Bipolar Disorder and Substance Use - Partnership to End Addiction

Bipolar disorder is a complex mental health condition marked by extreme mood swings. Imagine a roller coaster of emotions where loved ones navigate between the highs of mania and the lows of depression. These changes in mood can significantly impact their daily life, relationships and overall well-being. Although substance use can provide temporary relief from the symptoms of bipolar disorder, it can make managing it more difficult and result in a co-occurring substance use disorder.

Key Takeaways

Bipolar disorder is a mental health condition where people experience extreme mood swings. These include very happy or “up” periods called mania, and very sad or “down” periods known as depression. These mood changes can greatly affect one’s life, including their relationships and daily activities. Substance use can make bipolar disorder symptoms worse and complicate treatment.
Symptoms of bipolar disorder can vary, but typically include high energy and less need for sleep during manic episodes, and feelings of sadness or low energy during depressive episodes. Identifying bipolar disorder in teenagers can be particularly tricky since mood swings are also a normal part of teenage development. Factors that can increase the risk of developing bipolar disorder include family genetics, stress and even major life changes.
Diagnosing bipolar disorder involves talking to a healthcare professional who can assess symptoms and rule out other causes. Integrated treatment addressing both bipolar and substance use is key. It often includes mood stabilizers and anti-craving medications and therapy to help manage symptoms. Support from groups and understanding more about the disorder can also help loved one cope with the challenges of these disorders.

What are the symptoms of bipolar disorder?

There are several different types of bipolar disorder including Bipolar I and Bipolar II. A loved one with Bipolar I usually alternates between states of mania and depression.

Although the signs of mania can vary from person to person, they often include:

High energy levels
Racing thoughts
Inflated self-esteem
Pressured speech – talking very rapidly
Irritability
Sleeping less – perhaps a couple of hours a night
Having a creative or productive streak
Psychosis (seeing or hearing things that aren’t real)
Engaging in risky behaviors (e.g., wild spending sprees, having casual sex with many partners, substance use, suddenly quitting job, etc.)

Depressive symptoms may include:

Sadness, despair or guilt
Low energy
Not wanting to do activities that once offered pleasure
Feelings that you don’t matter
Sleeping too much or too little
Difficulty focusing and concentrating
Eating too much or too little
Suicidal thoughts

A loved one with Bipolar II has both depression and hypomanic episodes. A hypomanic episode is similar to a manic episode but less severe.

It’s important to note that to be diagnosed with Bipolar I or Bipolar II Disorder, mood episodes should cause significant distress or problems in social, work, school or other important areas of functioning.

A note about teens

Identifying bipolar disorder in teens can be tricky as mood swings are a normal part of development. However, teens with bipolar disorder experience more intense and unpredictable mood swings that go beyond the typical teenage emotional roller coaster. Additionally, teens with bipolar disorder may exhibit irritability, impulsivity and difficulty concentrating. These mood swings can disrupt their school performance, social relationships and participation in extracurricular activities.

Risk factors linked to developing bipolar disorder

The development of bipolar disorder is influenced by a combination of genetic, biological and environmental factors.[1] While it can affect individuals from all backgrounds, certain factors may increase the risk of developing bipolar disorder. Here are some key considerations:

Family history: Having a close relative, such as a parent or sibling, with bipolar disorder increases an individual’s risk. There is a genetic component to bipolar disorder, and individuals with a family history of the condition may be more predisposed to developing it themselves.

Biological factors: Imbalances in the chemicals that transmit signals in the brain, may play a role in bipolar disorder. Changes in the structure or function of the brain may also contribute to the development of the disorder.

Stressful life events: Traumatic or highly stressful events, such as the loss of a loved one, experiencing abuse or undergoing major life changes, can trigger the onset of bipolar disorder in individuals who are genetically at risk.

Substance use: Substance use can increase the risk of developing bipolar disorder. Additionally, it can worsen the course of the disorder in individuals who already have it.

