People with bipolar disorder have high rates of co-occurring substance use disorders. Many complex biological and personal factors lead to the development of these comorbid disorders, but the case is often simple: people with bipolar disorder frequently start using alcohol or other drugs to cope with their symptoms.
Unfortunately, the negative consequences of co-occurring bipolar and substance use disorders include increased risks of psychosis, suicide and self-harm through reckless actions.
Drug Abuse as a Hindrance to Bipolar Disorder Treatment
Treatment of bipolar disorder typically involves both therapy and medication. In the case of bipolar disorder, medication is essential. While trauma and personal factors can worsen and trigger bipolar symptoms, the disorder is biologically driven and persists even when people make significant psychological breakthroughs in therapy.
The medications most frequently prescribed for bipolar disorder are a class of mood stabilizers called anticonvulsants. Medications like lamotrigine and oxcarbazepine for bipolar disorder can help prevent or lessen symptoms of depression and mania. One of the biggest risks for people with bipolar disorder is thinking their symptoms have been cured, discontinuing medications and experiencing a serious manic or depressive episode.
Substance abuse significantly increases the risk that a person with bipolar disorder will stop taking their medications and trigger a recurrence of symptoms that may have been controlled for a long time. Using substances also interrupts the therapeutic process, causing people to forget or abandon skills or insights from therapy. The consequences of dropping out of bipolar disorder treatment can be severe, leading to hospitalization or even attempted suicide.
Effects of Substance Abuse on Bipolar Disorder Symptoms
People with bipolar disorder experience alternating mood episodes. Some people with bipolar disorder may simply shift from manic episodes to symptom-free periods, while many others experience manic or hypomanic episodes followed by depressive episodes.
Hypomanic and Manic Episodes
Mild manic symptoms like increased energy and excitement about new ideas can be pleasant, though they usually lead to more unpleasant symptoms like agitation and feelings of being out of control. Severe manic symptoms can include psychotic effects like hallucinations and delusions. Many people lose touch with reality during severe manic episodes and require hospitalization for their safety.
In depressive episodes, people suffer from a loss of energy, pleasure and interest in normal activities. They frequently experience hopeless thoughts. Severe depressive episodes carry risks of suicide, too. These risks can be even higher in transitional periods when a person is just emerging from a depressive episode and recovering the energy to act on thoughts of harming themselves.
Substance Use and Bipolar Symptoms
People with bipolar disorder may use the same substances in manic and depressive periods or use multiple substances with different effects. Drugs like alcohol and marijuana can help people feel calmer during manic periods or may act to heighten feelings of creative inspiration. Alcohol can also numb the pain associated with a depressive episode. Stimulants can temporarily boost energy.
Some of the biggest risks for people with co-occurring mood and substance use disorders come from the residual mood effects that occur between periods of use. Most substances that boost mood or energy causes people to experience dysphoria and lethargy after their effects wear off. Alcohol may temporarily induce mild euphoria but generally makes people feel depressed. These effects can be especially severe for people with bipolar disorder and may trigger a mood episode.
Statistics on Bipolar Disorder and Drug Abuse
Nearly 60 percent of people with bipolar disorder have had a substance use disorder at least once. Alcohol is the substance most commonly abused by people with bipolar disorder and in general. People with bipolar disorder are 14 times more likely to abuse drugs and six times more likely to have alcohol dependence than the general population. Substance abuse in people with bipolar disorder is linked to higher rates of suicide, hospitalization and accidents, as well as lower rates of participation in treatment, than people without this condition.
Bipolar Disorder and Alcohol
In addition to its social acceptance and accessibility, alcohol is versatile. People drink when they want to calm down or to celebrate and have fun. Artists sometimes use alcohol to focus on their work while other people use it to forget about their stressors. People with bipolar disorder often use alcohol to regulate their thinking and mood during both manic and depressive episodes.
Chronic alcohol use comes with many negative consequences, including increased risk of health problems and medical conditions such as diabetes, high blood pressure and heart disease. Alcohol abuse is also tied to higher rates of accidental death and suicide.
Combining bipolar and alcohol use can be especially deadly. For people with bipolar disorder whose symptoms are otherwise controlled, alcohol can induce a serious depressive episode. It can also complicate manic symptoms and make people more likely to act on delusions or have other psychotic symptoms.
