Bipolar and Addiction

Bipolar disorder, a disease characterized by the extreme oscillation from the highs of mania to the lows of depression, affects between 1 percent and 3 percent of people. People with bipolar face an exaggerated risk of substance abuse problems, with as many as 60 percent of bipolar patients experiencing a substance abuse disorder at some point in life.

No cure exists for bipolar disorder, but the disease can be managed through medication and psychotherapy. Left untreated, the disease can be devastating, and when bipolar is combined with alcoholism or drug addiction, this devastation is compounded.

Why Is Bipolar So Strongly Associated with Addiction?

Bipolar and addiction are so intertwined that some doctors routinely test patients with bipolar for drug or alcohol abuse or addiction. But why do bipolar patients face this elevated risk of addiction?

1. During a manic phase, people often live a more reckless lifestyle, often fueled in part by the use of alcohol or drugs. Frequent excessive use of alcohol or drugs can lead to dependency.

2. Bipolar patients may self-medicate with drugs or alcohol.

3. Bipolar medications may cause unpleasant side effects that are diminished through the use of alcohol or drugs.

The Consequences of Alcohol or Drug Abuse for Bipolar Patients

Many bipolar patients take drugs or alcohol in an attempt to regulate, stabilize or improve their moods. Drugs and alcohol can provide temporary symptom relief, but in time, the use of drugs or alcohol worsens the symptoms of bipolar disorder. This can result in ever increasing drug or alcohol use.

• Alcohol and drugs can reduce the effectiveness of bipolar medications.
• The abuse of alcohol or drugs tends to reduce bipolar treatment compliance (people aren’t as likely to remember to take their meds when on a three-day bender).
• Stimulant drugs, such as cocaine or methamphetamine, can induce mania and then deep depression.
• The withdrawal symptoms of certain drugs, such as methamphetamine or alcohol, can worsen depression.
• The abuse of drugs or alcohol can lead to a reduction in healthy social support systems. Alcoholics and drug addicts often cause strife and estrangement in the family.
• The abuse of alcohol or drugs often leads to poor eating and exercise habits and a reduction in overall physical health.
• Bipolar patients who abuse drugs or alcohol are at an elevated risk of suicide.
• Bipolar patients who abuse alcohol or drugs spend more time hospitalized than bipolar patients that abstain.

Treatment for Bipolar and Addiction

The best treatment for a dual diagnosis of mental illness and addiction integrates various concurrent therapies to treat the person as a whole, whereas in the past, doctors preferred to deal with one problem at a time.

If the patient is actively abusing drugs or alcohol, residential detoxification and treatment may be indicated for the initial phase of treatment to ensure that any withdrawal period is navigated safely and successfully. Then continuing residential dual diagnosis treatment should be considered to allow medications (for both bipolar and addiction) and psychotherapies time to start working.

Dual diagnosis treatment elements can include:

• Medication for the core mental illness
• Medication to help with alcohol or drug withdrawal symptoms or cravings
• Psychotherapy
• Support group meetings (such as the 12 Steps)
• Life skills training
• Nutritional therapy
• Recreational therapy
• Relapse prevention planning

Effective dual diagnosis treatment must address all areas of life, from social/recreational to medical/biological, to employment/living conditions.

It is vital that treatment occur at a drug rehab facility that is equipped to handle dual diagnosis patients. In many cases, bipolar symptoms are the core underlying reason for the substance abuse. Thus, to attempt treatment for addiction at any facility that is ill-equipped to treat bipolar symptoms concurrently is to invite almost certain failure.

Bipolar complicates the treatment of addiction, and so although addiction treatment does work for dual diagnosis patients, it can take longer. As always, the earlier addiction treatment occurs, the better the probability of a successful outcome.