Living with Bipolar Disorder and Addiction
As a kid, he was creative, energetic, and outgoing. As a teen, he got introduced to alcohol and cocaine. As an adult, he moved to Los Angeles to begin work as a writer. Out West, he struggled with his work, binged on cocaine, became addicted to painkillers, and ended up getting convicted for driving under the influence twice.
Not until his early thirties did Jeffrey get diagnosed with bipolar disorder. By that time, he had detoxed but was still using pain medications regularly. At the time of his interview in 2012 with “Health,” at the age of 32, Jeffrey was struggling with the use if Oxycontin for back pain and considering programs to help him stay clean. He was not taking medications for bipolar disorder because, as he put it, “bipolar medications don’t work for me.”
According to the National Survey on Drug Use and Health in 2016, over eight million adults were dealing with a mental health disorder and a substance use disorder. Individuals, like Jeffrey, who are dealing with both of these disorders are said to have a “dual diagnosis.” Research has shown that between 30% and 50% of individuals having bipolar disorder will develop an addiction in their lifetime.
What is bipolar disorder? Why are so many individuals with bipolar disorder at risk for developing an addiction? And what can you do if you or someone you know has a dual diagnosis of bipolar disorder and addiction? Let us address these questions in turn below.
Bipolar Disorder: A Definition
Bipolar disorder is a serious, chronic condition. Individuals having bipolar disorder switch back and forth between two very different moods or two different poles, as it were.
One of these poles is manic. When an individual is manic, they may have a great deal of energy, feel invincible, feel extremely irritable, and/or engage in impulsive or reckless activities such as shopping sprees or promiscuous sex. As Jeffrey described his manic episodes, “I felt like a god. But then I would black out and not know where I was when I woke up, or whether I’d spent the night with a stranger.”
The opposite pole is depressed. When an individual is depressed, they may have any number of symptoms including fatigue, loss of appetite, feelings of guilt, inability to concentrate, and thoughts of suicide. As Jeffrey described his depressive episodes, “I was depressed about my job [. . .] I started to ignore my friends and relatives.”
The cause of bipolar disorder remains unknown. However, multiple studies suggest that the disease has a strong genetic component. Researchers are working to figure out what genes interact to predispose individuals to developing bipolar disorder.
Diagnosis of bipolar disorder is often made by a psychiatrist. The diagnosis is based–among other things–on a person’s history of symptoms, severity of symptoms, and timing of symptoms. Once a diagnosis is made, treatment can be pursued. Some methods may include medications, therapy, and/or dietary and lifestyle changes.
Bipolar Disorder and Addiction
The National Epidemiologic Survey on Alcohol and Related Conditions–published in 2006–found that addiction occurred more frequently for individuals having bipolar disorder than with “any other mood or anxiety disorder.” Why is this so?
Cause and Effect: Use of an addictive substance may trigger symptoms of bipolar disorder. Conversely, having bipolar disorder may itself be a risk factor for developing a drug addiction.
Self-medication: Individuals with bipolar disorder may use drugs to ease the pain felt during manic or depressive episodes. As Quello and others have observed, “The substances may initially minimize or moderate the mood symptoms, but withdrawal and chronic abuse typically exacerbate mood degradation, leading to increasing abuse and ultimately dependence.”
Overlap: Some researchers argue that the areas of the brain in charge of “impulsivity, motivation, and the feeling of reward” get hijacked in both bipolar disorder and addiction. Hijacking of these areas of the brain thus may lead to both disorders happening at the same time.
Genetics: Some genes may predispose individuals to both mental illness and addiction. As Quello and others have pointed out, “families with substance abusers are more likely than those without to also have members with mood disorders, and vice versa.”
The two major ways for treating bipolar disorder and addiction are with medications and/or therapy:
Medications: More research remains to be done to figure out what medications work best at treating both bipolar disorder and addiction. Medications that have been used for years to treat bipolar disorder will not necessarily address concomitant drug addiction. In one study, the combination of valproate and lithium–both medications used to treat the manic episodes of bipolar disorder–helped decrease alcohol consumption in patients dealing with bipolar disorder and alcoholism. In another study, quetiapine–a medicine often used to treat bipolar disorder–lessened “alcohol consumption and craving” in those with dual diagnoses of bipolar disorder and alcoholism. It should be noted, however, that each individual responds differently to certain medications. For this reason, individuals and their healthcare providers must work together to figure out which medication or group of medications is most effective at treating the individual’s bipolar symptoms and addiction.
Therapy: You may pursue cognitive behavioral therapy (CBT), which helps individuals manage their symptoms and cope with stressors that can exacerbate their symptoms. Or you may consider attending AA or NA classes. Or you may decide on integrated therapy, which provides education, close follow-up with treatment providers, aggressive pharmacotherapy, and much more to individuals in a way that works best for them.
The wife of a man battling bipolar disorder and addiction made the following comments on a SAMHSA blog: “People can get better, but it’s not easy and some don’t because the science isn’t good enough yet. The struggle deserves to be honored.” The solutions that healthcare providers offer individuals do not always work, at first. As Jeffrey explained above, the medicines he tried for bipolar disorder just did not seem to work for him. Nonetheless, whatever dual diagnosis treatment you choose, do not lose hope. These are tough diseases to deal with and–though there might not be any easy answers–if you work with your healthcare providers as a team, you might find the right answers for you.