Addiction isn’t an official symptom of bipolar disorder. However, a remarkable number of people who have bipolar disorder do lean on the use and abuse of substances. It just seems like a prudent step, since the two problems occur together so very frequently.
In fact, a co-occurring substance abuse disorder is so common that many medical professionals perform routine addiction screenings in people who are diagnosed with bipolar disorder.
While it’s easy enough to discuss bipolar disorder as though it’s one disease that impacts all people in the same way, the truth is a little more complicated. Rather than providing one set of symptoms that cause the same type of dysfunction, bipolar disorders tend to take hold in a variety of different ways and the symptoms come in a range of intensities. They might all be impacted by substance abuse in one way or another, but understanding the different types of bipolar disorder could help some people to come to a deeper understanding of how their lives have changed due to bipolar disorder, and why they might need specialized help in order to heal.
The Bipolar Spectrum
Bipolar disorder is characterized by shifts in mood. On the one side is a depressed mood in which people feel low, sad and lethargic.
On the other side is a manic mood in which people feel powerful, energetic and perhaps happy or creative. People who have bipolar disorder tend to experience one or both of these moods without any particular outside prompt. They’re not depressed due to a death in the family, for example, or they don’t feel energetic due to a job promotion. Instead, they experience intense moods simply because their brain cells are firing at an unusual rate or at the wrong time.
Experts place people who have mood shifts into a bipolar disorder category, but there are a number of different ways in which the disorder can manifest. Often, experts suggest that there is a spectrum involved, in which people might have one, some or all of the possible symptoms that have been associated with the disorder. This isn’t a spectrum of severity, as people can have only one type of symptom and feel incredibly impaired by that symptom, but it does help experts to understand their patients just a little better and provide appropriate help as a response.
At one end of the spectrum is bipolar I disorder. According to an analysis in Psychology Today, about one percent of the population has this type of bipolar disorder, and their symptoms might be familiar to anyone who knows just a little bit about how classic cases of bipolar disorder work.
People who have this form of bipolar disorder swing between the highest highs and the lowest lows on a regular basis. During a manic episode, they might:
- Speak so quickly that they’re difficult to understand
- Spend an amazing amount of money
- Express delusional beliefs
- Refuse to sleep
- Have an increased interest in sex
The same person might then have episodes of intense depression in which life doesn’t seem worth living at all. They might refuse to go to work, find it hard to talk to others or struggle to make decisions. They seem as though they’re in a pit of despair.
Highest Highs and Lowest Lows
Substance abuse can play a major role in the life of someone who has bipolar I disorder. In fact, a study cited by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests that about 60 percent of people who have bipolar I also have a substance abuse problem. For people like this, substances seem to soothe the rough edges of life and make dysfunction a little easier to live with. They might use stimulants like cocaine to amplify an episode of mania, or they might use depressants like heroin to boost euphoria during a down episode. The drug use isn’t healthy, but to them, it seems to help.
This form of bipolar disorder can also make life difficult or impossible, but people like this don’t experience intense mania. Instead, they move from moments in which they feel just a little sad into moments in which they feel an intense amount of despair. People like this are still cycling from one mood to another, so they still fit the official diagnosis of bipolar disorder, but they may not experience the creativity and joy that comes with mania. Instead, they might always feel a little depressed or extremely depressed. This may explain why people who have bipolar II have what writers for PsychCentral suggest is the highest risk of suicide among all types of people on the bipolar spectrum. Their depression seems never-ending, and they may come to feel as though life just isn’t worth living.
The same study cited by the NIAAA suggests that 48.1 percent of people who have bipolar II have a substance abuse or dependence problem.
They may lean on euphoric drugs, so they can experience at least some form of happiness during days filled with chronic sorrow, but they might also choose to take stimulant drugs in order to boost their energy levels, so they can get through the tasks of the day even when depression is in play.
This form of bipolar disorder is on the other end of the spectrum from bipolar I, as it contains the same type of cycling between mania and depression, but the highs and lows are considered less severe.
People like this are still experiencing sudden shifts in mood that they might find difficult or impossible to control, but they may not have extreme forms of either mood.
