Bipolar disorder is a chronic or episodic (occasionally occurring and at irregular intervals) mental disorder. It can cause unusual, often extreme, and fluctuating mood, energy, activity, and concentration or focus changes. Bipolar disorder sometimes is called a manic-depressive disorder or manic depression, which are older terms.
Everyone goes through regular ups and downs, but bipolar disorder is different. The range of mood changes can be extreme. In manic episodes, someone might feel very happy, irritable, or “up,” and there is a marked increase in activity level. In depressive episodes, someone might feel sad, indifferent, or hopeless, combined with a shallow activity level. Some people have hypomanic episodes, which are like manic episodes, but less severe and troublesome.
Most of the time, the bipolar disorder develops or starts during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Although the symptoms come and go, bipolar disorder usually requires lifetime treatment and does not go away on its own. Bipolar disorder can be an essential factor in suicide, job loss, and family discord, but proper treatment improves.
The incidence of substance abuse is higher among individuals with bipolar disorder than among the population. The NCBI states that the rates of lifetime substance abuse were high for both alcohol (48.5%) and drugs (43.9%). Nearly 60% of the cohort had a history of some lifetime substance abuse. Males had higher abuse rates than females, but no differences in substance abuse were observed between subjects in manic and mixed bipolar states. Rates of active substance abuse were lower in older age cohorts. Subjects with a comorbid diagnosis of lifetime substance abuse had more psychiatric hospitalizations .
When severe bipolar disorder co-occurs with drug or alcohol addiction, the potential for adverse outcomes increases, a combination of therapies — including psychiatric medications, individual and group therapy, and intensive substance abuse treatment — can help these clients achieve a sense of inner balance and create more satisfying, productive lives.
Symptoms And Effects Of Bipolar Disorder
The symptoms of bipolar disorder vary from person to person. There are also different symptoms for manic and depressive episodes. Those who also suffer from addiction usually have heightened bipolar symptoms.
Manic Episode Symptoms
- Inflated sense of self-confidence
- Decreased need for sleep
- Extreme talkativeness
- Racing thoughts
- Short attention span
- Risky behavior
- Preoccupation with a specific goal
Some people experience manic episodes so severe that they cannot function in a social or occupational setting. People having these episodes may require hospitalization. A typical manic episode is not caused by drug abuse. This makes it hard to diagnose bipolar disorder if an addiction also exists.
Major Depressive Episode Symptoms
- Feeling depressed or hopeless most of the day
- Having a sense of worthlessness
- Weight loss or gain
- Insomnia or feeling the need to oversleep
- Loss of interest or pleasure in once enjoyable activities
- Feeling fatigued nearly every day
- Excessive feelings of guilt
- Lack of concentration
- Thoughts of death or suicide
Major depressive episodes leave people unable to function in social or occupational settings. A person’s depressed mood has to last at least two weeks to meet the clinical definition. Like manic episodes, an actual major depressive episode is not the result of drug abuse.
Four Different Types Of Bipolar Disorder
There are four different types of bipolar diagnoses. In each case, the disorder’s symptoms may vary slightly, resulting in unique challenges for a person coping with the condition.
- Bipolar I: Individuals with this form of bipolar experience the most dramatic transitions from mania to depression, and mood swings can be sudden and severe. The level of functional impairment is high with this form of the disorder, and many of these individuals must be hospitalized to protect their safety. It’s common for Bipolar I symptoms to appear for people in their teens or early 20s and rarely for anyone over the age of 50.
- Bipolar II: This bipolar is characterized by less severe fluctuations between emotional states. Depressive episodes may last longer and alternate with periods of hypomania, a milder form of mania. While it may be easier to function with this less severe disorder, bipolar II can interfere with everyday activities and cause functional impairment. Similar to Bipolar I, symptoms develop early in life and rarely develop as they get older.
- Bipolar With Mixed Features: In this form of the disorder, individuals may experience symptoms of mania and depression at the same time. For example, the individual may have elevated energy levels, sleeplessness, and appetite loss combined with feelings of despair, low self-worth, and sadness.
- Cyclothymia: This mood disorder is marked by milder depressive episodes and periods of hypomania. Episodes of depression are generally not as long or as profound as with bipolar I or II.
