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Bipolar Disorder Treatment Center in New Jersey
Dual Diagnosis: Substance Use and Bipolar Disorders
Co-occurring disorders such as substance use and bipolar disorder can easily trigger or aggravate the symptoms of each other.
Otherwise known as comorbidities, co-occurring disorders such as substance use and bipolar disorders pose significant health risks. Drug abuse and bipolar disorder must be addressed simultaneously, or else the patient risks an endless cycle of recovery and relapse.
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Table of Contents
Life With Bipolar Disorder
Bipolar disorder is truly a double-edged sword. On one side is mania, and on the other side is depression.
Mania
You can run and never get tired. Your optimism knows no bounds. You could crash your car only to get excited about rebuilding it. Your sex drive skyrockets.
Nobody can keep up with you in conversation. You switch topics so much you confuse yourself. You can get less sleep than anyone and be ready to go in the morning.
You can leap over tall buildings in a single bound, and you don’t feel the debilitating effects of extreme physical exertion. Few people seek bipolar treatment during this phase.
Depression
When you’re experiencing depression, bipolar disorder seems like a curse. Rather than feeling on top of the world, you feel miserable. You just want to be left alone. Shut the doors and bar the windows. Crashing your car might put you on the edge of a mental breakdown.
You might feel numb and have no pleasure from the things you normally love to do. Sleep seems like the only escape from the pain of being awake. You’re grumpy and mean for no reason. Most people seek a diagnosis of bipolar disorder during this phase.
A common sentiment is that during this phase, people want to go to sleep and not wake up. This is closely related to suicidal thoughts.
Diagnosis and Symptoms of Bipolar Disorder
A diagnosis for bipolar disorder must be performed by a licensed professional. A clinical diagnosis will use the two criteria set forth in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders 5th edition): 1) A patient must have had at least one manic episode, and 2) the episode cannot be better explained by another disorder (e.g., schizophrenia spectrum or psychotic disorder).[1]
Mood episodes or swings that toggle between excessive highs and lows are the primary symptoms of bipolar disorder.Â
Emotional highs for those with bipolar disorder are referred to as mania or hypomania, with hypomania being less intense than mania. Symptoms of mania include[2]:
- Being abnormally chipper
- Feeling suddenly wired
- Less desire for sleep or can’t stop sleeping
- Racing thoughts
- Excessive talkativeness
- Feeling a boundless surge of energy
- Having an elevated sense of self-importance and self-confidence
- Being easily distracted
Emotional bipolar lows can include psychosis, anxiety, and depression. Symptoms of depression include[3]:
- Non-restful sleep
- Less enjoyment of life
- Persistent guilt
- Lack of energy to function
- Inability to concentrate
- Lack of desire to eat
- Suicidal thoughts
Diagnosis and Symptoms of Substance Use Disorder
In the DSM-V, at least 2 of the following 11 criteria must be present over a 12-month period for someone to be diagnosed with a substance use disorder[4]:
- More substance is used and used for a longer time than intended.
- Attempts to decrease use have failed.
- Extra time, money, and energy effort are used to both obtain and recover from substances.
- Strong cravings related to the substance.
- Missed responsibilities as a result of substance use.
- Relational and professional difficulties due to substance use.
- Giving up on former hobbies to spend more time obtaining, seeking, using, or recovering from substances.Â
- Driving under the influence of the substance or other high-risk activities.
- Using the substance despite knowing the damage done.
- Needing more and more of the substance to achieve the same effects.
- Painful withdrawal symptoms when substance use is withheld.
Bipolar Disorder and Substance Use Disorders
It’s important to have a licensed physician separately diagnose bipolar disorder and substance use disorder (SUD).
The most likely mistake is to mistake the symptoms of substance use disorder for the symptoms of bipolar disorder. For instance, euphoria and depression can result from substance use and withdrawal just as easily as it can result from bipolar disorder.[5]
This is why a bipolar disorder diagnosis could yield a false positive if a co-occurring SUD is present with the same time frame.
Risk Factors of Substance Abuse and Bipolar Disorder
Bipolar Disorder
Although the exact cause of bipolar disorder is unknown, certain genetic, environmental, and physiological risk factors are believed to make people more likely to develop this condition. Bipolar risk factors include[6]:
- Having one or more immediate/first-generation family members with bipolar disorder
- Experiencing the recent loss of a close friend or family member
- Experiencing childhood abuse or childhood trauma
- Having specific variations in brain structure, brain chemistry, or general brain functioning
Bipolar Disorder and Substance Abuse Statistics
In the United States, the lifetime prevalence rate for bipolar disorder is around 4% (around 13 million people).[7]
Research suggests that 21.7% to 59% of clinically diagnosed bipolar sufferers will develop a substance use disorder at some point in their lives.[8] That means at any given time in the United States, there could be around 2.87 to 7.81 million people who have co-occurring bipolar disorder and an addiction disorder.
Bipolar disorder and alcohol use disorder are aggravating conditions. Research shows that people with bipolar disorder commonly misuse alcohol. For instance, combining alcohol with bipolar medication, such as atypical antipsychotics, may result in an extreme level of both CNS depression and impaired psychomotor functioning.[9]
Treating Bipolar Disorder and Addiction
Treatment for co-occurring bipolar disorder and substance use addiction will involve both pharmacological and psychological treatments.
There is no “cure” for bipolar disorder, in the sense that you can never know with certainty that it will never come back. Bipolar disorder can be a lifelong phenomenon that requires daily survival maintenance and coping strategies.
