There is a high rate of co-morbidity in bipolar patients; most often, the co-morbid disorder is substance abuse disorder. When substance abuse disorder is diagnosed with another clinically significant disorder, such as bipolar disorder, it is called a dual-diagnosis. A study conducted by the American Journal of Managed Care reported that about 41% of the bipolar patients engage in drug abuse, struggle with addiction, or have tried to relieve their chronic symptoms by consuming illicit drugs.
Bipolar Depression & Addiction
Bipolar Depression is a depressive mood disorder that shifts between highs, known as mania, and lows, known as depression. Its former name was manic-depression, however, changes in the diagnostic criterion over the last twenty years has led to the name of Bipolar disorder. One change made in the diagnosis was that changes in mood, which originally were diagnostically required to last at least two weeks at a time, were seen to shift rapidly in some patients; this led to a new diagnosis of “Rapid Cycling Bipolar Disorder”. Mood swings could cycle between mania and depression within 24 hours, in severe cases. Between episodes of depression and mania, those with bipolar disorder can be asymptomatic, or without symptoms. The addition of substance abuse to bipolar disorder exacerbates the condition, can produce faster cycling of moods, and lead to danger behavior, including delusions and suicidal thinking.
One common cause for the high rate of co-morbidity of the two disorders is that in the attempt their symptoms, those with bipolar disorder self-medicate, either with alcohol, OTC, or illicit drugs. To alleviate the uncomfortable symptoms of irritability, hyperactivity, and insomnia commonly experienced during manic periods of bipolar disorder, some people drink excessive amounts of alcohol or use other depressives, such as sedatives, sleep aids, and opiates. Sometimes the results are contrary and drug abuse can actually trigger a maniac episode instead of relieving it. Similarly, some people experiencing the depression symptoms of bipolar attempt to alleviate their low energy and lack of motivation by taking “uppers”, such as cocaine or amphetamines. Many bipolar people are also polysubstance abusers.
Prescription Drug Addiction
Substance abuse complicates the treatment of those with bipolar disorder. The medications used to treat bipolar disorder, which include mood stabilizers, like lithium and antipsychotics, like Seroquel or Zyprexa, normalize the brain chemicals or neurotransmitters. Substance abuse also affects the same neurotransmitters, causing an imbalance. Hence, concomitant use of drugs during bipolar therapy hinders the symptom maintenance of the needed prescribed medication. Also, many people who have bipolar disorder, who also have substance abuse disorder or addiction, do not take their prescribed treatment medications regularly or properly; the combination of events can lead to very serious episodes of mania and depression.
Dual-diagnosis treatment is focused on treating both the problems of drug abuse and the symptoms of bipolar disorder. Very often, the symptoms of drug abuse and the mental illness overlap, making treatment difficult. Treatment success is dependent upon choosing the right medications that don not produce deleterious interactions with each other. Patient education about the pre-existing condition is also very important for a better prognosis. The patient should be informed about and understand the role drug abuse has on the bipolar symptoms. Treatment that involves family support and close monitoring is also important for those strugging with bipolar disorder and addiction.