Dual Diagnosis: What's The Connection Between Bipolar Disorder And Substance Addiction?

Plenty of things raise a person's risk of developing a substance use disorder — circumstances like poverty, a difficult childhood, a family history of addiction, and social isolation, and disorders like anxiety, depression, post traumatic stress disorder, and ADHD, for instance, and that list goes on. 

Plenty of things raise a person's risk of developing a substance use disorder, but few impact the odds as much as bipolar disorder. With research estimating that an alarming 70 percent of people who suffer from bipolar disorder will face a substance addiction at one point in their life, it seems escaping this fate is the exception rather than the norm. Alcohol, cannabis, nicotine, and opioids are among the most common choices.

Why does bipolar disorder make a person vulnerable to substance abuse?

Research into the topic has made it clear that the exact reasons for the shockingly strong link between substance addiction and bipolar disorder are yet to be fully "excavated". All the four subtypes of bipolar disorder, however, feature strong fluctuations in mood and state of mind.

A person with bipolar disorder will usually go through episodes of depression, during which they'd meet all the diagnostic criteria for major depressive disorder if they weren't bipolar. Then, there are episodes of mania, during which a person may be euphoric, full of energy, agitated, touchy, or feel they can achieve anything at all — including, for instance, win the jackpot or safely jump off a tall building. Hypomania is a less extreme version of mania that can still leave someone experiencing one feel "on top of the world". 

It's not difficult to see how both states of mind can lead to substance abuse.

Depression, during which someone may feel extremely sad, hopeless, low, worthless, and unable to enjoy much of anything, is a well-known risk factor for substance abuse. In this case, abusing alcohol or drugs can be a form of misguided self-medication, an attempt to stop feeling the pain associated with depression. 

Mania, meanwhile, can make a person impulsive and incapable of assessing risk rationally. Whether a manic episode makes someone with bipolar disorder euphoric or aggressive, this state of mind can also be quite scary. 

How does a substance use disorder impact the symptoms of bipolar disorder?

The high rate of substance addictions among people suffering from bipolar disorder presents a special challenge not just because people with this dual diagnosis now require treatment for two different conditions. When someone with bipolar disorder develops a substance use disorder, they:

• Are more likely to attempt and commit suicide. 
• Will often find that the symptoms of their bipolar disorder become more severe.
• Are more likely to require hospitalization for bipolar disorder. 
• They are less likely to take the mood stabilizers and other medications prescribed to them as instructed by their doctor. Even if they do, the medications may interact with alcohol and drugs and work less well. 
• Have higher rates of disability. 

What are the treatment options for people with both bipolar disorder and a substance addiction?

Bipolar disorder is ideally managed through a combination of medications — very often including the mood stabilizer lithium — and talk therapy as well as social interventions. Dialectical behavior therapy, family-focused therapy, mindfulness-based cognitive therapy, and of course good-old cognitive behavioral therapy are all options that can be incredibly useful in helping people with bipolar disorder live full and satisfying lives. 

Substance use disorders can, meanwhile, be treated in a variety of ways. Getting someone clean in a safe way depends on the susbstance they have been using, and may require inpatient or outpatient medical and psychological monitoring. Contigency management, in which an addict receives rewards for staying off the substance, peer-support groups, and again cognitive behavioral therapy can all play a role. In some cases, medications are deployed to help people facing substance use disorders get and stay clean, too. 

It is important, then, for healthcare providers to assess an invidual's most pressing needs and to devise an individual treatment plan accordingly. In some cases, that will mean prioritizing the reduction of substance use. In others, it will mean focusing on bipolar disorder. Sometimes, treating both at the same time will be the right answer. 

Regardless of what choice is made in a particular case, it is important for patients to continue treatment and healthcare providers to follow up. Managing co-existing bipolar disorder and substance addiction isn't like a course of antibiotics that is finished after a finite amount of time, after all — this dual diagnosis leads to ongoing concerns. 

Both disorders will ultimately have to be treated. Managing the symptoms of bipolar disorder requires ongoing treatment with medication. With substance addiction, there's always the risk of a relapse. Regular check-ins with healthcare providers can help people keep both on track. Finding a fulfilling life that includes social support, a healthy environment, productive activities, physical exercise, and personal coping mechanisms also plays an essential role.