Bipolar Disorder and Substance Abuse

Bipolar disorder (sometimes known as manic depression) is a mental disorder characterized by quickly shifting moods, changing energy levels, and the inability to concentrate and complete daily tasks. 

There are three distinguishable types of bipolar disorder. While they can have different symptoms and treatments, all three generally involve mood swings and large variations in energy levels. Someone with any type of bipolar disorder will exhibit extreme high to low mood swings. The highs are known as manic episodes and can last for hours or weeks. These highs are almost always followed by difficult low periods known as depressive episodes.

Bipolar I Disorder

Bipolar I disorder is identified by manic episodes called highs that can last several days or by short-term manic symptoms that are so severe as to require hospitalization. Bipolar I disorder is also associated with depressive episodes, but they are generally shorter and of less intensity than manic episodes. Like any bipolar type, moods can change rapidly from extreme depression to elation on a whim. 

Bipolar II Disorder

Bipolar II disorder is usually identified by persistent depressive (or hypomanic) episodes. Bipolar II disorder is not usually associated with multi-day manic episodes associated with type 1.

Cyclothymic Disorder (also called Cyclothymia)

Cyclothymic disorder is a type of bipolar disorder characterized by extreme long-term episodes of either mania or hypomania. These episodes can last a year or more and are difficult to detect without the constant changes. 

Many people have one or more symptoms of bipolar disorder but do not fall directly into one of the categories above. These people will often be labeled with “unspecified bipolar disorder” or misdiagnosed with ADHD, depression, or anxiety. 

A bipolar diagnosis typically happens during the teen years or early adulthood. Occasionally, bipolar symptoms can appear in children as young as 3 but are often confused with ADHD, obsessive defiant disorder, or other similar behavioral disorders. While symptoms can ebb and flow, bipolar usually does not “go away” and often requires lifelong treatment. While facing bipolar can be daunting, professional help and medication can ease many of the more difficult symptoms of bipolar disorder.

Because of the nature of bipolar, symptoms can vary wildly from person to person. However, there are some commonalities to look out for that can help friends and family help a loved one. 

While experiencing a manic (high) episode, someone may exhibit some of the following symptoms:

• Sustained feelings of joy without an obvious reason
• Feeling ”high” or extremely energetic
• Inability to sleep
• Loss of appetite or forgetting to eat
• Randomly engaging in risky behaviors
• Feelings of invincibility
• Talking very fast

While experiencing a depressive (hypomanic or low) episode, someone may exhibit some of the following symptoms:

• Uncontrollable depression
• Feelings of worthlessness or loneliness
• Fluctuations in appetite or weight
• Difficulty concentrating and making decisions
• Loss of desire for sex, hobbies, or other things you enjoy

Bipolar disorder can disrupt the lives of a patient and their loved ones, but people who seek proper treatment can expect to see noticeable results. The first step is receiving a diagnosis from a licensed professional. Generally, this will include a physical exam and necessary tests to come to an accurate consensus. A doctor will also perform mental health screening or refer to a trained psychiatric care provider (counselor, social worker, or psychiatrist).

While general practitioners can make an accurate diagnosis, it is generally better to receive an opinion from a specialist. If there are any questions about the accuracy of the diagnosis, it is important to get multiple opinions. An accurate diagnosis is central to appropriate and effective treatment.

Effective treatment for any form of bipolar disorder is best approached in partnership with a licensed psychiatrist with experience dealing with bipolar patients. The best treatment plans are a team effort and include care from licensed mental health counselors, social workers, other treatment staff, and even friends and family.  

Bipolar is a lifelong disorder but the symptoms can be managed. Through a combination of treatments, bipolar patients can expect to see rapid and long-lasting improvement in symptoms. Some of the most common treatments for bipolar are found below. 

Medications

Depending on how severe the symptoms are, it may be important to begin medication soon after diagnosis. Commonly prescribed medications for bipolar disorder include mood stabilizers such as lithium or SSRIs such as Lexapro. 

Continued Treatment

Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. Skipping “maintenance treatment” increases the risk of relapse or sudden jump into mania/hypomania.

Outpatient Therapy

Outpatient treatment is one of the most common and effective methods of treating ongoing bipolar disorder. This consists of regular visits to a treatment center and meetings with a team of professional support staff. 

Hospitalization

Short- or long-term hospitalization may be an option if dangerous behaviors emerge that prove risky to you or those around you. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you’re having a manic or major depressive episode.

Substance Abuse Treatment

Often bipolar comes with a co-occurring disorder of some type of substance abuse. This is also known as a “dual diagnosis.” Treating the substance use disorder effectively can help many of the symptoms of bipolar disorder significantly. 

Most effective treatments for bipolar disorder include a combination of the methods used above.

Substance abuse is a common side effect of a hypomanic bipolar state. While not everyone who deals with bipolar disorder also suffers from substance abuse, as many as 40% share both disorders. This is known as co-occurring disorders or a dual diagnosis. Particularly during bouts of hypomania, those who suffer from bipolar disorder can use alcohol or other substances to numb the uncontrollable symptoms of hypomania.  

Research shows that risky substance abuse can ebb and flow with the symptoms of bipolar disorder. Individuals with bipolar disorder may not drink often but are much more prone to binge when they do. While there may be a healthy number of “abstinent days,” there will often be brief periods of excessive, even dangerous binging.  

Binge drinking episodes or drug use will often coincide with manic or hypomanic states. Someone with bipolar disorder can turn to substance use to numb the seemingly uncontrollable symptoms. Conversely, using drugs and alcohol can worsen all major symptoms of bipolar disorder.

How Does Bipolar Disorder Lead to Substance Abuse?

Anyone who has ever gotten drunk knows that the horrible feeling experienced often leads to a vow to never drink again. However, those suffering from bipolar disorder find this particularly difficult to carry out. Due to the rapidly changing nature of bipolar mood, individuals will still choose to drink and even do drugs in an attempt to escape the symptoms of bipolar disorder.

It is a fact that bipolar disorder can be difficult to manage. However, there is hope, even for those who also have a co-occurring substance use disorder. It is extremely important to understand that depressants like alcohol only magnify the negative effects of a hypomanic bipolar state. Because some of the commonly prescribed bipolar medications can prove almost as difficult to manage as the disease itself, many people choose to “self-medicate” with alcohol. This enables them to numb the feelings of ostracization and loneliness that hypomania can produce.  

Although it may offer short-term “relief” from bipolar disorder symptoms, alcohol is an extremely dangerous substance to mix with these. It is recommended to abstain from alcohol altogether if you have any symptoms. This is the only way to guarantee no addictive behaviors will develop.

Not everyone who suffers from bipolar disorder also has a substance use disorder, and vice versa. However, bipolar disorder and substance abuse do not mix well together and can present a dangerous problem. Any successful treatment for either bipolar disorder or substance abuse must address both diagnoses equally in order to be successful. 

Professional treatment is the most important aspect of learning to live with bipolar disorder and substance abuse. Finding a treatment center that can help with every aspect of recovery — from detox to counseling to mental health — is the key to navigating these difficult diseases. 

While some of the treatments for individual disorders do overlap, it is extremely important to seek help from a professional counselor who is skilled in dual-diagnosis treatment. Counseling, group therapy, 12-step programs, family support, accountability, and various medications may all play a role in successful treatment for bipolar disorder and alcohol abuse. 

At Intrepid Detox, our trained professionals are skilled in treatments for both disorders. We are ready to provide you with expert service from intake to follow-up. Our residential program will help you deal with the difficulties presented by bipolar disorder and substance abuse in a safe, clean and professional environment.