- Rapid-Cycling Bipolar: This manifestation of the disorder is characterized by multiple, rapidly alternating episodes of mania and depression, usually at the last four within 12 months. Individuals with other forms of bipolar may go through phases of rapid cycling, in which their moods fluctuate very quickly. During rapid cycling periods, depression may be more severe, and self-destructive behavior and suicide attempts are more common.
Bipolar And Addiction Symptoms
In an attempt to regulate these changes in mood and energy, individuals with bipolar disorder may abuse drugs or alcohol. According to the Journal of Clinical Psychiatry , up to 70 percent of people who meet the criteria for bipolar disorder also have a history of substance abuse. This percentage far exceeds the general population. Substance abuse affects the outcomes of bipolar disorder in several ways:
- Intensification of symptoms (mood swings, poor judgment, impulsivity, hostility, and irritability)
- Longer episodes of emotional instability
- Increased number of suicide attempts
- Diminished quality of life
Treating bipolar disorder and substance abuse can be complex, requiring intensive attention to the symptoms of mental illness and the behaviors associated with addiction. The treatment results for individuals with dual diagnoses, or a mental illness co-occurring with a substance use disorder, are generally much better if both conditions are treated simultaneously within the same program. To provide the most effective care, it should cross-train staff in mental health care and substance abuse treatment.
Addressing Bipolar And Addiction
The psychological and physical impairment caused by bipolar disorder makes it the most expensive behavioral health diagnosis, both in terms of health care costs and loss of quality of life. Individuals with bipolar disorder may feel misunderstood, stigmatized, or isolated because of their illness. The disorder can hurt all aspects of a person’s life, from occupational functioning to the quality of relationships. Having the support and concern of a close friend or family member can make a significant difference in treatment outcomes.
Many people feel uncomfortable about broaching the subjects of mental illness and addiction with a loved one. However, it is essential to remember that addiction and bipolar disorder will rarely improve without professional intervention. Expressing concern to a loved one may feel awkward or embarrassing at first, but this conversation could make a significant difference in the outcome of the disease. Too often, the official diagnosis of bipolar disorder comes years after the individual has first experienced symptoms.
The Journal of Clinical Psychiatry states that most people with the disorder do not receive treatment until at least six years after having their first episode. Because of this delay, symptoms tend to be more extreme, and relapse is more common in the early stages of treatment. Intervening on behalf of a loved one who is displaying the signs of bipolar disorder and substance abuse could prevent these unnecessary delays and expedite the process of recovery.
According to National Institute on Alcohol Abuse and Alcoholism, the role of genetic factors in psychiatric disorders has received much attention recently. Some evidence is available to support the possibility of familial transmission of both bipolar disorder and alcoholism (Merikangas and Gelernter 1990; Berrettini et al. 1997).
Common genetic factors may play a role in developing this comorbidity, but this relationship is complex (Tohen et al. 1998). Preisig and colleagues (2001) conducted a family study of mood disorders and alcoholism by evaluating 226 people with alcoholism with and without a mood disorder as well as family members of those people. The researchers found a more significant familial association between alcoholism and bipolar disorder (odds ratio of 14.5) than between alcoholism and unipolar depression (odds ratio of 1.7). These findings have implications for prevention and treatment. A positive family history of bipolar disorder or alcoholism is a significant risk factor for offspring .
Bipolar And Addiction Treatment Options
Bipolar disorder is a complex psychiatric condition, especially when combined with a substance use disorder. Therefore, treatment should draw from multiple modalities and disciplines to address the client’s neurological, psychological, physical, and psychosocial needs. In addition to intensive individual therapy, clients with dual diagnoses of bipolar disorder and addiction can benefit from the following research-based interventions.
- Motivational Interviewing (MI): Motivational Interviewing is a collaborative approach in which the therapist and client become partners in helping the client define sources of motivation and achieve self-defined goals. This positive, client-centered approach is instrumental in treating individuals working to recover from the effects of addiction. A study published in Issues in Mental Health Nursing showed that MI could help clients with bipolar disorder overcome ambivalent feelings about taking psychiatric medication.
- Cognitive Behavioral Therapy (CBT): CBT addresses the learned thought patterns and destructive behaviors that contribute to addiction, depression, and anxiety. Clients learn to identify self-defeating thoughts and actions and replace them with more positive, self-affirming coping strategies.
