Bipolar & Addiction

There is a link between bipolar disorder and addiction, with people who have bipolar disorder having high rates of substance use disorders (SUD). 

Higher rates of substance misuse among people with bipolar disorder are potentially due to the impulsivity that is associated with bipolar disorder. There are various shared risk factors between the two disorders, such as potential genetic predisposition, stressful life events, and depression.

Both bipolar disorder and addiction can be successfully managed with the right treatment. Programs that address co-occurring disorders often involve a combination of medications and therapy.

What Is Bipolar Disorder?

Bipolar disorder is a mental health disorder that causes an individual to experience extreme mood swings and changes in energy levels.

People who have bipolar disorder will experience manic and depressive episodes. During manic periods, energy is increased, and a person may feel irritable or extremely happy. During depressive periods, energy levels are low, and the person may feel sad or apathetic.

How Are Bipolar Disorder & Addiction Related?

According to the National Institute of Mental Health, people struggling with bipolar disorder may engage in risky behaviors while going through manic episodes. During these times, a person may abuse drugs, and with repeated misuse, this could lead to a substance use disorder (SUD).

There is no single accepted explanation for why bipolar disorder and substance use disorder overlap, but several theories have been posited.

One theory centers around the concept of self-medication. Proponents of this theory believe that people with bipolar disorder utilize substances to deal with the symptoms their disorder causes them.

Some people suffering from bipolar disorder may view their manic episodes as favorable compared to depressive ones. They may take substances in order to simulate or induce manic episodes when they are in a depressive state.

Another theory is that the two disorders originate in the same part of the brain, as both disorders may be related to impulse control and motivation. A third theory presents genetics as a possible contributing factor for both disorders. 

A substance use disorder may worsen the symptoms normally present with bipolar disorder, and vice versa. The presence of both disorders may make treatment more difficult when compared to situations where only one disorder is present. But the good news is that both disorders can be successfully managed with the right treatment approach.

Is Addiction or Substance Abuse More Likely for Those With Bipolar Disorder?

According to research compiled by the Substance Abuse and Mental Health Services Administration, studies have found that from just over 21 percent to 59 percent of those who have bipolar disorder may develop a substance use disorder during their lifetime.

Comparatively, only about 10 percent of adults in the United States experience a substance use disorder at some point during their life. Even when compared to people who have other mental health disorders, those who have bipolar disorder had the highest rate of substance use disorders, outside of those who have antisocial personality disorder.

Within the spectrum of people who have bipolar disorder, those who develop the disorder early in life are more likely to develop a co-occurring substance use disorder.

Common Drugs Abused by People With Bipolar Disorder

One of the most commonly abused drugs by people with bipolar disorder is alcohol. There is a higher risk of suicide and hospital visits for those with co-occurring alcohol use disorder and bipolar disorder.

Some studies have also found that people with a co-occurring alcohol use disorder are more difficult to treat, and they are less likely to stick with treatment.

Other drugs that are commonly abused by people with bipolar disorder include cannabis, amphetamines, and cocaine. People with bipolar disorder who use cocaine or amphetamines may have longer and more intense manic episodes, and the drugs themselves may cause a manic episode to begin. Long-term cocaine use has been linked to higher incidences of major depression disorder progressing to bipolar disorder.

Treatment for Bipolar Disorder & Co-Occurring Substance Use Disorder

Co-occurring bipolar disorder and substance use disorder are treated with a range of therapies that address both disorders. 

Treatment for Bipolar Disorder

Bipolar disorder is addressed with a variety of treatments, including medications and therapies. Here are some of them:

• Mood stabilizers: Medications such as lithium may help to even out mood swings. These medications are meant to prevent manic and depressive episodes.
  

• Antipsychotics: These drugs are specifically meant to reduce the symptoms of manic episodes. They are especially effective in tempering agitation and aggression in patients.
  

• Anticonvulsants: These medications also reduce the effects of manic episodes, and they can be used as substitutes for lithium in cases where it is not effective.
  

• Sleep and anxiety medication: If people are experiencing anxiety or trouble sleeping, medications may be used to address those specific symptoms and create a better quality of life.
  

