How Substance Abuse and Bipolar Disorder Are Related

The Problem With Self-Medicating

Self-medicating with alcohol is common in BP
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Substance abuse and addiction are common in people with bipolar. But that does not mean, however, if you live with bipolar disorder, you are destined to develop an addiction or abuse alcohol or drugs. 

At the U.S. Psychiatric & Mental Health Congress, Kathleen Brady, M.D., Ph.D., an associate professor of psychiatry at the Medical University of South Carolina, reported that substance abuse occurs in 30 to 60 percent of patients with bipolar disorder, adding abuse "is more likely to coexist with bipolar illness than with any other Axis I psychiatric disorder." According to Dr. Brady, "two to four percent of alcoholics and up to 30 percent of cocaine abusers meet the diagnostic criteria for bipolar disorder."

Drug and Alcohol Abuse Related to Bipolar Disorder

For the most part, higher rates of substance abuse in those with bipolar disorder are generally believed to stem from either biological or physiological causes. However, there are social and psychological causes as well. If you've had a difficult time coping with bipolar disorder, you may be more likely to self-medicate or try drugs in the first place.

You then may continue to use drugs if you notice you get a short-term release from symptoms of your mania or depression. This can begin a cycle of substance abuse. Unfortunately, the reality is that the relief of symptoms via self-medication is most often short-lived. Those with both bipolar disorder and a history of substance abuse tend to have the following in common:

  • Dysphoria during manic phases (More than 90 percent)
  • Other serious comorbid mental disorders (50 percent)
  • Slower recovery time 
  • More lifetime hospitalizations
  • Earlier age of illness onset.

Managing Bipolar Disorder and Addiction

For those struggling with bipolar disorder and either substance abuse or addiction, there are treatments available. Getting a dual diagnosis, however, can be difficult as sometimes symptoms of addiction or withdrawal can mimic those of bipolar disorder.

If you believe you have a substance abuse problem or an addiction, speak to the physician or therapist managing your bipolar disorder. The sooner you identify any problems, the easier it will be to treat. 

What treatment you require will likely depend on your addiction. Treatment for substance abuse can vary based on the severity of your addiction as well as what substance you are addicted to. For example, if you have an opioid addiction, you may use methadone to lessen symptoms of withdrawal, whereas with alcohol addiction you may be placed on benzodiazepines so you can safely go through withdrawal.

Whether or not you need medication, should be determined by a qualified physician. To avoid potential drug interactions, you'll also want to make sure the physician treating your addiction is aware of any medication you are taking for bipolar disorder.

Beyond prescription medications, behavioral therapies can also help address any underlying psychological issues you may have. As research continues and more health care practitioners gain more knowledge of the complicated issues surrounding dual diagnosis, the options and prognosis will continue to improve. 

Brady, K. & Goldberg, J. (1996). Substance Abuse and Bipolar Disorder.

Hatfield, A. B. (1996). Dual Diagnosis: Substance Abuse And Mental Illness.
SoberDykes Hope Page. (2000). "Dual Diagnosis."
Souto, B. (1996). "Dual Diagnosis: Adolescents with Co-occurring Brain Disorders and Substance Abuse Disorders."