Dual Diagnosis: Bipolar Disorder And Addiction
An individual with addiction may have a coexisting bipolar disorder. Treating co-occurring disorders requires a treatment program that addresses both conditions at the same time.
“Substance use problems are more common with bipolar disorder than with any other diagnosis, and make bipolar disorder problems worse,” (Substance Abuse and Mental Health Services Administration).
Substance addiction and abuse are both defined as substance use disorder. A substance use disorder (SUD) occurs when a person’s use of alcohol or another drug causes them significant clinical and functional impairment. A person suffering from SUD often experiences health problems (mental and physical) and may have difficulty at work, school, or home as a result of their substance use.
A person suffering from bipolar disorder may attempt to self-medicate their symptoms with alcohol, illicit drugs, or prescription drugs. Attempting to self-medicate the symptoms of bipolar disorder runs a particularly high risk of development of a comorbid substance use disorder.
Drugs commonly associated with bipolar disorder include cocaine, alcohol, marijuana, opioids, and antidepressants. Most drugs are not solely responsible for bipolar disorder, but they may contribute to the symptoms. When a person suffers from a coexisting mental and substance use disorder, it is defined as a co-occurring disorder (dual diagnosis).
Alcohol and other drugs can worsen the symptoms of a mental disorder, and even a person with no history of any mental illness can develop bipolar disorder. A study found that 56 percent of individuals with a bipolar disorder had a lifetime substance use disorder.
Understanding Bipolar Disorder
Bipolar disorder (manic-depressive illness) is a mood disorder that causes extreme shifts in mood, activity, energy, and the ability to carry out day-to-day tasks.
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Bipolar mood episodes range from extreme highs to severe lows. A high mood, which often includes elation and energetic behavior, is known as a manic episode. A low mood, which includes sadness and hopelessness, is referred to as a major depressive episode.
There are four types of bipolar disorder, all of which involve changes in mood, energy, and activity levels. The four types of bipolar disorder include:
- Bipolar I Disorder—defined by manic episodes that last at least seven days, or by symptoms that require immediate clinical care. Depressive episodes generally last up to 14 days. Some individuals experience manic and depressive episodes at the same time.
- Bipolar II Disorder—defined by a pattern of hypomanic and depressive episodes that are not as extreme as Bipolar Disorder I.
- Cyclothymic Disorder—defined by numerous periods of elevated mood (hypomanic symptoms) and numerous periods of low mood (depressive symptoms) lasting at least two years. These symptoms do not meet the diagnostic requirements for a manic episode or a depressive episode.
- Specific and Unspecific Bipolar Disorder—defined by bipolar disorder symptoms that do not match the other three types of bipolar disorder.
Not everybody who suffers from a bipolar disorder will experience all of the symptoms. A person suffering from a bipolar disorder may abuse alcohol or another drug, have relationship problems, or have problems meeting requirements at work, school, or home.
Signs And Symptoms Of Bipolar Disorder
A person suffering from bipolar disorder experiences major shifts in mood, emotions, sleep patterns, and behavior. The highs and lows of bipolar disorder are known as mood shifts, which may include manic, depressive, or mixed episodes. Manic-depressive episodes aren’t necessarily caused by drug abuse, which can make diagnosing a co-occurring disorder difficult.
Symptoms Of Manic Episode
- feeling of elation
- excessive energy (hyperactivity)
- increased activity levels
- difficulty sleeping (insomnia)
- talking fast
- inability to stay focused
- feeling powerful or able to do many things at once
- risky behaviors
Symptoms Of Depressive Episode
- feeling sad or hopeless
- minimal energy
- decreased activity levels
- decreased/increased sleep
- feelings of discontent
- constant worry and emptiness
- trouble concentrating
- shifts in diet or weight
- feeling tired or slowed down
- excessive feelings of guilt
- thoughts of death or suicide
An individual may experience symptoms of both manic and depressive episodes, known as an episode with mixed features. A person may feel very low and hopeless but extremely energetic at the same time. A person suffering from cocaine abuse may experience the euphoria elicited by cocaine but still feel severely depressed at the same time.
Knowing the signs and symptoms of bipolar disorder can help ensure that a person gets the treatment they need.
Bipolar Disorder Causes And Risk Factors
There is no single cause of bipolar disorder or substance use disorder. There are many risk factors that contribute to bipolar disorder, including brain structure and functioning, genetics, and family history. Substance abuse can also be major risk factor for bipolar disorder.
Brain Structure And Functioning
A person with bipolar disorder may have a different brain structure from someone without bipolar disorder. The brain abnormalities of bipolar disorder generally occur in the prefrontal cortex. This brain deformity may be responsible for the mood shifts that people with bipolar disorder experience.
Researchers have found that people with certain genes are more likely to develop bipolar disorder. Genes, however, are not the only risk factor for bipolar disorder. Some studies have found that, though one identical twin may develop bipolar disorder, the other twin doesn’t always develop the same disorder. Identical twins share all of the same genes.
Bipolar disorder, like substance use disorder, tends to run in the family. Children or siblings of a person with bipolar disorder are more likely to develop the same disorder, yet most people with a family history of bipolar disorder will not develop the illness.
How To Test For Bipolar Disorder And Addiction
Diagnosing bipolar disorder in a person with addiction isn’t always easy. Professionals use the following tests to determine whether a person has bipolar disorder, substance use disorder, or both.
- psychological tests
- physical exams
- mood charts
- making comparisons
In order to accurately test for bipolar disorder, a professional considers each of an individual’s symptoms, including their length, frequency, and severity. Bipolar disorder symptoms may differ from one person to the next. The manic and depressive symptoms of bipolar disorder often mirror those of drug addiction.
Many people suffering from drug addiction experience intense withdrawal symptoms when they stop using a drug. Withdrawal may last for several weeks, and symptoms may include irritability, mania, depression, changes in diet, and insomnia.
Most trained professionals are able to tell the difference between mood and substance use disorders. Yet it isn’t always easy to distinguish between bipolar disorder and addiction. Knowing if an individual suffers from a co-occurring disorder is vital to finding the right treatment plan.
Treatment Of Dual Diagnosis: Bipolar Disorder And Addiction
A physician may incorporate a medication-assisted treatment to help calm an individual’s mood shifts, allowing them to be more responsive to behavioral therapy. Bipolar disorder medications include benzodiazepines, anticonvulsants, lithium, and antipsychotics. Mixing medications with alcohol or other drugs can be fatal. Benzodiazepines can be habit-forming, so physicians are slow to prescribe them to people with a history of substance abuse.
Behavioral treatment may include cognitive-behavioral therapy (CBT) to help an individual overcome co-occurring bipolar disorder and addiction. Behavioral treatments help patients to understand and address negative thoughts and feelings that may be contributing to their addiction. Treating a co-occurring disorder isn’t always easy, but it’s most effective when both mood and substance use disorder are treated at the same time.Article Sources
National Institute of Mental Health - https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml