The Link Between Bipolar Disorder and Substance Abuse

The Link Between Bipolar Disorder and Alcohol Abuse

Substance abuse is a hallmark of a hypomanic bipolar state. While not everyone who deals with bipolar disorder also suffers from substance abuse, as many as 40% share both disorders. Particularly during bouts of hypomania, those that suffer from bipolar can turn to alcohol or other substances to numb the overwhelming senses of hypomania.  

Researchers believe that those who have episodes of hypomania may experience a fluctuation in their drinking behaviors just as they experience a fluctuation in their moods.

Individuals with bipolar may not drink consistently but are much more prone to binge when they do. While there may be a healthy number of “abstinent days”, there will often be brief periods of excessive, even dangerous binging.  

Often, these binge drinking episodes will coincide with “emotional binges” represented by the natural extremes of a bipolar patient. The rapid swings in emotion will often lead to attempts to self-regulate through substance use, hence the likelihood of binge drinking. 

How Bipolar Disorder Leads to Alcohol Abuse

Anyone who has consumed too much alcohol knows that the horrible feelings experienced (during and after) often lead to saying “I’m never drinking again”. However, those suffering from bipolar find this vow extremely difficult to follow through on. Due to the rapidly changing nature of a bipolar disposition, individuals will still choose to drink and even abuse alcohol despite the readily observable negative consequences.   

It is no secret that bipolar disorder is difficult to manage. However, there is hope, even for those who also abuse alcohol. It is extremely important to understand that “depressants” like alcohol only magnify the negative effects of a hypomanic bipolar state. Because some of the commonly prescribed bipolar medications can prove almost as difficult to manage as the disease itself, many people choose to “self medicate” with alcohol. This enables them to numb the feelings of ostracization and loneliness that hypomania can produce.  

Although it can provide temporary “relief” from bipolar symptoms, alcohol is an extremely dangerous substance to mix with bipolar. It is recommended to abstain from alcohol altogether if you have any symptoms of bipolar. This is the only way to guarantee no addictive behaviors will develop.  

What is Bipolar Disorder?

Bipolar disorder, also known as manic-depression, is a mental disorder recognized by rapidly shifting moods, energy and activity levels, and the ability to concentrate and complete daily tasks. 

There are three commonly identified types of bipolar disorder. While they do have different symptoms and varying treatments, all three involve drastic mood changes and rapidly changing mood/activity levels. The mood swings of someone with bipolar disorder will alter drastically between extreme highs and lows, often with little warning or reason. The “highs” (also known as manic episodes) may last for hours or weeks but will always be followed by extreme lows (also known as depressive episodes).

Types of Bipolar Disorder

• Bipolar I Disorder— Bipolar I disorder is identified by manic episodes (highs) that last at least 7 days or by manic symptoms that are so severe as to necessitate hospitalization. While depressive episodes occur as well, they are usually shorter and less intense than the manic bouts. Brief periods of intense up and down swings are also possible with this bipolar type.  
• Bipolar II Disorder—  Bipolar II disorder is identified by a persistent reoccurrence of depressive or hypomanic episodes. Bipolar II disorder does NOT generally have large-scale manic episodes associated with type I.
• Cyclothymic Disorder (also called Cyclothymia)—  Cyclothymic disorder is a bipolar type that is defined by extremely long-lasting periods (as long as a year or two) of mania or hypomania. Because the periods are so long, they may not be easily identified without the common rapid swings.  

Many people may share symptoms of bipolar disorder without falling directly into one of the three categories above. These people would potentially be labeled as having an “unspecified bipolar disorder” or can often be misdiagnosed as simply having depression, anxiety, or ADHD. 

Bipolar disorder is typically diagnosed during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Bipolar disorder can also first appear during a woman’s pregnancy or following childbirth. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

Signs and Symptoms of Bipolar Disorder

Those suffering from bipolar disorder will have symptoms that vary wildly based on whether they are in a manic or depressive episode. While everyone will experience the disorder differently, some things to look for areas listed below.

