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Bipolar I Disorder & Drug Abuse

There is a strong correlation between bipolar I disorder and substance abuse.  This is due to the impulsive and high-risk behavior one may exhibit during a manic episode, and the fact that many people with bipolar disorder may seek to self-medicate with alcohol or drugs.

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What Is Bipolar Disorder?

Bipolar disorder is a mental illness that causes an individual to have extreme mood swings as well as dramatic changes in energy levels and the ability to think clearly and logically. The symptoms include intense manic episodes, which are usually followed by a period of depression.

When left untreated, the symptoms of bipolar disorder often get worse. The condition is generally managed with medication and therapy.

In order to be diagnosed with bipolar disorder, an individual must experience at least one episode of mania or hypomania. Mania is characterized by periods of severe agitation or elevated moods, abnormally high energy, racing thoughts, and extreme and unpredictable behavior. Hypomania is generally shorter-lasting and more manageable than mania, but hypomania can evolve into mania.

Bipolar disorder is also characterized by extreme periods of depression, which are often debilitating. Individuals with bipolar disorder who are in a depressive phase may be overwhelmed with feelings of hopelessness, loss, guilt, fatigue, and sadness.

The Types of Bipolar

Depending on the type and length of these depressive episodes, people may be diagnosed with one of four kinds of bipolar disorder. Bipolar I disorder is generally signified by full manic episodes, whereas bipolar II disorder and other forms of bipolar disorder involve less complete manic cycles.

The types of bipolar disorder include:

  • Bipolar I disorder. Manic episodes last at least a week, and they feature psychotic symptoms. Depressive episodes usually last about two weeks.To be diagnosed with bipolar I disorder, the person must have experienced at least one episode of mania that lasts at least a week or a manic episode that is so severe, it requires hospitalization. A depressive episode is not necessary for a bipolar I diagnosis, though most people experience depressive episodes.
  • Bipolar II disorder. Depressive episodes occur, and only mild forms of mania occur, called hypomania. They shift from depressive episodes to hypomanic episodes, but never experience a full manic episode.
  • Cyclothymic disorder (cyclothymia). This is a mild form of bipolar disorder, signified by recurring mood swings. The highs and lows are not severe enough to qualify as depression or mania.It is usually signified by a chronically unstable mood that lasts at least two years. People may experience periods of normal moods that last less than two months.
  • Other varieties. Symptoms do not fall into the above categories. The disorder may be due to a medical issue or substance abuse.

Who’s Affected by It?

The estimate on the number of adults in the U.S. who suffer from bipolar disorder varies. Research published by the National Institute on Mental Health indicates that at least 2 percent adults in the U.S. are diagnosed with bipolar disorder each year. Approximately 4.4 percent of U.S. adults experience bipolar disorder at some point in their lives. Some estimates are much higher, and the fact that bipolar disorder may often be left untreated or misdiagnosed must also be taken into account.

Bipolar disorder appears to affect both men and women at equal rates. The average age of onset of bipolar disorder is 25, but bipolar disorder also occurs in adolescents as well as, more rarely, children. Adults can begin to experience symptoms of bipolar disorder later in life, although later diagnosis can also be the result of undiagnosed bipolar disorder. Symptoms often get worse when left untreated.

Over 80 percent of cases of bipolar disorder receive the classification of “severe.”

The Symptoms

To understand the symptoms of bipolar disorder, one must understand the very different symptoms of manic and depressive phases of the disorder.

Many associate the manic phase of bipolar disorder with someone being in great, energetic mood that lasts a long time, but this is not always the case. The mania phase can be extremely destructive and dangerous. It can result in the person engaging in high-risk behavior, and it can even cause them to become suicidal.

A person experiencing a bipolar disorder manic phase may:

  • Appear be jumpy, edgy, or abnormally energetic.
  • Talk fast and jump from one subject to the next.
  • Seem abnormally “up.”
  • Be abnormally high energy or active.
  • Display increased irritation or sudden agitation.
  • Attempt to rapidly multitask.
  • Appear unable to stop racing thoughts or rambling speech.
  • Participate in high-risk, impulsive behavior, such as risky sexual activity, gambling, or spending money irresponsibly

Sometimes the depressive phase of bipolar disorder is overlooked or misdiagnosed because a person suffering from it may become more withdrawn. The symptoms may be less noticeable than those displayed during a manic episode.

The depressive symptoms are just as serious and dangerous. They can include:

  • Feelings of sadness, worthlessness, hopelessness, shame, and guilt.
  • Abnormally low energy and activity levels.
  • Sleeping problems — either being unable to sleep or wanting to sleep excessively.
  • Feeling overwhelmed by everyday tasks and activities.
  • Difficulty concentrating or remembering things and appointments.
  • Feelings of worry and anxiety.
  • Overeating or a lack of appetite.
  • Suicidal thoughts or a focus on death and mortality.

