Bipolar Disorder and Substance Abuse

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Bipolar disorder interrupts regular life, making it difficult for those who suffer from it to maintain relationships and perform ordinary activities. People with bipolar disorder also suffer from substance use disorders at rates much higher than those for the general population. Substance abuse may provide a temporary relief of symptoms, but it can also increase the length, severity and frequency of symptoms. Treatment for co-occurring disorders helps patients live happier lives.

Bipolar disorder is characterized by abnormal changes in mood and energy levels. The mental illness is more dramatic than mild mood swings. People with bipolar disorder suffer severe changes in mood, suffering from depression, mania or a combination of both.

Without treatment, people with bipolar disorder struggle to maintain interpersonal relationships and regular employment. They may consider suicide. Sometimes it can be difficult to recognize symptoms of bipolar disorder. Between episodes of depression or mania, people with the disorder may be free of symptoms. Others experience less severe symptoms between episodes.

Bipolar disorder usually occurs near the end of adolescence and the early part of adulthood, with about 50 percent of diagnoses occurring before age 25. Bipolar disorder is a lifelong disease for most people, but medical treatment can ease symptoms and help patients maintain more stable moods.

Treatment is more difficult when a person is involved with substance abuse. People with bipolar disorder misuse substances such as drugs and alcohol at rates much higher than those of the general population. Some experts estimate that people with the disorder are up to seven times more likely to have a substance use disorder.

In one study of bipolar disorder patients’ lifetime substance abuse rates:

Health care professionals aren’t sure why people with bipolar disorder misuse drugs and alcohol at a high rate. Some people attempt to treat symptoms of their illness with the substances, but substance abuse can activate or prolong symptoms. Symptoms of bipolar disorder, such as difficulty controlling behavior, may contribute to someone abusing drugs or alcohol.

People with bipolar disorder also tend to suffer from other co-occurring illnesses, including attention-deficit hyperactivity disorder (ADHD) or anxiety disorders, such as social phobia or post-traumatic stress disorder (PTSD). Symptoms of the disorders may overlap, making diagnosis difficult.

It can be extremely difficult for people with bipolar disorder to live daily life without treatment. Substance abuse may provide a temporary fix for some, but it can cause prolonged or heightened symptoms and lead to addiction. Fortunately, some rehabilitation clinics specialize in treating patients with bipolar disorder and other co-occurring illnesses.

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Symptoms of Bipolar Disorder

People with bipolar disorder feel seemingly opposite symptoms depending on the type of episode they’re experiencing. Manic episodes are usually characterized by an unusual high feeling, and depressive episodes are characterized by intense feelings of sadness. Some people experience mixed episodes in which they experience both high and low feelings.

Symptoms of manic episodes include:

  • Feeling unusually happy or outgoing
  • Impulsive, high-risk behavior
  • Irritability
  • Restlessness
  • Alertness
  • Racing thoughts
  • Distractibility

Symptoms of depressive episodes include:

  • Feeling sad or hopeless
  • Feeling tired
  • Problems concentrating
  • Losing interest in enjoyable activities
  • Changing eating and sleeping routines
  • Contemplating suicide or death

People in a mixed state feel a combination of symptoms. They may feel energized and sad or feel agitated while having suicidal thoughts.

Others with severe bipolar disorder may have hallucinations or other psychotic symptoms. During a manic episode, they may think they’re famous or have supernatural abilities. During a depressive episode, they may believe their family has left them or think they did something they did not do.

Types of Bipolar Disorder

Health professionals characterize bipolar disorder by severity and duration of symptoms.

Types of bipolar disorder include:

  • Bipolar I disorder: People with bipolar I tend to experience manic or mixed episodes lasting at least seven days and depression lasting at least two weeks. Manic episodes may be so intense that the person requires immediate medical attention.
  • Bipolar II disorder: People with bipolar II suffer depression and less severe manic or mixed episodes than people with bipolar I.
  • Bipolar disorder not otherwise specified: Doctors diagnose people with BP-NOS when a person’s symptoms are unmistakably abnormal but they do not meet criteria for bipolar I or bipolar II.
  • Cyclothymic disorder: Also called cyclothymia, cyclothymic disorder is characterized by mild episodes of mania and depression occurring for at least two years. Doctors diagnose it when symptoms do not meet criteria for bipolar I or II.
  • Rapid-cycling bipolar disorder: People with rapid-cycling bipolar disorder suffer four or more episodes of depression, mania or mixed episodes in one year.

