The illness once known as manic depression is nowadays called bipolar disorder. It’s a lifelong disease that comes with mood swings that go from extreme exhilaration to debilitating depression, sometimes described as as emotional "ups" and "downs". Millions of people worldwide suffer from bipolar disorder and co-existing mental disorders.
According to the American Psychiatric Association, there are four types of bipolar disorder:
- Bipolar I disorder
- Bipolar II disorder
- Cyclothymic disorder
- Bipolar disorder due to another medical or substance abuse disorder
The symptoms of mania are relatively easy to recognize, including off-the-charts good mood, rapid speech, general unrest, and taking part in high-risk behaviors. Hypomanic, depressive, or mixed episodes are harder to decipher, especially when they’re accompanied by psychosis or substance abuse. In fact, substance abuse makes psychiatric conditions including bipolar disorder extremely hard to diagnose. Research that included 700 people with a bipolar disorder diagnosis has shown that only 43 percent of them met Structured Clinical Interview for DSM-IV (SCID) criteria after they sobered up.
1. Substance abuse can contribute to the development of bipolar disorder
Illegal drugs, alcohol, and the abuse of prescription drugs have the ability to rewire parts of brain responsible for controlling our behavior and emotions. Addiction leads to permanent damage to these parts of the brain and prevents once-healthy and stable people from controlling their mood and behavior in the long run.
2. Substance abuse is common in bipolar patients
Bipolar disorder often goes hand-in-hand with other mental disorders such as anxiety, which is the most common comorbidity, but eating disorders and substance abuse are also frequent co-occurrences. Several large studies concluded that at least 40 percent of patients with bipolar I disorder abuse alcohol and drugs, along with around 20 percent of people with bipolar II disorder.
Eating disorders are associated mostly with the depressive phase of the illness, and substance abuse disorders are likely to be connected to manic symptoms. Alcohol and cannabis are the most commonly used substances within bipolar circles, which is probably due to better accessibility than – let’s say – cocaine or opioids.
Studies have shown that the sooner the person is diagnosed with bipolar disorder, the more prone they are to substance abuse. Those with adult onsets of the illness are less likely to start abusing substances.
3. Sober bipolar patients have milder symptoms
Bipolar patients with comorbid substance abuse tend to have a more severe clinical picture and worse symptoms than those patients without substance use problems. Those who abuse alcohol or drugs are more likely to contemplate and attempt suicide, go through anxieties, accidents, and hospitalizations, not respond to treatment, and have more depressive episodes in general.
Manic and depressive episodes are a vicious cycle in which stress and substance abuse can wreak havoc on a person’s life. Bipolar disorder is a serious illness that should be treated either with medication or psychotherapy, but a combination of several methods is usually the preferred treatment. A person can indeed live a full life with this disease, but only if they decide that health is their number one priority. Substances such as alcohol or cannabis help only ostensibly, never in the long run. There’s a big chance that your life will end in disaster if – next to your mind-blowing mania – you decide to spice it up with cocaine or you try to hush your depressive thought with vodka.
4. It’s best to treat bipolar disorder and substance use disorders together
In recent years, it’s common practice in psychiatry to integrate treatment for both disorders. Most doctors will treat bipolar disorder with mood-stabilizing medications such as lithium, and leave substance abuse treatment drug-free and recommend counseling instead.
5. Certain medications can induce manic-like behaviors
According to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), a person can exhibit symptoms similar to those of bipolar disorder after using certain antidepressant medications, but if these symptoms stop after a person is taken off the drugs. The experts consider these symptoms psychological effects of the drugs.
What’s important to know is that hypomanic or manic behavior that continues even after antidepressants are stopped is not considered substance-induced. The same goes for electroconvulsive therapy-induced hypomanic or manic behaviors – if they still occur beyond the psychological effects of ECT, it’s considered a dangerous phase of the illness.
People often mix up the term substance dependence with abuse or addiction. Dependence is often the body's normal answer to certain drugs used to treat mental issues and doesn’t automatically mean someone is addicted to a certain medication.
The bottom line
Substance abuse makes bipolar disorder hard to diagnose and even if the doctor provides the right diagnosis, the symptoms of the disease are worsened over time by alcohol and drugs, which is ironic since most people first use these substances to alleviate the symptoms of bipolar disorder.