Pennsylvania Bipolar Disorder and Addiction Treatment

Dealing with Dual Diagnosis:
How Bipolar Disorder and Addiction are Connected

When bipolar disorder or another mental illness co-occur with addiction, it is known as a dual diagnosis. Dual diagnosis (also known as co-occurring disorders) is fairly common, with an estimated 7.9 million Americans living with both a substance use disorder and a mental illness.

People with a mental illness are more likely to abuse drugs or alcohol as a form of self-medication. Unfortunately, substance abuse worsens symptoms of mental illness including bipolar disorder, and it may increase the risk for suicide in people who are bipolar. Here, we take a closer look at bipolar disorder, including why it commonly co-occurs with addiction and what it takes to recover from both disorders.

What is Bipolar Disorder?

Bipolar disorder is a serious mental illness characterized by alternating episodes of high and low moods. Around 5.7 million American adults have bipolar disorder annually on average, and it is the sixth leading cause of disability worldwide, according to the Depression and Bipolar Support Alliance.1

Four types of episodes occur with bipolar disorder: mania, hypomania, depression, and mixed episodes, which are a combination of symptoms.

Mania

During a manic episode, you may experience moments of great joy alternating with moments of deep pessimism. Feelings of grandiosity and self-importance are common with mania. Other symptoms associated with mania include:

  • Rapid talking
  • Reductions in sleep
  • Impaired judgment
  • Engaging in high-risk behaviors
  • Irrational thoughts and behaviors
  • Hallucinations

Hypomania

Symptoms of hypomania are similar to those of mania, but they are less intense and don’t involve any type of psychosis. During an episode of hypomania, you may feel happier than usual, more energetic, and able to take on more responsibilities. You’re able to manage your daily activities, and you may feel like your bipolar disorder is under control. However, hypomania may include negative symptoms such as:

  • Irritability
  • Reduced need for sleep
  • Engaging in high-risk behaviors like drug or alcohol abuse

Depression

Depressive episodes that occur with bipolar disorder can bring on feelings of hopelessness, helplessness, sadness, guilt, and self-hatred. Other symptoms of depressive episodes include:

  • A loss of interest in activities once enjoyed
  • Increased sleep
  • Changes in appetite
  • Fatigue
  • Thoughts of death and suicide

Four Types of Bipolar Disorder

Symptoms of bipolar disorder are rarely cut-and-dried. Mental health professionals diagnose four types of bipolar disorder:

Bipolar I Disorder

Bipolar I disorder is the most severe type. It is diagnosed when someone has one or more major depression episodes and at least one manic or mixed episode.

Bipolar II Disorder

Bipolar II disorder involves a deeper depression than what occurs with bipolar I. Bipolar II is diagnosed when someone has at least one major depressive episode and at least one hypomania episode.

Bipolar Not Otherwise Specified

Bipolar Not Otherwise Specified doesn’t follow a predictable pattern. People with this type may have repeated episodes of mania without any depressive episodes, or they may alternate quickly between depressive and manic episodes.

Cyclothymia

Cyclothymia is a milder type with less-intense depressive episodes that alternate with hypomania. It is diagnosed when these alternating episodes last for at least two years.

Each type of bipolar disorder can be diagnosed as rapid cycling, which involves having four or more depressive, manic, or hypomanic episodes in a 12-month period.

Why Bipolar Disorder and Addiction Commonly Co-Occur

According to the U.S. National Comorbidity Survey, 71 percent of people with bipolar disorder report having had a substance use disorder at some point in their lives. 2 People with bipolar disorder who abuse alcohol are hospitalized more frequently, and they experience an earlier onset of bipolar symptoms.

The National Institute on Drug Abuse (NIDA) describes three scenarios that help explain the link between mental illness and substance abuse:

Self-Medicating

People who have a mental illness like bipolar disorder are very likely to self-medicate symptoms with drugs or alcohol, which may seem to reduce the intensity of symptoms initially. However, drug and alcohol abuse always makes symptoms worse in the long run.

One Leads to the Other

Drug abuse can cause a mental illness to occur, or it can worsen symptoms of an existing mental illness. According to NIDA, people who have a mood disorder are twice as likely as those who don’t to become addicted to drugs or alcohol. Conversely, people who have a substance use disorder are twice as likely to be diagnosed with a mood disorder. ​3

Overlapping Risk Factors

The risk factors behind addiction and mental illness often overlap, which leaves some people at a higher risk for developing both.

Three overlapping factors can influence the development of both substance use disorders and mental illnesses:

Overlapping Genetic Risk Factors

Around half of a person’s risk for addiction is genetic. Several areas of the human genome are associated with both mental illness and substance use disorders. Some genes have a direct influence, such as genes that control the way drugs or alcohol are metabolized in the body. Other genes have an indirect influence, such as genes that predispose you to engaging in risk-taking behaviors, including drug and alcohol abuse.

