Bipolar disease is of interest when discussing alcohol and drug abuse because bipolar disorder and alcoholism are present in the same person at a much higher rate than would be expected by chance.
In general, people with psychiatric disorders commonly engage in substance abuse. Many studies show that those with bipolar disorder are the most likely to also suffer from substance abuse.
It is estimated that between 30 and 60 percent of the individuals who suffer from bipolar disease also are affected by alcoholism or drug addiction. The term "dual diagnosis" is given to a person that has a bipolar disorder and also has a drug and/or alcohol problem.
What is Meant by the term Bipolar?
Bipolar disorder is a mood disorder. It is often referred to as manic depression. As the name indicates, individuals affected with bipolar disorder most often have mood swings that range from severe depression to mania (excitability, euphoria). These periods can last from days to weeks to months. There may also be periods when the person's mood is normal.
Both men and women are affected by manic depression. Age can very, but the disorder often first appears when the individual is between 15 and 25 years of age.
A person who is bipolar may exhibit some or all of the following symptoms:
- rapid speech, excessively talkative
- more energetic than usual; increased mental and physical activity
- difficulty controlling fast, continuous thought processes
- sudden ambitions, plans, that are quite grand and may exceed expectation and ability
- the ability to sleep fewer hours without feeling tired
- extremes of agitated moods from overly happy to overly angry or irritable
- unusually comfortable or interested in excessive risk taking
- unusually impulsive. This may be exhibited in many different ways, such as through shopping, sex, alcohol, drugs, etc.
On the other hand, during periods of depression, some or all of the following symptoms may be exhibited:
- overly tired, less energy
- less active
- less talkative
- sadness that lasts longer than normal
- Excessive anxiety, overly worried
- decreased or increased appetite
- feelings of hopelessness, thoughts of suicide
- difficulty concentrating, inability to make decisions
- loss of interest in normal activities
- Restless, irritable
- Feelings of guilt
- sleeping too much, sleeping too little
The precise cause of bipolar disease is unknown, but there appears to be a genetic link in many individuals.
Two types of bipolar disorder have been identified:
(1) Type 1 - characterized by the occurrence of at least one manic episode and also periods of severe depression.
(2) Type 2 - periods of what is known as hypomania, increased energy and impulsiveness, but not to the extreme as that of true mania. This is interspersed with periods of major depression.
Sometimes an additional category called cyclothymia is included. This is a mild form of bipolar disorder and is different from Type 2 only in that the individual suffers from mild depression, not severe depression.
It often occurs that Type 2 individuals and those with cyclothymia are misdiagnosed as having just depression.
So why is there a link between bipolar disorder and alcohol and drug abuse?
There are various theories that have been put forward to explain this relationship. These theories generally fall into one of 3 categories:
(1) The theory that the two disorders just happen to coexist in the same person without a causative relationship between them. This is generally based on the theory that there is a genetic link. The two disorders simply occur at the same time in the same individual due to genetics.
(2) The theory that substance abuse is the result of underlying mental illness and that drugs and alcohol are an attempt to self-medicate.
(3) The theory that the reverse is true and that substance abuse may actually cause the symptoms of mental illness .
One thing that is for certain is that being bipolar can be a lonely and isolating condition, especially during times of depression. It is not a surprise then that a person with bipolar disease may turn to alcohol and drugs to help cope with their intense feelings and pain. It is SO very important that an individual with bipolar disease AND a substance abuse problem get a proper diagnosis. Treating one without treating the other has extremely high failure rates. Therefore, if you or a loved one are seeking treatment for either, please be totally honest with your medical/psychiatric professionals.
It is equally important for medical/substance abuse professionals to get a very detailed history from their patients and be on the alert for this dual diagnosis situation. It often gets missed because many substance abuse emergencies take place in emergency rooms where a detailed history is often overlooked. Also, those with drug addiction or alcoholism are reluctant to tell someone they have a problem. Often, they have not even come to terms with it themselves.
In addition, it is possible for drugs and alcohol or the withdrawal from them to produce symptoms that look like mental disorders or that mask them. Also, drug and alcohol abuse can actually cause or bring out mental disorders or worsen existing conditions.
Regarding bipolar disorder specifically, drugs and alcohol can bring about its emergence at an earlier age, make already diagnosed patients worse, and bring about rapid cycling. Substance abuse also increases the resistance of the disorder to treatment. An increased sensitivity to alcohol and drugs is also a characteristic of bipolar disorder. Mood can be affected with relatively low to moderate amounts of either.
Dual diagnosis treatment usually addresses the substance abuse problem first or more intensely. That's because alcohol and drugs can have very negative interactions with the medications used to treat bipolar disease.
Also, individuals with substance abuse problems tend to refuse to take their medication or forget to take their medication so the treatment for their bipolar disorder is not very successful until the substance abuse problem is addressed.
In summary, millions of people are affected by bipolar disorder. Many of these same individuals are also addicted to drugs and/or alcohol. Each of these disorders can make the other more severe, harder to diagnose, and more difficult to treat.
It's difficult enough to recover from drug addiction and/or alcohol dependency, but to face bipolar disease AND addiction is much more difficult. It is rare to overcome one without treating the other.
The only way to effectively treat both disorders is through dual diagnosis treatment.
Diagnosing both disorders and treating both disorders offers, by far, the only real solution.