- Solution-Focused Therapy (SFT): This practical, client-centered modality helps individuals with mental illness and addiction set and achieve specific goals. Rather than delving deeply into the origins of mental health issues or substance abuse, SFT focuses on measurable therapy outcomes.
- Trauma Therapies: A history of trauma, childhood abuse, violence, or chaotic living environments can increase the severity of the bipolar disorder. Trauma therapies such as Seeking Safety and Eye Movement Desensitization Reprocessing (EMDR) target the unprocessed memories and internalized fears that can intensify anxiety or depression.
For many individuals with bipolar disorder, medication therapy is highly effective at controlling symptoms. By stabilizing moods and restoring balance to energy levels, psychiatric medications can also help to curb the impulse to abuse alcohol or drugs. However, medications must be selected and adjusted carefully, as certain medications can trigger manic episodes or worsen depression.
For example, antidepressants that are used successfully to treat major depression may not effectively treat bipolar depression and can induce a manic phase in bipolar patients, mainly if they are used without other medications. The most common drugs used to treat bipolar disorder fall into the following categories:
- Mood Stabilizers: Lithium is the most widely prescribed mood-stabilizing medication for bipolar disorder. Lithium is most effective at preventing or reducing the severity of manic episodes and may be prescribed in combination with other medications.
- Anticonvulsant Drugs: Anti-seizure medications such as Divalproex (Depakote), lamotrigine (Lamictal), carbamazepine (Tegretol), and topiramate (Topamax) are also prescribed to prevent mood instability in individuals with bipolar disorder. These drugs are beneficial for reducing the frequency and severity of depressive episodes.
- Antipsychotic Medications: Quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa), and aripiprazole (Abilify) are some of the most common antipsychotic medications used to treat the effects of bipolar disorder. These medications help to minimize the delusional thought patterns and erratic moods that characterize manic phases.
In addition to psychiatric medications, pharmacologic treatment for bipolar disorder may involve medications that address the physical symptoms that can contribute to bipolar symptoms. These include certain blood pressure medications that slow down the activity of the central nervous system and medications that help to correct hormonal imbalances.
Bipolar And Addiction Treatment
Substance abuse treatment should co-occur through the same program to provide comprehensive care for a client with a dual diagnosis. This integrated approach to treatment represents a departure from older schools of thought, which maintained that substance abuse treatment and mental health were separate, distinct fields. Today, integrated rehabilitation programs incorporate therapy for bipolar disorder and other forms of mental illness with addiction treatment. Addiction treatment services include:
- Medical Detox (inpatient or outpatient)
- Inpatient Treatment
- Residential Services
- Partial Hospitalization Programs
- Outpatient Programs
Both bipolar disorder and addiction are complex, multifaceted conditions that affect all aspects of the individual’s life. Like bipolar disorder, addiction is a progressive illness that increases in severity if left untreated. To provide comprehensive care and maximize therapy outcomes, a rehab program should offer services for both substance abuse and mental health treatment. With a combination of research-based therapeutic modalities, pharmaceutical interventions, and psychosocial services, bipolar disorder and addiction outcomes can improve significantly.
At We Level Up Treatment Center provides world-class care with round-the-clock medical professionals available to help you cope. We offer a program that addresses the impact of bipolar and addiction treatment. We understand that it must treat bipolar disorder and substance abuse disorders individually to help the client recover. Make this your opportunity to reclaim your life. Call today to speak with one of our treatment specialists. Our counselors know what you are going through and will answer any of your questions.
Your call is private and confidential, and there is never any obligation.
 National Institute of Mental Health. (2012). What Is Bipolar Disorder? Retrieved on July 8, 2015, from: http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml
 NCBI – Bipolar Disorder. (2001). Substance abuse in bipolar disorder. Retrieved on July 8, 2015, from: http://www.ncbi.nlm.nih.gov/pubmed/11552957
 NCBI – https://www.ncbi.nlm.nih.gov/pubmed/17081077
 NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629059/
 National Institute on Alcohol Abuse and Alcoholism. (2002). Bipolar Disorder and Alcoholism. Retrieved on July 8, 2015, from: http://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm
 NCBI – https://www.ncbi.nlm.nih.gov/pubmed/22224961