The reasons some people suffer bipolar I and others suffer bipolar II isn’t clear. Health professionals are still trying to understand the causes of all types of bipolar disorder.

Causes of Bipolar Disorder

Most experts believe bipolar disorder can be caused by multiple factors that act together to increase the risk of the illness.

Like many mental illnesses, bipolar disorder seems to run in families. There’s evidence that certain genes make someone more susceptible to the illness, but people with siblings or parents with bipolar disorder may never develop it.

Researchers studied twins with the same genes and found that one twin may develop bipolar disorder while the other one doesn’t. The results lead experts to believe environmental factors may play a large role in a person’s likelihood of experiencing the illness.

Studies of the brain indicate that the parts of the brain that handle problem solving and decision making are different in people with bipolar disorder. Their brain development is also similar to that of people with multi-dimensional impairment, a disorder with symptoms similar to schizophrenia and bipolar disorder.

Treating Substance Abuse Disorders and Bipolar Disorder

Treating someone with bipolar disorder and a substance use disorder can be difficult when health professionals are unaware of the co-occurring disorders or are inadequately equipped to treat them.

Substance abuse makes symptoms of bipolar disorder worse and decreases the benefits of standard treatment. People tend to take longer to recover, spend more time in health facilities and be more likely to contemplate suicide when they misuse substances during treatment. Individuals with co-occurring disorders can find the best care at rehabilitation facilities specifically equipped for treating both illnesses.

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Treatment for substance abuse typically begins with a detoxification process, which may include medication depending on the substance of abuse and severity of withdrawal symptoms. Health professionals do their best to treat withdrawal symptoms to keep patients as comfortable as possible.

Doctors can not cure bipolar disorder, but treatment can reduce the severity and frequency of symptoms. Long-term treatment is required to control symptoms throughout life.

Treatment for bipolar disorder normally begins with medication, but medication may not be appropriate for everyone. Patients should discuss the benefits and risks with their doctors before taking a medication.

Medications for bipolar disorder include:

  • Lithium: Available in brand names Eskalith and Lithobid, lithium effectively stabilizes moods during both manic and depressive episodes.
  • Anticonvulsants: Anti-seizure drugs like Depakote (valproic acid) and Lamictal (lamotrigine) can manage symptoms of bipolar disorder.
  • Atypical antipsychotics: When taken in combination with other drugs, atypical antipsychotics, such as Risperdal (risperidone) and Seroquel (quetiapine), can treat bipolar disorder.
  • Antidepressants: Antidepressants may treat depressive episodes, but they are often taken in combination with other drugs to prevent a manic episode from developing.

Treatment with medications works best when used alongside behavioral therapy. Therapy is also used to treat most substance use disorders, so individualized treatment plans can help patients recover from co-occurring disorders simultaneously.

Types of behavioral treatments include:

  • Cognitive behavioral therapy: Assists patients with removing harmful behaviors or choices from their lives and decreases negative thoughts.
  • Family-focused therapy: Includes members of the family to build coping and recognition strategies. It encourages families work together to provide support.
  • Interpersonal and social rhythm therapy: Helps patients manage daily life and improve interpersonal relationships.
  • Psychoeducation: Teaches patients about their condition and treatment options. The therapy teaches patients to recognize upcoming changes in behavior and manage them before symptoms become worse.

Getting Help

When health professionals develop co-occurring disorder treatment plans specific to an individual, patients see improvements in the way they enjoy life. Patients do recover from substance use disorders, but treatment takes time and hard work. Bipolar disorder cannot be cured, but patients can learn to minimize and manage their symptoms.

Without treatment, symptoms of bipolar disorder can deteriorate. The severity, length and frequency of manic and depressive episodes can worsen. Delays in diagnosis and receiving treatment can negatively affect regular life and relationships.

Facilities that specialize in treating bipolar disorder with co-occurring disorders can rehabilitate patients so they can enjoy life.

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