Pharmacology
There are three classes of medications helpful for treating bipolar disorder and substance use addictions: Mood stabilizers, antipsychotics, and antidepressants.Â
To recover from your bipolar disorder, you might get prescribed mood stabilizers like Lithium or Divalproex sodium or antipsychotics like Quetiapine or Lurasidone, which help regulate your average mood state. Antidepressants such as Fluoxetine–olanzapine are less frequently prescribed because they could trigger a manic episode.
Antidepressants raise your dopamine and/or serotonin levels, and unfortunately, the increase in dopamine is associated with mania.
By far and away the most best established long-term treatment for Bipolar disorder which reduces the occurrence of relapse is lithium. In an analysis of five placebo-controlled trials, lithium reduced the risk of manic relapse by about 38% and depressive relapse by about 28%.[10][11]
Psychotherapy
In addition to medication, you might be enrolled in different talking therapies, such as CBT, family therapy, and interpersonal therapy.Â
CBT helps you convert negative thought patterns into more thoughtful and realistic ones, whereas family therapy helps your whole family understand bipolar disorder and effective coping strategies. Interpersonal therapy reveals the ways interpersonal problems manifest themselves in your mood state, which is related to depressive or manic episodes.
In one double-blind comparative study, one group of patients with acute bipolar depression were only prescribed mood stabilizers while a similar group was prescribed mood stabilizers plus thirty sessions of psychotherapy.Â
The researchers found that in twelve months following initial treatment, patients receiving adjunctive psychotherapy were more likely than the placebo controls receiving just mood stabilizers to recover more rapidly and be clinically well in any given month of the study.[12]
Absolute Awakenings Editorial Guidelines
At Absolute Awakenings, we take information integrity seriously. We have dedicated our resources to ensure that all content published to our blog is medically sound. As such, all content on our blog has been thoroughly reviewed by a doctorate level clinician such as a Medical Doctor, or Psy.D, so that you can trust all of the data we publish.
What We Treat
We Accept With Most Major Insurance
If you or a loved one is ready to get help but finances are holding you back, give us a call. We can work with your health insurance provider.
Related Topics
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Bipolar and Substance Use Treatment FAQ
What drugs can trigger bipolar disorder?
Substance abuse can affect bipolar disorder, especially if it involves drugs that produce dopamine (like amphetamines and opiates).
Since bipolar is associated with the function of dopamine, adding a substance that causes your body to produce more dopamine or prevents the reuptake of dopamine into the synapses could send you into a manic state.
However, merely experiencing the symptoms of mania is not equivalent to bipolar disorder.
Mania, followed quickly by a depressive state, could result from drug use and then withdrawal rather than bipolar disorder.
What are the five stages of bipolar disorder?
There are actually three distinct phases and four distinct episodes of bipolar disorder. The phases are early, acute, and maintenance.
- Early: Years before the onset of manic or depressive symptoms
- Acute: Full-blown symptomology of a mood episode
- Maintenance: Stable and managing symptoms
The episodes of bipolar disorder are mania, hypomania, depression, and mixed features.
- Mania: Extremely elevated changes in your mood or behavior
- Hypomania: Less extreme than mania, but still elevated changes in your mood or behavior
- Depression: A persistent sadness that causes a loss of interest in normal activities
- Mixed Features: Could be displaying symptoms of both mania and depression simultaneously
What are the three most effective treatments for bipolar disorder?
There is no cure for bipolar disorder. A diagnosis of bipolar disorder will require the patient to learn lifelong coping mechanisms and likely take long-term medication. There is no such thing as a universal three most effective treatments for bipolar disorder.
Even with evidence-based therapies, it’s hard work to stay at the maintenance level. For some of us, just staying at the “normal” level of functioning is hard work.
Two promising treatments which have shown great success in conjunction with one another are lithium treatments and psychotherapy.[13] Combining chemical pharmacotherapy and behavior-based psychotherapy has proven effective in helping people learn the skills they need to manage their long-term bipolar symptoms.
What percentage of addicts are bipolar?
In 2023, it’s estimated that around 13.24 million (roughly 4%) of all Americans have bipolar disorder. Of that demographic, 4 to 6.6 million people with bipolar disorder also suffer from co-occurring substance use.
In the year 2023, so far, 46.3 million Americans have been diagnosed with a substance use disorder.[14] Bringing both surveys together indicates that roughly 8.5 to 14% of people with substance abuse disorder may also have bipolar disorder.
Sources
[1][5] Preuss, U. W., Schaefer, M., Born, C., & Grunze, H. (2021, November 17). Bipolar disorder and comorbid use of illicit substances. Medicina (Kaunas, Lithuania). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623998/
[2] Mania – StatPearls – NCBI Bookshelf. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK493168/
[3] Depression – statpearls – NCBI bookshelf. (n.d.-a). https://www.ncbi.nlm.nih.gov/books/NBK430847/
[4] DM;, J. A. (n.d.). Substance use disorder. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/34033404/
[6] U.S. Department of Health and Human Services. (n.d.). Bipolar disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder
[7][8][9] Williams, A. (n.d.). Bipolar Disorder and Co-Occurring Substance Use Disorder. https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4960.pdf
[10][11][12][13] Geddes, J. R., & Miklowitz, D. J. (2013, May 11). Treatment of bipolar disorder. Lancet (London, England). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876031/
[14] Substance Abuse and Mental Health Services Administration (SAMHSA). (2023, January 4). Samhsa announces National Survey on Drug Use and Health (NSDUH) results detailing mental illness and substance use levels in 2021. HHS.gov. https://www.hhs.gov/about/news/2023/01/04/samhsa-announces-national-survey-drug-use-health-results-detailing-mental-illness-substance-use-levels-2021.html
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