Neurological conditions: Certain neurological conditions or diseases may be associated with an increased risk of bipolar disorder. For example, some research suggests a link between traumatic brain injury and the development of mood disorders, including bipolar disorder.

Age and gender: Bipolar disorder can develop at any age, but it often emerges in late adolescence or early adulthood. Biological women and biological men are affected equally, but the pattern of the disorder may differ between genders. Women may experience more depressive episodes, while men may experience more manic episodes. The same goes for transgender and gender-nonconforming individuals.

Sleep disruptions: Irregularities in sleep patterns or disruptions in circadian rhythms may contribute to the development or exacerbation of bipolar disorder. Sleep disturbances can be both a risk factor and a symptom of the disorder.

It’s important to note that while these factors may increase the risk, they do not guarantee the development of bipolar disorder. Many individuals with one or more risk factors do not develop the condition, and some with no apparent risk factors do.

How is bipolar disorder diagnosed?

Diagnosing bipolar disorder involves a complete assessment by a mental health professional, typically a psychiatrist or psychologist. The mental health professional gathers information about the individual’s symptoms, medical history, family history and any potential triggers or stressors. This information helps in understanding the context of the individual’s experiences.

Information from multiple sources, including family members, friends and previous healthcare providers may be considered to gain a comprehensive understanding of the individual’s mental health history.

Bipolar disorder shares symptoms with other mental health conditions, such as major depressive disorder or certain personality disorders. The mental health professional must differentiate between these conditions to arrive at an accurate diagnosis.

It’s also important to ensure that a loved one’s problems isn’t the result of substance use as the symptoms of some substances can mimic the signs of bipolar disorder. For instance, a loved one using cocaine might seem very up and energetic at times – similar to what you might see is they were having a manic episode. A loved one using substances like opioids or alcohol may seem down and lacking in energy – again like what you might see if they were depressed.

Additionally, it’s important to rule out any medical conditions or medications that could be contributing to mood symptoms. Certain medical conditions, such as thyroid disorders or neurological conditions, can mimic symptoms of bipolar disorder.

It’s important to note that bipolar disorder exists on a spectrum, and the severity of symptoms can vary widely among individuals.

The link to substance use

Unfortunately, some people with bipolar disorder turn to substances as a way to cope with their symptoms. This is known as a co-occurring disorder, where substance use and mental health conditions intersect. The substances chosen are often those that provide a temporary escape or seem to regulate mood. Common choices include alcohol, marijuana and stimulants. However, substance use can make bipolar symptoms worse, complicate treatment and contribute to a more challenging recovery process.

Understanding the specific substances individuals with bipolar disorder are likely to choose is needed for effective intervention. Alcohol is a common choice due to its depressant effects, providing temporary relief from manic symptoms. Marijuana, with its calming properties, might be appealing during manic episodes to help with relaxation. Stimulants, on the other hand, may be sought during depressive episodes to counteract the lack of energy associated with that phase of bipolar disorder.

Treating co-occurring bipolar and substance use disorders

Integrated treatment programs address both bipolar disorder and substance use disorder concurrently. These programs often involve a team of psychiatrists, psychologists, social workers and addiction specialists who collaborate to provide comprehensive care. These programs may include individual therapy, group therapy, medication management, psychoeducation and support groups tailored to the needs of individuals with co-occurring disorders.

Medication management: Mood stabilizers such as lithium, valproate or lamotrigine are commonly prescribed to help stabilize mood swings and prevent manic or depressive episodes. Antipsychotic medications may be used to manage symptoms during acute manic or depressive episodes.

For substance use disorder, medications such as naltrexone (for alcohol or opioid dependence), acamprosate (for alcohol dependence) or buprenorphine (for opioid dependence) may be prescribed to help reduce cravings and withdrawal symptoms. You loved one may also wish to consider some ways to reduce the risks associated with substance use, especially if they are unable or not ready to stop using substances. Learn more about harm reduction.

Counseling: Cognitive-behavioral therapy (CBT) is often used to address both bipolar disorder and substance use disorder. It helps individuals identify and change negative thought patterns and behaviors, develop coping skills, and prevent relapse. Motivational interviewing (MI) is another therapy approach that focuses on increasing motivation and commitment to change unhealthy behaviors.

Lifestyle changes: Adopting a healthy lifestyle can support recovery from both bipolar disorder and substance use disorder. This includes regular exercise, balanced nutrition, adequate sleep and stress management techniques. Avoiding triggers such as stressful situations, substance-related environments and disruptions in sleep patterns can help prevent relapse.

Support groups: Participating in support groups for bipolar disorder or substance use disorder can provide peer support, encouragement and accountability. Support groups offer opportunities to share experiences, learn from others and develop coping strategies for managing both conditions.

Finding the right support group can make a big difference for those dealing with bipolar disorder. Here are some organizations that offer support groups for individuals with bipolar disorder and their families:

Depression and Bipolar Support Alliance (DBSA) – DBSA provides extensive resources for people with bipolar disorder, including online support groups, local in-person meetings and educational materials.
National Alliance on Mental Illness (NAMI) – NAMI offers a variety of support groups, including those specifically for individuals with bipolar disorder. They also have family support groups and educational programs.
International Bipolar Foundation (IBPF) – Though primarily focused on education and advocacy, IBPF also lists support resources that can be accessed for help.
Mental Health America (MHA)- MHA offers resources to find local support groups for various mental health conditions, including bipolar disorder.
Dual Recovery Anonymous – For those dealing with both bipolar disorder and substance use disorders, this organization offers specialized support groups.
Online Communities and Forums – Websites like Psych Central and HealthUnlocked provide forums where individuals can join discussions about bipolar disorder and share experiences in a moderated online setting.

Family education and support: Family involvement in the treatment process can enhance support and understanding for loved ones with co-occurring disorders. Family education programs provide information about bipolar disorder, substance use disorder and strategies for supporting recovery.

Continued monitoring and follow-up: Ongoing monitoring and follow-up with healthcare providers are essential for managing co-occurring disorders. Regular appointments allow for adjustments to treatment plans based on individual progress and changing needs.

Additional approaches to treatment

Some newer approaches to treating bipolar disorder are being evaluated. Here are some potential novel treatments and areas of research for co-occurring bipolar disorder and related conditions:

Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It has shown promise in the treatment of depression and is being explored as a potential therapy for bipolar disorder. Research is ongoing to determine its efficacy and safety.

Ketamine and Esketamine: Ketamine, traditionally used as an anesthetic, has gained attention for its rapid antidepressant effects. Esketamine, a derivative of ketamine, has been approved by the U.S. Food and Drug Administration (FDA) for treatment-resistant depression and is being studied for its potential in bipolar disorder.

Cognitive Remediation Therapy (CRT): CRT is a therapeutic approach that focuses on improving ways of thinking, including attention, memory and problem-solving skills. It is being investigated as a complementary treatment for bipolar disorder.

Digital Therapeutics: Mobile apps and online platforms are being developed to support traditional therapies for bipolar disorder. These digital therapeutics may include mood tracking, psychoeducation, and therapeutic exercises to support individuals in managing their symptoms and maintaining stability. Examples include Daylio and Woebot.

Immunomodulation: Some researchers are exploring the role of inflammation and the immune system in bipolar disorder. Immunomodulatory treatments, typically used for conditions like rheumatoid arthritis, are being investigated for their potential effects on mood disorders.

As for clinical trials, participation in research studies can provide access to innovative treatments. ClinicalTrials.gov is a database maintained by the U.S. National Library of Medicine, where you can find information on ongoing clinical trials for various conditions, including bipolar disorder.

Co-occurring bipolar and substance use disorders are very serious mental health conditions. To learn more about encouraging treatment and providing other support to your loved one, click here.

Addressing bipolar disorder, especially when it’s combined with substance use, can be challenging, but there’s a hope for loved ones facing these issues. By engaging in therapy, medications and other tools, loved ones with bipolar disorder and substance use problems can improve their lives. They can feel more stable and happier as they work towards a healthier future.