Not everyone with bipolar disorder experiences the most extreme phases of mania and depression. Some experience hypermania, a milder form of mania that the person may not realize to be harmful in any way; it may just appear to be a period of higher energy and productivity. But friends and family may notice the unhealthy mood swings, which can develop into more severe cases of mania and depression if left untreated.

A person with bipolar disorder may also experience episodes that involve both manic and depressive symptoms. These are called episodes with mixed features. For example, a person may experience higher energy and activity levels while also feeling abnormally sad, worried, or hopeless.

A Connection with Substance Abuse

There is often a link between mental illness and substance use problems. Individuals may look to substances to alleviate the symptoms of their mental illness. Oftentimes, there are shared underlying issues relating to both problems, such as genetics, trauma, or growing up in a household where substance abuse and mental illness were present.

According to the National Institute on Drug Abuse, having a mood disorder (including bipolar disorder) nearly doubles the risk of developing a substance use disorder. Likewise, having an addiction increases the likelihood of developing mental health issues.

While any mental health issue increases the likelihood of substance abuse, there is an even stronger connection between bipolar disorder and substance use disorders. The more extreme the mood disorder, the higher the risk of developing a substance use disorder.

A 2014 study found that individuals with severe mental illnesses, such as bipolar disorder, are at four times the risk of using recreational drugs. While this doesn’t mean these people will go on to chronically abuse these drugs, initial use obviously increases the likelihood of this happening.

What Are the Dangers of Self-Medicating to Treat Bipolar Disorder?

Those who suffer from bipolar disorder, especially those whose disorder isn’t diagnosed or being properly managed, may turn to alcohol or drugs to self-medicate. They may try to smooth out the rough rollercoaster ride of their moods with uppers (stimulants like cocaine or methamphetamine) or downers (like alcohol, opioids, or benzodiazepines). They may try to escape the feelings of powerlessness over their mood swings with any high that’s accessible to them.

Self-medicating with alcohol or drugs may provide temporary relief, but it ultimately exasperates the symptoms of bipolar disorder over time. Abuse can quickly lead to dependence on the substance. Increasing doses due to tolerance make overdose more likely.

While self-medicating any mental health or emotional issue is always dangerous, the risks are compounded when dealing with a severe mental illness like bipolar I disorder.

The symptoms of bipolar I include highly impulsive and reckless behavior, impairment of judgment and clear thought, and feelings of depression, worthlessness, and suicide. These symptoms make it more likely that the person will take higher doses, combine different substances, or engage in dangerous behavior while under the influence. All of these things increase the risk for severe harm and even death.

How to Treat Co-Occurring Disorders

When someone is experiencing two chronic issues, such as bipolar disorder and substance use disorder, it’s known as co-morbidity or a dual diagnosis. Co-occurring disorders are best treated by a compassionate recovery professional who has experience in caring for individuals with both bipolar disorder and substance abuse issues.

Integrated treatment is recommended, in which both disorders are treated simultaneously as part of one comprehensive treatment program. A treatment plan for someone with this dual diagnosis will likely include:

  • Bipolar disorder is generally treated with medication. The primary medications used are mood-stabilizing drugs, antipsychotics, and antidepressants. The supervising physician will determine the best combination of drugs to use, and their effectiveness will be assessed over time.Depending on the substance of abuse, medication may be used to assist with withdrawal and ongoing recovery. Medication-assisted treatment (MAT) is most frequently used to address addiction to opioids, alcohol, and benzodiazepines.

    Other medications may be used to address specific symptoms, such as insomnia, anxiety, or depression.

  • Comprehensive therapy. Therapy is part of the overall treatment program to address both bipolar I disorder and substance abuse.Solutions-based therapy, such as cognitive behavioral therapy (CBT), can be helpful in establishing new behavioral patterns. It helps individuals to identify emotions or events that may trigger bipolar episodes or cravings for substances.

    Group therapy can help individuals feel less alone, as they learn from others’ experiences in a positive environment. Family therapy can begin to repair relationships that were damaged due to addiction or ongoing mental health issues.

  • A strong aftercare plan. There is no cure for bipolar I disorder or substance use disorders. Maintaining recovery involves the implementation of a solid aftercare plan that supports balance and sobriety.Each person’s aftercare plan will be different, but most plans commonly include ongoing therapy, participation in support groups, a regular sleep schedule, consistent exercise, and engagement in healthy and sober activities that support overall wellness.

    Individuals are encouraged to identify and build a strong support system of people they can turn to when times get tough. These people are positive sources of encouragement that fortify against the urge to relapse.

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