Involvement of Similar Brain Regions

Several regions of the brain are involved in both mental illness and addiction. The dopamine system, for example, is involved in the development of addiction, and it is also a key player in depression and other mood disorders.

Environment

The development of both addiction and mental illness is commonly influenced by environmental factors. For example, chronic stress and family dysfunction can lead to substance abuse as a way to cope, causing mental illnesses like anxiety or depression.

Misconceptions About Bipolar Disorder

Although bipolar disorder is very common, myths and misconceptions about this mental illness are abound. These can make it more difficult for someone with bipolar disorder to get help and find the support they need from family and friends. Here are some common misconceptions about bipolar disorder:

Bipolar disorder is just mood swings, and everyone experiences mood swings.

The highs and lows of bipolar disorder are far more complex than simple mood swings. People with bipolar disorder experience extreme shifts in energy levels, sleep patterns, and the ability to engage in normal daily activities. Episodes can last for days if the bipolar disorder is rapid cycling, or they can last for months.

Manic episodes are productive and enjoyable.

During manic episodes, someone with bipolar disorder may be in a good mood, feel great, and get lots of things done. But manic episodes aren’t a walk in the park. During mania, people with bipolar disorder may become anxious or irritable, lose control of their thoughts and behaviors, and lose their grip on reality. They may make impulsive decisions with big consequences, such as spending exorbitant amounts of money or heavily abusing drugs or alcohol.

People with bipolar disorder are either depressed or manic at any given time.

Bipolar symptoms and episodes aren’t always as simple as “depressed” or “manic.” People with bipolar disorder can experience periods of balance, called euthymia. They may also experience a mixed episode, which has features of both depression and mania.

Medication for bipolar disorder makes you feel like you’re not yourself.

A number of medications are used to treat bipolar disorder. What works great for one person may not work well for another. It can take some time to find the right medication or combination of medications for you, and communicating about how you feel and the side effects you experience will help care providers dial in the medications that work for you without uncomfortable side effects.

Bipolar disorder is a rare mental illness.

In fact, bipolar disorder is very common, affecting almost three percent of the U.S. adult population.

Celebrities with Bipolar Disorder

Stars with bipolar disorder include:

  • Demi Lovato
  • Mariah Carey
  • Jean-Claude Van Damme
  • Catherine Zeta-Jones
  • Russell Brand
  • Carrie Fisher
  • Lou Reed
  • Mel Gibson

Other famous people who are diagnosed with the disorder include Winston Churchill, Patrick Kennedy, Jesse Jackson Jr., Edgar Allen Poe, and Jackson Pollock.

Misconceptions About Addiction

Like bipolar disorder, addiction is widely misunderstood. Here are some common myths and misconceptions about addiction:

Overcoming addiction is a matter of willpower.

NIDA stresses that willpower and good intentions are rarely enough to end an addiction. Addiction changes the brain’s physical structures and chemical functions and is characterized by compulsive drug abuse despite the negative consequences. The changes in brain function affect thought and behavior patterns, which perpetuate the compulsion to seek out and use drugs. According to NIDA, professional help is almost always needed to end an addiction in the long-term.

Addiction is a choice.

Although initially using drugs or alcohol is a choice someone makes, choice is no longer a factor once an addiction develops. The compulsion associated with addiction is extremely powerful, which is why addicted people continue using even though their life is falling apart around them.

People who are addicted have low morality.

Addiction has nothing to do with morality. Addiction almost always has underlying causes, including chronic stress, a history of trauma, family dysfunction, and mental illness. It involves genetic, biological, and environmental factors, and can affect anyone of any age and from any walk of life. Addiction is a chronic disease of the brain, and while it can’t be cured, it can be sent into remission for the long-term.

Addiction is too hard for most people to overcome.

Recovering from an addiction isn’t easy, but most people who enter rehab and fully engage with their treatment plan will successfully recover. The relapse rate for addiction is similar to that of other chronic diseases like diabetes and heart disease. Around 40 to 60 percent of people in recovery will relapse at some point. However, relapse is no longer considered to be a catastrophe. Rather, it is widely regarded as a normal part of recovery. Getting back on track quickly and identifying and addressing what led to the relapse helps people return to sobriety stronger and more motivated than ever to stay in recovery.

You have to hit rock bottom before you getting help.

Some people with substance use disorder continue to function well in their lives despite their substance abuse, holding down jobs and meeting their responsibilities at home. Because the addiction hasn’t caused life-altering problems, they may feel that they don’t need treatment or that treatment is only for those who are “down-and-out.” The truth is that anyone who feels they can’t control their drug or alcohol use will benefit from treatment. It is important to understand that addiction is a progressive disease that only grows worse with time. Getting help before things go south in your life can prevent a lot of heartache and serious problems down the road.

