Although not officially symptomatic of each other, a high percentage of people with bipolar disorder struggle with addiction. 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.
There are many subtypes of bipolar disorder with a wide range of symptoms and severities. Understanding the different types of bipolar disorder and the common connections with addiction is important for those who are living with bipolar disorder and for their loved ones.The more information and insight, the more empowered they will be to pursue the specialized they 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 associated with the disorder. This isn’t a spectrum of severity as you may expect. However, the spectrum allows experts to understand their patients better and respond with appropriate help.
At one end of the spectrum is bipolar I disorder. About one percent of the population has this type of bipolar disorder, and their symptoms present as what the public might know as classic bipolar disorder.1 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 engage in the following behaviors:
- Speak so quickly that they’re difficult to understand
- Spend an extremely largeamount 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.
Substance abuse can play a major role in the life of someone who has bipolar I disorder. This is a commonality across all mental health disorders. In 2014, it was estimated that 7.9 million people had both a substance use disorder and a mental health disorder.2For people like this, substances seem to make dysfunction a little easier to live with.
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 cycle between feeling a little depressed or extremely depressed. People with bipolar II have what the highest risk of suicide among all people on the bipolar spectrum because their depression seems never-ending.3
People with bipolar II are also susceptible to drug use. They may lean on euphoric drugs to feel some form of happiness or take stimulant drugs in order to boost their energy levels, so they can get through the day even while depressed.
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 with cyclothymia experience sudden shifts in mood that they might find difficult or impossible to control, but they may not have extreme forms of either mood.4
These patients may also 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 lead to a more severe form of bipolar disorder.
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 well into the diagnostic criteria. People with this form of bipolar disorder might have episodes of only mania with no depression, or they may have only a few symptoms of mania and a few symptoms of depression, but their episodes may notcome quickly enough to merit a formal diagnosis.
It can be incredibly difficult to live with NOS bipolar disorder as many struggle to find the right care. Since their symptoms don’t fit other categories, they may not receive medication support or counseling therapies needed for healing. Therefore, it’s common for people with NOS bipolar to self-medicate with drugs and alcohol which can lead to increase symptoms and a more severe form of bipolar.
Shifting Moods and Rapid Cycling
While everyone who has bipolar disorder experiences mood shifts, people who have a rapid cycling form of the disease can go from one mood to the other extremely fast. They might awaken in the morning feeling depressed and experience mania by midday. People who deal with shifts like this can feel profoundly disabled being completely unaware of what mood may come next, constantly feeling on edge.
Those with rapid cycling may be at a higher risk for substance abuse and addiction feeling desperate to make the problem stop.5 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 are likely to try anything — like drugs and alcohol—to make the sensations stop.
Care for Addiction and Bipolar Disorder
While people may abuse drugs because they want to manage their symptoms, substance abuse makes the problems associated with bipolar so much worse. Specialized treatment in co-occurring disorders can make all the difference. Specialized care for those with co-occurring disorders usually begins with the following:
- A thorough assessment of the symptoms the person is currently experiencing
- 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 alleviate the symptoms
Adjust to Sobriety
Detox is the next step, in which the body is rid of all illicit substances in a safe and controlled environment so their brains can adjust to life without drugs without triggering episodes of mania or depression.Once detox is complete, doctors may begin to utilize mood-stabilizing medications to manage bipolar symptoms. However, since these medications can interact with illicit drugs, it’s vital for people to completely detox before they begin medication therapies.
Psychotherapy is another important step in treatment. 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 setting, as well as do group work and learn from peers who also have bipolar disorder.
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 to a better state of health with medication management, psychotherapy, support groups and complementary therapies. Please call our 24 hour, toll-free helpline today to begin your journey of healing.
1 Rubin, E. “Bipolar Spectrum Disorder: A Problematic Concept.” Psychology Today, May 9, 2011. Accessed 25 September 2017.
3 Leach, H. “Do You Understand the Bipolar Spectrum?” PsychCentral, August 21, 2013. Accessed 25 September 2017.
5 Mcgregor, S. “Substance Abuse and Bipolar Disorder.”
PsychCentral, July 17, 2016. Accessed 25 September 2017.