How to Treat Bipolar Disorder with Co-Occurring Addiction

The Substance Abuse and Mental Health Administration (SAMHSA) publishes that close to 8 million American adults suffered from both a mental health disorder and an addiction in 2014. When someone battles two disorders at the same time, they are said to be co-occurring disorders, and specialized treatment is optimal to manage both issues.

Mood disorders like bipolar disorder commonly co-occur with substance abuse and addiction, the journal Substance Abuse Treatment, Prevention, and Policy reports, and individuals suffering from bipolar I disorder also battle addiction at least 40 percent of the time. More than 2.5 percent of the American adult population struggle with bipolar disorder, and over 80 percent of these cases are considered severe, the National Institute of Mental Health (NIMH) publishes. Bipolar disorder is also sometimes referred to as manic-depressive disorder, and it is recognized by unusual and dramatic shifts in energy and activity levels and moods that can interfere with a person’s ability to carry out daily tasks.

Addiction is a brain disease characterized by compulsive drug-seeking and using behaviors and an inability to control or stop drug use. The National Survey on Drug Use and Health (NSDUH) reports that over 21 million adults in the United States suffered from addiction in 2014.

Both addiction and bipolar disorder can contribute to, and complicate, symptoms of and treatment for each other. These co-occurring disorders are ideally managed through a complete and integrated treatment program that addresses both disorders simultaneously.

Bipolar Disorder Explained

Bipolar mood shifts can be extreme, ranging from big ups to significant downs. The up periods are called manic episodes and the lows are called depressive episodes. Manic episodes may have the following symptoms:

  • Heightened energy and activity levels
  • Elevated moods
  • Difficulty sleeping and settling down
  • Feeling “wired” and jumpy
  • Rapid thoughts
  • Perception that a lot of things can be done at once
  • Fast talking and quickly switching subjects
  • Irritability, agitation, and being “on edge”
  • Risk-taking behaviors like big spending or unsafe sexual practices

A depressive episode may have the following symptoms:

  • Low energy and decreased activity levels
  • Sleeping too much or difficulties sleeping
  • Feeling “low,” sad, hopeless, and empty
  • Disrupted appetite
  • Anxiety and worrying
  • Difficulty finding enjoyment in anything
  • Fatigue, lethargy, and tiredness
  • Trouble concentrating and remembering things
  • Suicidal thoughts or actions

Psychotic symptoms can also be potential side effects of manic and depressive episodes and may include hallucinations, delusions, and paranoia.

Sometimes, both mania and depression can present simultaneously, which is called a mixed episode. During mixed episodes, both manic and depressive symptoms may occur, as in a person may feel energized while still feeling sad and lonely. Symptoms may not always be extreme either.

Individuals may suffer from hypomanic episodes, too, which are less severe than full-blown manic episodes. During a hypomanic episode, a person may seem to be functioning well, getting a lot of things done while feeling good; however, these mood shifts should not be overlooked as they can lead to more severe mania down the road.

There are two main types of bipolar disorder: bipolar I and bipolar II. Bipolar I disorder is characterized by manic episodes that last at least a week and are often significant enough to require hospitalization. Depressive episodes lasting two weeks or longer, or mixed episodes, may also occur with bipolar I disorder. A mixture of depressive and hypomanic episodes define bipolar II disorder. Another type of bipolar disorder is cyclothymia, in which depressive and hypomanic symptoms can occur and last for two years or more.

There is no known single cause for bipolar disorder; however, it is understood that certain risk factors, such as heritability and genetics as well as brain structure and function, may contribute to its onset.

Individuals who suffer from bipolar disorder are at a high risk for illnesses, which can include obesity, diabetes, thyroid disease, migraine headaches, and heart disease, as well as anxiety disorders, eating disorders, ADHD (attention deficit hyperactivity disorder), and substance abuse, NIMH reports.

Complications of Addiction

Addiction is a complex disease that impacts the way the brain functions. It also influences thoughts, behaviors, and actions, therefore disrupting relationships, work production, family life, finances, and more. When someone abuses drugs, chemical messengers in the brain are disrupted from their normal functions, and with repeated drug use, the brain’s structure and chemical makeup can actually be changed.

Drugs can artificially enhance moods, quell anxiety, and manage stress, all of which can make their use desirable. When drugs wear off, however, the opposite effects can occur, and a person may feel depressed, anxious, irritable, and agitated. These are often signs of drug withdrawal, which can set in after chronic drug use leads to physical drug dependence. Cravings to use drugs are common as well.

Drug use can lower inhibitions, impair thinking, and cause a person to act in a way they wouldn’t normally, which may cause a person to become injured, fall victim to crime, or make questionable decisions that can have potentially hazardous consequences.

Addiction also interferes with daily life functioning, as a person is liable to spend most of their time using drugs, figuring out ways to get them, and recovering from them. Finances can become strained, as money is spent obtaining and using drugs. Work production can slide, leading to the potential loss of employment.