• Antidepressants: While mood stabilizers may treat anxiety without the use of antidepressants, antidepressants are often prescribed to patients who receive a mood stabilizer or antipsychotic prescription to specifically target depression.
  

• Psychotherapy: General talk therapy can include psychoeducation or cognitive behavioral therapy. There are also therapies that are specifically meant to address bipolar disorder, such as interpersonal and social rhythm therapy or family therapy.
  

• Electroconvulsive therapy: This treatment stimulates a patient’s brain, and it can potentially help in serious cases of bipolar symptoms.
  

• Transcranial magnetic stimulation: This treatment stimulates a patient’s brain on a near-daily basis over the course of a month, and it is generally used for depression. It shows promise, but more research must be done before its effects on bipolar disorder are clear.

Addiction Treatments

Treatment for addiction generally includes the use of individual therapy, complementary therapies, medications (as needed), and support group participation.

The use of medications will depend on the specific substance use disorder. For example, medication-assisted treatment (MAT) is the gold standard of treatment for opioid use disorder. It is also recommended for alcohol use disorder.

In other cases, it may be recommended to address specific symptoms, such as antidepressants to address depression and anxiety and sleep medications to aid insomnia.

Support is a key component of addiction recovery. Group therapy, support groups, and help from family and friends are essential parts of the recovery process for many people.

Treatment for Co-Occurring Disorders

According to the Substance Abuse and Mental Health Services Administration, people with co-occurring bipolar and substance use disorders should be treated as early as possible due to the fact that the two disorders may worsen each other and build in intensity, making late treatment even more difficult.

Medications will be used to address both disorders as needed. The care team will ensure there are no negative interactions between the different prescribed medications. This is part of the reason it’s so important to have one team managing treatment for both disorders.

Therapy is the cornerstone of treatment for those with co-occurring bipolar disorder and substance use disorders. Psychosocial therapy is often recommended, which comes in various forms.

• Sequential psychosocial therapy: In this method, the more severe disorder is addressed, and the second disorder is treated after the first one is stable.

• Parallel psychosocial therapy: In this method, both disorders are treated during the same period of time, but not in the same session.

• Integrated psychosocial therapy: In this method, both disorders are treated both during the same period of time and in the same setting. This method may be more effective, as it aims to address not only a person’s disorder but address them as a whole person.

Comprehensive treatment approaches the whole person, effectively treating all co-occurring disorders simultaneously. When recovery occurs on all fronts, relapse on any front is less likely.

References

Bipolar Disorder. (January 2020). National Institute of Mental Health.

An Introduction to Bipolar Disorder and Co-Occurring Substance Use Disorders. (2016). Substance Abuse and Mental Health Services Administration.

Bipolar Disorder and Comorbid Use of Illicit Substances. (November 2021). Medicina (Kaunas).

The Prevalence and Significance of Substance Use Disorders in Bipolar Type I and II Disorder. (October 2007). Substance Abuse Treatment, Prevention, and Policy. 

Shared Genetic Factors Influence Risk for Bipolar Disorder and Alcohol Use Disorders. (June 2014). European Psychiatry.

Brain Reward Circuitry: The Overlapping Neurobiology of Trauma and Substance Use Disorders. (June 2021). World Journal of Psychiatry.

10 Percent of US Adults Have Drug Use Disorder at Some Point in Their Life. (November 2015). National Institutes of Health.

Treatment – Bipolar Disorder. (March 2019). United Kingdom National Health Services.

Antipsychotic Drugs in Bipolar Disorder. (September 2003). The International Journal of Neuropsychopharmacology.

Anticonvulsant Use in the Treatment of Bipolar Disorder: A Primer for Primary Care Physicians. (June 1999). Primary Care Companion to the Journal of Clinical Psychiatry.

Psychotherapies. (June 2021). National Institute of Mental Health.

Lifetime Cocaine Use Is a Potential Predictor for Conversion From Major Depressive Disorder to Bipolar Disorder: A Prospective Study. (April 2020). Psychiatry and Clinical Neurosciences.

Bipolar Spectrum – Substance Use Co-occurrence: Behavioral Approach System (BAS) Sensitivity and Impulsiveness as Shared Personality Vulnerabilities. (September 2010). Journal of Personality and Social Psychology.