By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Bipolar.
Photo courtesy of Pixabay.com
HUGE connection between Bipolar Disorder and Substance Disorders.
There are so many connections between having Bipolar Disorder and having a Substance Use Disorder. In treatment facilities that screen for mental illness, it is not uncommon for Bipolar to be the single most common co-occurring mental illness. Anti-social disorders are common in court order referrals and sometimes you might see a lot of clients with PTSD but most often it is the combination of Bipolar Disorder and a Substance Use Disorder that really stands out.
Drugs and alcohol can mask psychiatric symptoms, can create them and both intoxication and withdrawal can look like mental illness, but the combination of Bipolar Disorder and a substance use disorder is so common it is an expectation.
Bipolar Disorder coexists with substance abuse more often than with all the Depressions put together. All mood disorders other than Bipolar Disorder are sometimes labeled unipolar depression to separate them from the bipolar condition.
The overlap between these two conditions is huge. The Epidemiological Catchment Area Study reported that more than 60% of people with Bipolar also had a substance use disorder.
Alcohol was the drug of choice for both people with Bipolar Disorder and unipolar depression.
Because many people with Bipolar Disorder report liking the mania or hypomania they most often go undetected and untreated for long periods of time. Most of the time they come in for treatment because of an episode of depression. Many also escape detection until they have legal consequences that send them to a treatment program.
Most people who finally do arrive at the diagnosis of Bipolar Disorder have seen five or more health care professionals and have spent ten or more years on the process before getting diagnosed with Bipolar Disorder.
The extreme fluctuations in mood in Bipolar Disorder interact with drugs and alcohol. The reported rate of Bipolar Disorder is 1-2 % though it seems likely that many subclinical cases go undetected for prolonged periods of time.
Cyclothymia is another diagnosis related to Bipolar Disorder that has low highs and not so low lows. It is sometimes described as on the bipolar spectrum. For a full diagnosis of Cyclothymia, you need to have had the condition for at least two years.
This disorder is rarely diagnosed and treated as it does not cause the huge impairment or legal consequences of the more severe forms of Bipolar Disorder. People with Cyclothymia have periods of feeling better and stop treatment. They only come in when depressed and hide the hypomania well. In my own clinical experience, this condition is probably vastly underdiagnosed.
When we talk about having a substance use disorder most people will respond that they are not drug addicts or alcoholics. There are forms of the disease of addiction that stop short of physical addiction but result in ruined lives, broken relationships, and periods of time incarcerated.
The hallmarks of a substance use disorder are:
Obsessions – you can’t stop thinking about it.
Cravings – repeated urges to use
Loss of control – using more and more often than planned.
Increased tolerance – Needing more to get the same high or getting less of a result from the same amount of drug.
Withdrawal effects when you run out of the drug.
Psychological addiction or dependence occurs long before physical addiction.
Bipolar Disorder may have existed before the substance abuse but did not get diagnosed because there had been no severe mania. Some people with Bipolar begin using to cover up the symptoms or to help themselves cope. We think of this as “self-medicating.
Drugs and alcohol may increase the risk of developing Bipolar Disorder.
People with Bipolar disorder and substance abuse issues are hospitalized more often and for longer. They are more likely to have rapid cycling Bipolar Disorder and to have developed the symptoms at a younger age. They are also much more likely to have mixed episodes of both mania and depression at the same time.
Co-occurring Bipolar Disorder and substance abuse are much more resistant to treatment and people with both conditions at the same time are far more likely to drop out of or fail to complete treatment.
Alcoholism is more often a result of having Bipolar Disorder rather than a risk factor and those with alcohol as their primary drug of choice do better in treatment than many other co-occurring disorders.
Further complicating this picture we should know that any alcoholic with or without a mental illness is likely to have severe mood swings. Alcohol withdrawal and alcohol intoxication can mimic many mental illnesses and it can take some period of sobriety before a baseline for diagnoses is clear.
Alcohol and illicit drug use will also interfere with getting the medication right resulting in many med changes that might otherwise not have been needed.
So there are some brief thoughts about the connections between Bipolar disorder and substance abuse, especially alcohol abuse.
If you or someone you care about has a problem with drugs, alcohol, or may have a mental illness please encourage them to go for professional assessment and treatment.
Other articles about Bipolar Disorders and related conditions can be found at:
Bipolar – misdiagnosed or missing diagnosis?
Bipolar Disorder Genetics research study – Come one come all
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Great post, and a hugely important distinction to make. My biploar (type 2) was misdiagosed for 20 years (which resulted in a quitye bizarre array of inappropriate treatments) during which time I also self-diagnosed alcohol as being at the root of my problems rather than a symptom.
As a result of this I also attended AA and did a stint in rehab both of which, in retrospect (although without wishing to in any way denigrate the support structure that these instutions provide for those for whom substance abuse is the primary issue), were a huge waste of time and, in the case of the latter, money.
Having said that, it was only giving up drinking during this time that I fully noticed the extent of my ‘highs’; whilst drinking, I was only ever really aware of the extended periods of depression that are the predominant feature of my condition (and which were no doubt considerably worsened by my drinking), without even considering that I might have been subconciously self-medicating.
Having finally been successfully diagnosed and treated with Lamotrigine 3 years ago, my life has been utterly transformed, and without any negative side effects from the medication.
I do wonder just how many other people are out there who have not been correctly diagnosed and are sufferingly unecessarily or pursuing inappropriate forms of treatment). Informations resources such as yours are hugely helpful in terms of debunking myths and helping people work towards accurate diagnoses, so thanks for making the effort to post!
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Thanks for your comment and sharing you experience.
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