Addiction can play a role for people like this, as they may choose to self-medicate with drugs and alcohol in order to smooth out the shifts they’re feeling. Unfortunately, cyclothymia tends to grow more severe in time, if the right treatments aren’t provided, and those who are using drugs might not get that treatment. As a result, their drug use could lock them into a severe form of bipolar disorder, as it screens them from the severity of the disease until it’s been in place for a long period of time.
Not Otherwise Specified (NOS)
This form of bipolar disorder can sit anywhere on the spectrum, as it’s applied to people who have a cluster of symptoms that don’t fit into a tidy diagnostic criteria. People like this might have episodes of only mania with no depression following behind, or they may have only a few symptoms of mania and a few symptoms of depression, but they may not have episodes that come quickly enough to merit a formal diagnosis.
It can be incredibly difficult to live with NOS bipolar disorder, as people like this often struggle to find the right kind of care. Since their symptoms don’t fit into tidy categories, they may not get the medication support or the talk therapies that allow them to heal, since their doctors may not provide a proper diagnosis. Not surprisingly then, it’s common for people with NOS bipolar to self-medicate with drugs and alcohol.
They can’t get the support they need, so they look for their own solutions. Again, this form of self-medication could allow people to ignore their mental illness for too long, and that could allow symptoms to increase in severity.
While everyone who has bipolar disorder experiences mood shifts, no matter where they are on the spectrum, people who have a rapid cycling form of the disease can go from one mood to the other with extreme speed. They might awaken in the morning feeling depressed, and then experience mania by midday. People who deal with shifts like this can feel profoundly disabled, as they may be completely unaware of what mood might strike at any given moment, and they might always feel as though they’re on edge and waiting for the next shift to take hold.
While rapid cycling can be temporary for some people who have bipolar disorder, PsychCentral suggests that this type of sudden shift is associated with higher rates of substance abuse and addiction, as people who have these symptoms can be desperate to make the problem stop.
Similarly, some people who have bipolar disorder experience two types of emotions at the same time. During these mixed episodes, they might feel profoundly depressed and profoundly energetic, all at the same time. It can be hard for people to put their feelings into words when they’re in the midst of an episode like this, but they can be likely to do anything to make the sensations stop. Drugs can sometimes play a role here as well.
Care for Addiction and Bipolar Disorder
While people who abuse drugs may feel as though their habits help them to manage their disease effectively, substance abuse can make a bipolar problem so much worse. For example, experts quoted in Everyday Health suggest that rapid cycling is more common in people who abuse substances, no matter what type of bipolar disease they have. That’s why it’s so vital for people to enroll in treatment programs that allow them to learn how to control both the symptoms of bipolar disorder and those associated with addiction.
Care for people like this begins with:
- A thorough assessment of the symptoms the person is experiencing now
- Blood and urine tests for drugs and alcohol
- A discussion about the person’s substance abuse habits
- A timeline regarding symptom eruption and what the person did to control those symptoms
Adjust to Sobriety
Detox is the next step, where people have the opportunity to stop using illicit drugs in a safe and controlled environment, so their brain cells can adjust to sobriety without erupting into symptoms of despair and dysfunction.
Once the person is completely sober, medications might come into the mix, as people with bipolar disorder often need mood-stabilizing drugs in order to keep their symptoms under control. But since these medications can interact with illicit drugs, it’s vital for people to get clean and sober before they start in on medication therapies.
Psychotherapy is another important part of the treatment picture. Here, people work with a therapist to understand their motivation for taking drugs, along with their triggers for bipolar shifts. They might work in a one-on-one fashion with a therapist, but they might also do group work and learn from peers who also have bipolar disorder.
While this kind of treatment is effective, many people who have bipolar disorder have never received the help they need. For example, the National Institute of Mental Health suggests that only 69 percent of people with NOS bipolar were getting any kind of treatment for mental illness. This is a statistic we’d like to change.
At Black Bear Lodge, we specialize in treatments for mental illness, particularly those that have been compounded by addiction. We believe that everyone who has these disorders can get better, and we work hard every day to get people on the right track with our blend of medication management, psychotherapy, support group work and complementary therapies. Please call, and we’ll tell you more.