The Dual Diagnosis of Bipolar Disorder and Substance Abuse

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The American Journal of Managed Care reports that 56% of individuals with bipolar also experienced alcohol or drug addiction during their life. 46% of this group had also abused alcohol or were already addicted. 41% had abused drugs and alcohol was found to be the most commonly abused substance with those suffering with bipolar disorder. Women in particular have up to seven times greater alcoholism rates than that of the general population.

Understanding Bipolar Disorder

Bipolar can be difficult to diagnosis, especially if the patient is abusing drugs and/or alcohol. Several of the symptoms, such as extreme mood swings, can mimic symptoms of withdrawal or intoxication. When those with bipolar are in a manic episode, they may use stimulants like methamphetamine, or cocaine, to prolong he high-energy period or depressants (like alcohol) to come down from the mania.

In a depressive episode of bipolar, patients may use sedatives or depressants to calm or numb feelings of hopelessness and isolation, and stimulants may be used to elevate the depressive symptoms (lift mood).

People with bipolar can also experience periods of significant depression with alternating episodes of mania. Research has shown that brain chemistry may influence both bipolar disorder and substance use.

Typically those with bipolar have abnormal levels of serotonin, dopamine, and norepinephrine. These chemicals can affect functions such as appetite, metabolism, sleep, response to mood and emotions, as well as the way body responds to stress.

Impact of Drugs and Alcohol

The use of drugs and alcohol can interfere with the way brain processes these chemicals, causing emotional instability, erratic energy levels and depression. Those with bipolar typically turn to substance abuse to attempt to stabilize moods and numb the symptoms of bipolar.

The National Institute of Mental Health reports that drinking and using drugs may trigger depressed or manic moods in someone who has bipolar disorder. When an individual has both substance abuse and a co-occurring mental illness, addiction relapse will worsen the disorder, and when the mental health disorder goes undiagnosed, or relapses, addictive behaviors increase significantly.

There are several underlying causes and risk factors for developing bipolar. One major factor is genetics. According to the Depression and Bipolar Support Alliance, 2/3rd of individuals with bipolar have one or more family member who is also diagnosed with a mood disorder. Another factor is neurological shifts in the brain.

Man with bipolarNeurotransmitters, such as dopamine, norepinephrine, and serotonin play crucial roles in mood, energy, hormonal, and emotional regulation. When individuals have bipolar these chemicals may be deficient or imbalanced.

Another risk factor for the development of bipolar is a person’s environment in which they were raised, such as family history of substance abuse, trauma, or abuse, chaotic living environments. Just as there are several risk factors for the development of bipolar, many are similar to that of substance abuse. Often risk factors include chaotic living environments, especially as a child, genetic markers for substance use, and history of abuse/trauma.

Effective Treatments for Co-occurring Disorders

Integrated treatment uses a varied of treatment modalities to treat both the substance use and bipolar disorder. Cognitive Behavioral Therapy, Dialectical Behavioral Therapy can help with behavioral and cognitive learning and changes to cope with emotional dysregulation and symptom management.

Motivational Interviewing can help the client define sources of motivation and achieve self-defined goals. This can be most beneficial when working on addiction treatment. Solution-Focused Therapy works with patients to set and achieve specific goals. This therapy focuses on measurable outcomes. Trauma therapy is another modality to use when there is a history of trauma, childhood abuse, violence, or chaotic living environments.

A treatment team can provide a more holistic approach, which includes psychiatry for medication management, therapist, and support groups and often higher level care facility for severe cases. Individuals suffering with comorbid issues are more likely to require hospitalization and attempt suicide and are less likely to comply with treatment.

Medication management for this dual diagnosis can include anticonvulsant drugs such as Depakote, Lamictal, Tegretol, and Topamx to prevent mood instability and reduce the frequency of depressive episodes.  Antipsychotic medications, such as, Seroquel, Risperdal, Zyprexa, and Abilify can help minimize the delusional thought patterns and erratic moods.

Other medications that are geared for other medical symptoms can also help with bipolar symptom management. Some blood pressure medications can slow the central nervous system and may correct hormonal imbalances.

Friends discussing substance abuseIn conclusion, there are strong connections between bipolar disorder and substance abuse. There are various reasons for the development of bipolar, the strongest being genetic influences, and the risk factors of abuse, trauma, living environment can influence management of the disorder.

Use of substances are common for those with bipolar and temporarily numb the severe symptoms of bipolar. With a treatment team, holistic approach, and use of varied treatment modalities and medication, the individual suffering with bipolar can effectively manage the symptoms without use of substances.

Community Discussion – Share your thoughts here!

What connections do you see between bipolar and alcoholism? What are your thoughts that women have a higher rate of this dual diagnosis than the general population?

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Certified Eating Disorder Specialist (CEDS) who works with individuals and families in the area of eating disorders. Mrs. Lyons works in the metropolitan St. Louis area and has been practicing in the field for 11 years. Libby is also trained in Family Based Therapy (FBT) to work with children-young adults to treat eating disorders. Mrs. Lyons has prior experience working with the United States Air Force, Saint Louis University, Operating Officer of a Private Practice, and currently works with both Saint Louis Behavioral Medicine Institute within their Eating Disorders Program and Fontbonne University


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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.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on November 7, 2016
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About Jacquelyn Ekern, MS, LPC

Jacquelyn Ekern founded Addiction Hope in January, 2013, after experiencing years of inquiries for addiction help by visitors to our well regarded sister site, Eating Disorder Hope. Many of the eating disorder sufferers that contact Eating Disorder Hope also had a co-occurring issue of addiction to alcohol, drugs, and process addictions.