Regular obligations are overlooked, and individuals may lose interest in anything and anyone not related to drug use. Family and other relationships suffer, as moods swings, unpredictable and erratic behaviors, poor communication, increased secrecy, and irregular sleeping and eating patterns can lead to a chaotic and unstable home life.

Someone battling addiction will likely continue to use drugs even though they know how harmful they can be to their physical, emotional, and behavioral health, and they may also use them in potentially hazardous situations and environments. Legal and criminal problems may be the result of drug use and addiction as a result.

Several factors play a role in the onset of addiction, including environmental ones like high levels of stress and exposure to trauma, family history of addiction, biological and genetic aspects, polydrug abuse, age at first use (earlier use tends to result in more substance abuse and addiction issues later in life), and any co-occurring mental or medical disorders.

Addiction can have a wide range of long-term side effects, the National Institute on Drug Abuse (NIDA) reports, which can include any of the following:

  • Unemployment
  • Homelessness
  • Emotional issues, including mental health disorders
  • Physical health problems impacting the cardiovascular, musculoskeletal, gastrointestinal, and respiratory systems
  • Increased rate of diseases, including HIV/AIDS, hepatitis, diabetes, kidney, liver, heart, and lung disease
  • Unhealthy weight fluctuations
  • Stroke
  • Cancer

NIDA further publishes that substance abuse and addiction cost society over $700 billion a year in criminal, healthcare, and lost workplace production costs in the United States.

Complexity of Co-Occurring Bipolar and Addiction

Co-occurring bipolar disorder and addiction exacerbate the symptoms of each other and serve to complicate treatment of each disorder. Alcohol, marijuana, cocaine, and opioids are common drugs of abuse for individuals suffering from bipolar disorder. Use of these drugs can increase and prolong manic and depressive episodes, lower quality of life, increase suicidal ideations, interfere with medications, and decrease adherence to treatment.

Central nervous system depressants like alcohol, marijuana, benzodiazepines, and opioids may seem to take the edge off the significant mood swings caused by bipolar disorder but can only serve to make these symptoms worse in the long run. Stimulants like cocaine and methamphetamine may send individuals battling bipolar disorder into mania only to result in an even harder crash and possible psychotic symptoms, Psych Central warns.

Drugs and alcohol may seem to blunt the side effects of bipolar disorder at first, but drug dependence and addiction come with their own set of problems and risk factors that are all heightened by the underlying mental health disorder.

Drugs and alcohol can become unhealthy coping mechanisms for symptoms of bipolar disorder, and their abuse can lead to additional issues. Individuals who suffer from a mental health disorder have a higher risk for addiction, as do those with genetic and biological vulnerabilities to the disease, such as a family history of addiction. Impulsivity and risk-taking behaviors that accompany a manic episode can make it more likely for an individual to suffer from drug and alcohol problems as well.

Both bipolar disorder and addiction involve similar regions or dysfunctions of the brain and its chemistry, and there may be overlaps that can make a person have a higher risk for both of these disorders. Environmental factors, such as trauma and high levels of stress, can incite a bipolar episode as well as lead to drug and alcohol abuse and addiction. When both bipolar disorder and addiction co-occur, a comprehensive treatment strategy is needed.

Integrated Care for Co-Occurring Disorders

When bipolar disorder and addiction occur at the same time, the optimal treatment method is an integrated model that manages symptoms of both disorders simultaneously. Treatment providers should all work together and be on the same page to achieve common goals. Medications are often helpful to treat bipolar disorder; however, some drugs should be avoided if someone has a history of drug abuse and addiction.

NIDA reports that integrated group therapy (IGT) that deals with both bipolar disorder symptoms and addiction at the same time during sessions helps to improve side effects of both disorders. By helping individuals work through issues surrounding both disorders at the same time, proper coping mechanisms can be formed, and triggers can be identified and managed.

Treatment for bipolar disorder and addiction generally includes pharmacological management, often in the form of mood stabilizers, antipsychotics, and/or antidepressants. Detox may be necessary in the case of dependence on alcohol, opioids, benzodiazepines, cocaine, or other substances, as withdrawal symptoms and cravings can be significant. Medications may be helpful to minimize the potential side effects of withdrawal.

As part of a complete and integrated treatment plan for both disorders, various treatments may be included, such as individual and group therapy sessions, life skills training workshops, education on both disorders, and support group meetings. Behavioral therapies, such as Cognitive Behavioral Therapy (CBT), may be useful to help individuals recognize thought patterns that may be self-destructive and what may lead to manic or depressive episodes or drug and alcohol abuse. Relapse prevention strategies and methods for mitigating possible stressors can be learned in therapy as well. Families often play a big role in treatment and recovery, and many programs involve loved ones in order to improve the overall health and wellbeing of the entire family unit.