How Dual Diagnosis with Bipolar Disorder is Treated

When a mental illness co-occurs with a substance use disorder, treatment must be integrated for successful recovery from both disorders. Integrated treatment addresses the addiction and the mental illness at the same time, each in the context of the other. Treating just the addiction won’t help with the bipolar disorder, and vice-versa.

Integrated treatment for dual diagnosis with bipolar disorder should take a holistic approach to recovery, and it should address the underlying causes of the addiction and the multiple needs of the individual. According to the Substance Abuse and Mental Health Services Administration (SAMHSA,) holistic treatment offers the best outcomes.​​​4

A holistic approach to treatment will utilize a variety of treatment therapies and interventions to promote whole-person healing, such as:

Traditional Therapies

Traditional therapies, or “talk” therapies, are the foundation of treatment. Cognitive-behavioral therapy is the most commonly used therapy in treatment, and it has proven to be highly effective. Cognitive-behavioral therapy helps individuals identify dysfunctional thought and behavior patterns and false or outdated beliefs. It helps them change their self-destructive ways of thinking to promote healthier behaviors, and it helps them develop essential skills for coping with symptoms of bipolar disorder and triggers for addiction relapse. Other traditional therapies include dialectical behavior therapy, acceptance and commitment therapy, and family therapy.

Complementary Therapies

Complementary therapies are used in high quality treatment programs to help people look at old issues from new angles. Complementary therapies are hands-on therapies such as art therapy, music therapy, restorative yoga, and meditation. These therapies reduce stress, improve mood, increase self-awareness, and promote healing of mind, body and spirit.

Pharmacotherapy

Pharmacotherapy is the use of medications to treat mental illness or addiction, or both. For people with bipolar disorder who have an opioid or alcohol addiction, medication-assisted treatment can help reduce cravings, improve brain function, and block the effects of alcohol or opioids. Medications used to treat bipolar disorder help bring depression and mania under control and stabilize the mood.

Psychoeducational Groups

Psychoeducation is a combination of education and therapy. The purpose of psychoeducational groups is to help individuals better understand addiction and mental illness, including how they develop, how they progress, and how they’re sent into remission. Psychoeducation helps individuals develop coping skills, and it increases motivation in recovery.

Support Groups

Participating in a support group for people with a dual diagnosis improves the chances of successful recovery. Support groups promote personal accountability, and they offer people the chance to help and support others in their group while also receiving help and support. People who continue attending support groups after treatment are more likely to stay in recovery than those who don’t.

Other Interventions

Treating a dual diagnosis requires addressing all of an individual’s problems and issues, from family dysfunction to housing problems. Treatment plans for dual diagnosis are highly individualized. Depending on the individual’s needs, additional interventions used in treatment may include:

  • Help finding safe housing
  • Educational assistance
  • Vocational training and rehabilitation
  • Family therapy or marriage counseling
  • Life skills classes
  • Parenting classes
  • Legal assistance

Benefits of Treatment

Through therapy, psychoeducational groups, and other interventions, individuals in treatment can:

  • Learn to think and behave in healthier ways
  • Develop a healthy lifestyle that promotes recovery
  • Repair damaged relationships
  • Learn how to develop healthy relationships
  • Find purpose and meaning in a life without drugs or alcohol
  • Learn how to have fun without drugs or alcohol
  • Develop crucial life and coping skills that foster recovery

Treatment for dual diagnosis involving bipolar disorder typically takes place at an inpatient facility, which provides a safe, supportive environment, around-the-clock support and supervision, and a tight-knit community of peers and care providers. Ideally, treatment will last at least 90 days, which is the minimum recommended duration of treatment. Anything less is of limited effectiveness.

Recovery is Possible

Many people who have a dual diagnosis feel helpless and hopeless that recovery is not within their reach. From where they stand, their addiction is too severe and their problems too great to overcome. But the very nature of dual diagnosis treatment offers hope for a better future. Dual diagnosis treatment addresses the gamut of problems and issues and helps individuals restore their lives on all fronts. Repairing damage in your life, developing coping skills, and finding purpose and joy in a sober life removes the need for substance abuse, and it can lead to authentic happiness in your life despite having bipolar disorder.

If you or someone you love has bipolar disorder and a substance abuse problem, treatment can get the mental illness under control and end the addiction for good for a happier, healthier life and a greater sense of well-being moving forward.


Resources:

  1. http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_bipolar_disorder
  2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847357/
  3. https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf
  4. https://www.samhsa.gov/find-help/recovery