bipolar disorder and substance abuse

If you or a loved one are dealing with substance abuse, you know how damaging this can be to stability, well-being, and quality of life. If you’re dealing with both bipolar disorder and substance abuse, you’re facing some unique challenges.

When setting treatment goals for bipolar disorder that occurs with addiction, it’s important to remain hopeful. Dealing with these two disorders at once is usually difficult, but it’s not impossible.

Before beginning treatment, it can help to understand a little more about the relationship between bipolar disorder and substance abuse.

Types of Bipolar Disorder

In some cases, a person who struggles with addiction already knows they have bipolar disorder. Sometimes, though, the diagnosis of bipolar disorder may only become clear once someone is already in treatment for substance abuse.

There are three main types of bipolar disorder, and it can be helpful to know a bit about each type.

Bipolar I

With this diagnosis, someone has at least one manic episode lasting seven days or more. They also may have symptoms of mania so severe they need to be hospitalized. In a manic episode, a person feels very energized. This can look like extreme elation or extreme irritability. Untreated manic episodes may lead to spending extravagant sums of money, engaging in risky sexual behavior, or otherwise behaving impulsively.

Most people with bipolar I disorder also have depressive episodes, or periods of depression. Some people may also experience mixed episodes. These involve having symptoms of both mania and depression in one episode.

Bipolar II

This form of bipolar disorder involves a pattern of depressive episodes and episodes of hypomania. Hypomania is similar to the mania seen in bipolar I, but it is less severe. It also does not often require hospitalization.

Hypomania involves an elevated (either positive or irritable/agitated) mood. However, this mood doesn’t usually have the same devastating consequences as an episode of full mania. However, with both bipolar I and II, depressive episodes can be equally severe and long-lasting.

Cyclothymia

This disorder involves both symptoms of hypomania and symptoms of depression. On their own, these symptoms don’t meet the criteria for a major depressive episode or a manic episode. Cyclothymia can involve a somewhat rapid cycling of moods, but these don’t reach the extremes seen in bipolar I or II.

Signs of a Manic Episode

It’s important to remember that only a qualified health professional can make a diagnosis of bipolar disorder. If you think you or a loved one may be struggling with both bipolar disorder and addiction, it helps to understand some of the signs of bipolar disorder. Here are some of the signs of a manic or hypomanic episode:

  • “Pressured” speech, or talking very quickly
  • Racing thoughts
  • Restlessness or hyperactivity
  • Risky or impulsive behavior
  • A decreased need for sleep
  • Inflated or extreme self-confidence

Signs of a Depressive Episode

  • Feeling fatigued nearly every day
  • Loss of interest in things you usually like to do
  • Preoccupation with death or suicide
  • Either insomnia or sleeping too much
  • Excessive feelings of guilt or worthlessness

Treatment goals for bipolar disorder almost always focus on getting mood symptoms to a manageable level. Uncontrolled bipolar disorder lessens quality of life and causes problems in careers and relationships. It also increases a person’s risk of suicide.

Most patients with bipolar disorder are prescribed a mood stabilizer or similar drug to help regulate moods. However, medication is only one part of the picture. Successful treatment of bipolar disorder involves learning healthy habits and coping mechanisms as well. Most patients also benefit from individual therapy, group therapy, or both.

How Are Bipolar Disorder and Drug Abuse Connected?

In some cases, a person who has undiagnosed or untreated bipolar disorder may turn to drugs or alcohol as a way to cope with symptoms. For example, someone who is experiencing agitation during a manic episode may turn to alcohol or other depressants.

bipolar disorder and substance abuse

During a depressive episode, they may take cocaine, amphetamines, or other stimulants. These substances may help them to overcome fatigue or to feel something other than down. Patients may do this consciously, but turning to drugs or alcohol is often an unconscious attempt to regulate moods and feel more “normal.”

Using drugs in this way is called self-medicating. When someone regularly uses drugs or alcohol in this way, it may lead to an addiction — this is why bipolar disorder and drug abuse often go hand in hand.

For those battling bipolar disorder and addiction, any treatment plan must address both the mental health diagnosis and the addiction. Treating both issues at once increases the chances of a positive outcome. Drug or alcohol abuse often makes mood symptoms worse. In turn, worsening mood symptoms often increase a person’s risk of relapse.

When setting treatment goals for bipolar disorder, a patient’s treatment team will carefully help them decide on coping skills and strategies to reduce relapse risk and keep moods managed. At Harmony Ridge, patients are encouraged to take an active role in developing their treatment plan.

Can Addiction Cause Bipolar Disorder?

You may already know that routine substance abuse causes physical changes in the brain. Over time, these physical changes have a clear impact on thinking and behavior. If substance abuse is severe and long term, it has the potential to cause substance-induced bipolar disorder. Therefore, it’s possible that someone with no previous mental health issues could develop bipolar disorder as a result of drug or alcohol abuse.

Why Is Dual Diagnosis Treatment Important?

Dual diagnosis treatment was not always the standard when it came to treating patients with a mental health diagnosis and an addiction. Up until the 1990s, the norm was to require anyone with a substance abuse issue to first get completely clean and sober. Then, they could receive help with any mental health diagnoses.

For people suffering from bipolar disorder and substance abuse, this requirement often meant that they never got the help they needed. For people with co-occurring mental illnesses and substance abuse issues, the substance abuse is often a conscious or unconscious attempt to self-medicate mental health symptoms.

When these people try to quit drugs or alcohol with no medical help, the symptoms of their mental illness may become so difficult to deal with that they return to abusing substances.