While experiencing a manic episode, someone may exhibit the following symptoms:

• Sustained feelings of elation for no apparent reason
• Feeling “Wired” or constantly energetic
• Inability to sleep
• Loss of appetite or forgetting to eat
• Suddenly engaging in risky or dangerous behaviors
• Feelings of invincibility
• Talking very fast

While experiencing a depressive or hypomanic episode, someone may exhibit the following symptoms:

• Feelings of uncontrollable depression
• Feelings of worthless or loneliness
• Fluctuations in appetite or weight loss/gain
• Trouble concentrating and making decisions
• Loss of desire for sex or hobbies or other things you enjoy

Diagnosing Bipolar Disorder

While bipolar disorder can be very disruptive, patients who seek and receive proper treatment can expect to lead healthy and active lives. The first step is seeking information about treatment from licensed professionals. Generally, this will include a physical exam and necessary tests to pinpoint an accurate diagnosis. The doctor will then conduct a mental health screening or refer to a trained mental health care provider, such as a psychiatrist, counselor, or clinical social worker. While general practitioners can make an accurate diagnosis, it is generally better to receive an opinion from a specialist.   

Mental health professionals will make an informed diagnosis based on presenting symptoms, family and medical history, and observed behaviors. Accurate diagnosis is extremely important to appropriate treatment.  

Treatment for Bipolar Disorder

Appropriate treatment for bipolar disorder is best led by a licensed psychiatrist with experience diagnosing and treating bipolar disorder. The most effective treatment plans are a team effort and will also include licensed mental health counselors, social workers, and other trained staff. 

While it can be effectively managed, bipolar is a lifelong condition. Treatment is not geared towards a “cure” but rather the management of symptoms and seeking normalcy. Depending on your presenting type and regular symptoms, treatment may include: 

• Medications- Depending on the severity of symptoms, it may be important to begin medication soon after diagnosis. Commonly prescribed medications for bipolar disorder include mood stabilizers such as lithium or SSRIs such as Lexapro. 
• Continued treatment- Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
• Day treatment programs- Day Treatment Programs, or outpatient therapy, are one of the most commonly used treatments for bipolar. Day treatment will include individual and group counseling, behavior management, and education on coping/life skills. 
• Substance abuse treatment-If you have a co-occurring condition (dual diagnosis) such as bipolar AND alcohol abuse, you will need to seek treatment for both disorders. 
• Hospitalization- Hospitalization (partial or full) may be an option if there are dangerous presenting behaviors that prove risky to you or those around you. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you’re having a manic or major depressive episode.

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups.

Treatment for Bipolar and Alcohol Abuse

Not everyone who suffers from alcohol abuse also has bipolar, and vice-versa. However, they can feed off one another and exacerbate each other if left untreated. It is extremely important to address both diagnoses individually in order to overcome the struggle they present together. 

Professionally guided treatment is an essential part of a successful recovery plan Alcohol Use Disorder (AUD) and Bipolar Disorder are often treated separately. However, it is almost always better to treat the dual diagnosis at the same time rather than have the untreated illness bring back symptoms of the one that received treatment.

Although there is little research to treat both these disorders simultaneously, therapy is a key success factor for any disorder. Learning to deal with bipolar disorder the right way can influence smarter choices such as the choice to remain abstinent from alcohol.

Many of those suffering from bipolar disorder turn to alcohol to suppress the symptoms the disorder comes with. Medicine can be prescribed to reduce the uncontrollable state experienced, reducing the motivation to drink alcohol as a coping mechanism. Additionally, many bipolar medications react very negatively with alcohol, causing effects such as intense hangovers and vomiting.

Are you or a loved one struggling with addiction to alcohol and bipolar disorder? Many inpatient and outpatient programs help deal with both disorders, ideally eliminating the cravings for alcohol and stabilizing bipolar disorder. Contact us today!