When you have a dual-diagnosis it is necessary to treat both conditions simultaneously. This isn’t a chicken or the egg scenario—it is more akin to having a flood in the basement and a fire in the attic.
If you deal with one first, the other may have inflicted irreparable damage to the house by the time you get to it. Do not despair, this dual-diagnosis is well documented and treatment options are available with professionals who deal with the fire and the flood together.
Understanding Bipolar Disorder
The flood of bipolar is a condition where you proceed through periods of depression where lethargy and hopelessness are profound, and then you switch into manic states where grandiosity, impaired judgment, energy and productivity can take over. The erratic switch in these positions is disconcerting and leaves sufferers confused until they understand what is happening.
When we feel perpetually confused, ashamed and out of control it makes sense that we often lose hope and desperately attempt to alleviate this situation. Enter the fire of alcohol, which acts as a depressant and reduces emotional intensity.
It appears that managing enormous and confusing swings in mood and productivity are desirable, yet often are joined by alcoholism’s effects; physical ailments, denial and other side effects. Alcohol dependence can ensue, along with brain adaptations.
Connection Between Bipolar Disorder and Substance Abuse
It is apparent that bipolar disorder increases your vulnerability to abuse substances. Research by Hirschfeld and Vornik  demonstrate the vociferous link between bipolar disorder and addiction:
- Close to 56% of individuals with bipolar in a national study had experienced drug or alcohol addiction at some point.
- Around 46% of this group was either addicted to alcohol or had been in the past—that is approximately 25% of bipolar sufferers in the study.
- Alcohol has proven the most abused substance by bipolar sufferers.
Effective Treatment Approaches
The standard treatment for alcoholism usually requires an intensive course of outpatient or inpatient treatment to help people through withdrawal and to build more effective methods of handling life stress and emotions.
Some can find recovery through self-motivated programs like AA. The focus is to replace the use of a substance with skillful living, self-understanding, relational skills, and often to a lesser degree, healing from past wounds.
In contrast bipolar disorder is commonly treated through medication to manage destabilizing mood swings, and personal therapy. This therapy can focus on a number of avenues but usually includes a focus on managing depression and mania, whilst growing self-awareness and sensitivity to shifts as they occur. This allows sufferers to manage their emotions and implement tools to remain productive and relational—this is no small matter.
It may seem that integrating these two—the common treatments for fire and flood—would be daunting. However, there are specific treatment centers that have designed treatment programs that address the co-morbid (occurring together) conditions.
They attempt to blend the structured withdrawal from alcohol (or other substances) whilst providing ample personal support, and the development of new coping skills. This takes place across a range of group therapy, individual therapy, skills training and implementing self-care. The length and location of these treatments vary, but are relatively easy to search for.
Expecting treatment for this comorbid condition to last beyond any intensive treatment is wise. Treatment centers can provide a vital catalyst and provide stability as you begin recovery and management of your condition.
However, personal, ongoing therapy is recommended to sustain changes and help you continue to manage bipolar “swings”. These can change over time and be disorienting when you are managing them with new skills—not the old bottle. Formal group programs including DBT therapy are especially helpful to continue building effective tools for life.
Medication can also be a helpful co-laborer as you build a satisfying life. Specific medications have been developed for bipolar disorder, yet they can reduce one’s ability to fully experience joy.
Further, it is well known by professional healthcare workers that we respond differently to medications. Family history and biology all play a part in this difference.  Work closely with a psychiatrist and allow them to help you find the right balance of medication to help you.
Setting Up a Support System
When you return to your normal community (or if you stay there), it is critical to disconfirm the stigma of a diagnosis by recruiting a social support structure where people know and care about your wellbeing. This starts with family who may need to be educated by your therapist, or doctor, about the challenges of bipolar disorder so that they can support your actions and new skills.
It is recommended to widen this social support to trusted friends, church leaders and other community support persons. A wider network consists of committing to support groups where you will have fellow travelers who intimately understand the struggle. This can consist of AA groups for the alcohol addiction, bipolar support groups who understand the perils of mood swings, or other recovery groups that are more general.
Remember, when a flood and a fire have broken out, it is nearly impossible to attend to both effectively without professional help and support. Denial or shame may hold you back from seeking treatment, but this may cause damage to become more severe in the meantime. Caring and considered help is available, and I’d encourage you to reach out.
About the author: Paul Loosemore, MA PLPC, author of “21 Movements Towards Life” – The step-by-step guide to recovering from sexual addiction or pornography. Paul works as a mental health counselor, and consults with those who wish to recover from Sexual Addiction—both individuals and couples. He is the founder of www.stopsexualaddiction.com where you can find his guide, or contact him.
: Robert M.A. Hirschfeld, MD, Lana A. Vornik, MSc. (June 15, 2005) Bipolar disorder costs and comorbidity. American Journal of Managed Care. Online.
: For more, see: Expert Consensus Guideline Series, Gary S. Sachs, M.D., David J. Printz, M.D., David A. Kahn, M.D., Daniel Carpenter, Ph.D., John P. Docherty, M.D. (2000) Medication Treatment of Bipolar Disorder.
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Reviewed By: Jacquelyn Ekern, MS, LPC on December 5, 2016
Published on AddictionHope.com