has shown that the most effective treatment combines supportive psychotherapy and the use of a mood-stabilizer (either lithium, carbamazepine, or divalproex/valproic acid), often with an antipsychotic medication. No research exists to show that any form of psychotherapy is an effective substitute for medication.

Prevention

The best recoveries are achieved when individuals with bipolar disorder get effective treatment and faithfully follow that treatment for a lifetime. The patient should regularly see a supportive physician who is knowledgeable about the psychiatric management of this disorder, should learn what symptoms predict the return of this illness and what additional “rescue” medication can be taken, and should learn to trust the warnings given by family and friends when they see early signs of relapse.

Bibliography

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Goodwin, F. K., and K. R. Jamison. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression. 2nd ed. New York: Oxford UP, 2007. Print.

Johnson, C., et al. “Convergent Genome-Wide Association Results for Bipolar Disorder and Substance Dependence.” American Journal of Medical Genetics B: Neuropsychiatric Genetics 150.2 (2009): 182–90. Print.

Mondimore, Francis Mark. "Alcoholism and Drug Abuse." Bipolar Disorder: A Guide for Patients and Families. 3rd ed. Baltimore: Johns Hopkins UP, 2014. 174–92. Print.

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