With the dual diagnosis approach, people suffering from bipolar disorder and substance abuse receive help for both diagnoses at the same time. While in treatment, these patients will often receive expert psychiatric care while also receiving substance abuse counseling.

By working on coping strategies and adjusting psychiatric medications if necessary, treatment providers can help patients maximize their chances of a successful recovery and increased quality of life. This is part of the holistic treatment embraced at many treatment centers.

What’s Involved in Dual Diagnosis Treatment?

At Harmony Ridge Recovery Center, we offer many different levels of care. Treating bipolar disorder and addiction can be challenging, and treatment looks different depending on individual circumstances.

Depending on your treatment goals for bipolar disorder, your treatment plan might involve inpatient care, outpatient care, or a combination of both. Here are some of the care options offered at Harmony Ridge:

Detox

When treating bipolar disorder and substance abuse, the first step to recovery is often coming off of the drug of choice. However, depending on the severity of the dependency, it may be necessary to undergo supervised detox. Supervised detox helps ensure both safety and comfort for patients coming off drugs or alcohol.

When dealing with bipolar disorder and addiction, it’s also important to keep in mind that withdrawals can also make some bipolar symptoms worse. In our detox facility, patients receive round the clock medical care and support in order to make detox as comfortable as possible.

Once detox has been successfully completed, patients are ready to proceed to a treatment option. Members of the treatment team will be able to review treatment options and help the patient decide on one.

Inpatient Treatment

For patients struggling with bipolar disorder and drug abuse, inpatient treatment is often recommended. Since patients are under 24-hour care, psychiatric medications can be adjusted more quickly, and patients often start seeing an increase in quality of life sooner.

Upon admission to Harmony Ridge, a treatment team will review your history and your goals for bipolar disorder and addiction treatment. They can then make a recommendation for level of treatment. You may be eligible for a partial hospitalization program (PHP) or intensive outpatient program (IOP) once you’re discharged from residential treatment.

Outpatient Treatment

Bipolar disorder and substance abuse are two conditions that tend to make each other worse over time. In order to maximize your chances of long-term recovery, your treatment goals for bipolar disorder may also include a recommendation for outpatient treatment. Outpatient treatment can help patients ease back into the “real world” after residential treatment is completed.

Some patients with a dual diagnosis of bipolar disorder and substance abuse may be unable or unwilling to undergo residential treatment. In these cases, patients can start out with a partial hospitalization program (PHP).

This outpatient program is essentially a hybrid of typical residential treatment and outpatient treatment — patients will be in treatment for four to six hours a day for three to five days a week. This is much more intensive than typical outpatient programs.

Intensive Outpatient Treatment

For patients who don’t need this high level of care to treat bipolar disorder and addiction, an intensive outpatient program (IOP) may be a more appropriate step-down from residential care. This program does not meet as often as a PHP. However, it provides some guidance and oversight as patients learn to live sober lives.

If you aren’t sure which treatment option is best for your bipolar disorder and drug abuse diagnoses, don’t worry — our trained counselors and medical professionals will be able to carefully review your medical history and make a treatment recommendation based on it.

Therapy

In both inpatient and outpatient treatment for bipolar disorder and substance abuse, therapy is a key treatment. Therapy can help patients understand behaviors that may have contributed to the development of addiction, and patients can learn healthier coping mechanisms. When used alongside other treatment methodologies, therapy can dramatically reduce risk of relapse.

bipolar disorder and substance abuse

At Harmony Ridge, therapy is important at all levels of care — both residential and outpatient. And while individual therapy can help patients process their past and look to the future, group therapy can help to foster a healthy, recovery-focused environment.

Group therapy helps patients facing bipolar disorder and addiction know that they aren’t alone, and it also helps peers in the group to support each other through the early days of sobriety.

Lastly, when a patient battles bipolar disorder and drug abuse, their entire family is affected. If chosen as a treatment goal, family therapy can help mend issues caused by addiction. Through family therapy, the patient and their family members can learn about the roots of their addiction and discover healthier behaviors to use going forward.

Holistic Treatment

Bipolar disorder and substance abuse are diagnoses that affect the whole person, so it makes sense that a recovery program would include treatments that also help the whole person to heal. Treatment goals for bipolar disorder almost always include psychiatric management and treatment of substance abuse disorders, but holistic treatment options help patients develop self-confidence and cultivate healthy coping mechanisms.

At Harmony Ridge, each patient’s treatment plan is unique, and holistic therapies will be tailored to their individual interests and goals. Here are some of the holistic therapies you’ll find here:

  • Nutrition therapy
  • Art therapy
  • Exercise therapy
  • Massage therapy
  • Biofeedback therapy
  • Yoga
  • Tai chi

Medication-Assisted Treatment

When dealing with bipolar disorder and drug abuse, it is especially important to avoid relapse. Returning to substance abuse often means a return to, or worsening of, bipolar symptoms. In some cases, a return to uncontrolled bipolar symptoms can have life-altering consequences.

When setting treatment goals for bipolar disorder and for substance abuse, a patient’s treatment team may decide whether or not medication-assisted treatment is the right choice for a patient. Harmony Ridge offers treatment with naltrexone, buprenorphine, or methadone for patients battling opioid addiction.

These medications can help reduce cravings and lessen a patient’s risk for relapse. If your treatment team thinks they might be a viable option for you, these medications can make it easier to integrate back into the world as a sober person.

Ready To Make a Change?

Making the decision to pursue recovery can be frightening and overwhelming, but the journey toward a better life is made one step at a time. If you’re ready to make a change or if you’re simply looking for more information for a loved one, contact us today. Our trained counselors are standing by to assist you, and they’re available 24/7 to take your call.

Resources:

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340700/