In our last Dual Diagnosis Brief, we looked at Obsessive Compulsive Disorder (OCD) and Substance Use Disorders (SUDS). Today, we will explore Bipolar Disorder and the complications that arise when someone with Bipolar Disorder also misuses drugs or alcohol.
What is Bipolar Disorder?
According to the National Institute of Mental Health (NIMH),
“Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.”
Bipolar Disorder is a complicated and multi-faceted illness that has been broken into 3 types by professionals. All 3 types are characterized by changes in mood, behavior, and energy levels which range from elated and very high to depressed and very low. In a general sense, the types are divided by severity of mood, but attempting to classify one type as being less serious than another would be short-sighted. Each type can cause immense suffering for the individual. The 3 types of Bipolar Disorder are Bipolar I, Bipolar II, and Cyclothymic Disorder.
- Bipolar I is defined by mania. An individual who experiences a manic episode for a period of 7 days or manic symptoms severe enough to require immediate hospitalization would be diagnosed with Bipolar I. Sometimes people with Bipolar I also struggle with debilitating depressive episodes, but these do not define this diagnosis.
- Bipolar II is defined by alternating periods of hypomania and depression.
- Cyclothymic Disorder is defined by alternating periods of depressive and hypomanic symptoms over the course of two years. The symptoms do not meet full criteria for either hypomania or major depression.
Individuals diagnosed with Bipolar Disorder experience pain and disruption in their lives. In extreme cases, psychotic symptoms like hallucinations and paranoia may be present, and suicide is not uncommon in Bipolar patients. Among the psychiatric disorders, Bipolar Disorder and SUDS have one of the highest comorbidity rates. It’s not at all uncommon for someone with Bipolar Disorder to abuse drugs or alcohol.
Bipolar Disorder is complicated on its own. When an individual with Bipolar Disorder uses drugs and alcohol, things can get even more challenging. While the person using substances might be trying to find relief from their symptoms, drugs, and alcohol can actually make those symptoms worse. This isn’t hard to imagine since intoxication and withdrawal from various substances can cause irritability, depression, insomnia, grandiosity, and impulsivity – all symptoms of Bipolar Disorder.
There are several warning signs that a Dual Diagnosis of Bipolar Disorder and SUDS may be present. Specific warning signs depend on both the type of Bipolar Disorder and the drug that is being misused. For example, a person with Bipolar I who is abusing Cocaine might show different symptoms than a person with Cyclothymic Disorder who is misusing alcohol. With that said, here is a general list of warning signs that might be helpful:
- Difficulty holding employment
- Destructive relationships or difficulty maintaining relationships
- Legal issues
- Financial problems
- Mood swings
- Decreased need for sleep
- Goal preoccupation
- Risky behaviors/impulsivity
- Racing thoughts
- Overly talkative
- Feeling Unworthy
- Insomnia or hypersomnia
- Weight gain and weight loss
- Extreme guilt
- Loss of interest in things that were once enjoyable
- Difficulty concentrating
- Suicidal thinking
- Hallucinations or paranoia
Getting professional help is critical, and the right kind of treatment can make all the difference. Evidence consistently suggests that Bipolar-specific psychotherapy and group interventions, combined with medication are most associated with positive treatment outcomes. Further, integrated group experiences that treat the co-occurring disorder as a single issue rather than 2 separate problems have been shown to be beneficial for people with a dual diagnosis. The FIRESIDE Principles cited by the Substance Abuse Mental Health Services Association (SAMHSA) set out a specific plan for integrated services that can be useful when looking for appropriate care. Here are some other things to watch for when trying to find a treatment center or an individual practitioner:
- Professionals with experience working specifically with Bipolar Disorder and addiction;
- a combination of psychiatric and addiction professionals with postgraduate degrees and ongoing training in the treatment of co-occurring disorders (depending on the level of care, these professionals may be on staff or contracted by the facility);
- and collaborative treatment planning and discharge planning that includes referrals to appropriate professionals for ongoing care.
If you or someone you know is struggling with any of the warning signs listed above, please reach out. Treatment is critical, and it’s available. You can reach out to the SAMHSA at 1-800-HELP (4357) or visit https://www.findtreatment.gov/. If you are looking for an individual therapist, consider visiting Psychology Today. You can search by zip code and then look for therapists with specialized experience in Bipolar Disorder and substance use disorders. We are also here to help. You can reach us by phone or via email, and we can assist you with an assessment and any questions you might have about Dual Diagnosis Treatment.