Since it is a depressant, alcohol has a significant effect on a person’s mood. People who drink tend to be more irritable and volatile. Using alcohol can make someone with bipolar disorder have less stable moods. It can also make them more likely to become aggressive and angry, even to the point of having what some people call a “bipolar rage episode.”
This unpredictability can have a significant negative effect on relationships at home and work, leading to potential job loss or increasing social isolation. These, in turn, may cause worsening depression that is likely to be particularly severe for someone having a depressive episode.
Marijuana Abuse and Bipolar Disorder
Marijuana and bipolar symptoms interact in a similar way as alcohol and bipolar. Cannabis can have a calming effect that makes it easier to rest and focus during episodes of anxiety or mania. Unfortunately, it can just as easily trigger severe anxiety, paranoia and panic.
Another paradox of cannabis and bipolar disorder is that people often use marijuana when they want to be creative, but the drug’s cognitive effects can make it harder to hold on to ideas and insights or to write them down. Chronic, heavy marijuana use can affect people’s motivation to complete projects and ultimately cause them to become less creative and productive.
Under the influence of marijuana, bipolar symptoms are more likely to progress into psychosis. Research shows marijuana can trigger psychotic symptoms, especially in vulnerable individuals like people with mental health conditions that predispose them to psychosis. This is only one reason weed and bipolar disorder is a dangerous combination. In addition to causing people to experience psychotic symptoms, marijuana use is linked with longer and more frequent mood episodes for people with bipolar disorder.
Marijuana is a complex drug with multiple psychoactive components. Many people who want to use it for pain or anxiety management are thwarted by the anxiety-inducing properties of tetrahydrocannabinol (THC). People are experimenting with extracting cannabidiol (CBD) to help others experience the benefits of medical marijuana without the negative effects of THC. Using CBD oil for bipolar disorder has not been thoroughly researched and therefore carries the risk of inducing unknown psychological effects.
Bipolar Disorder and Stimulants
People use stimulants for many reasons. People who are looking for a boost to help them get through a challenging project at home or work are often drawn to this class of drugs. In small doses, stimulants can increase mental energy and focus. They can also induce feelings of mild euphoria or empowerment that make challenging activities more engaging and less stressful. These are the six most commonly used kinds of stimulants:
- MDMA (Ecstasy)
- Prescription stimulant drugs like Adderall
- Synthetic stimulant drugs, such as bath salts
People with bipolar disorder are especially likely to abuse cocaine or amphetamines. While cocaine is more commonly used in social contexts, amphetamines are often used to facilitate work or school projects. Unfortunately, using these drugs causes longer and more serious manic episodes and more frequent hospitalization.
Stimulant use, in general, comes with many risks. Like marijuana, stimulants can induce severe anxiety, panic attacks and paranoia. They can cause people to become irritable and reactive, capable of bursting into a rage at even the slightest provocation. Stimulants can also trigger psychosis, especially in large doses.
For people with bipolar disorder, stimulants have additional risks. They can trigger manic symptoms and episodes even in people whose symptoms are managed by mood-stabilizing medications. This is why people with co-occurring bipolar and attention-deficit hyperactivity disorder (ADHD) are rarely prescribed the stimulants that are commonly used to treat ADHD. For instance, Adderall and bipolar disorder do not mix well.
Despite these risks, people with bipolar disorder frequently abuse stimulant drugs, often in an attempt to prolong the more pleasant symptoms of hypomania.
Drug Abuse as a Cause of Bipolar Disorder
Bipolar disorder is rooted in genetic and biological factors and cannot be caused solely by environmental factors or adult behavior like substance abuse. However, using substances can trigger mood episodes in people who already have the disorder. In addition, substance use in adolescence may cause people who are vulnerable to develop bipolar disorder more rapidly or to become symptomatic.
Treatment for Bipolar Disorder and Co-Occurring Substance Use Disorders
Bipolar disorder is usually treated with a combination of psychiatric medication and therapy. People with bipolar disorder work with therapists to recognize signs and triggers of mood episodes and how to change their behavior to assist the mood-regulating effects of bipolar disorder medications. They may need to process past trauma and explore interpersonal issues.
People with bipolar disorder can benefit from group therapy or support groups that help these people connect to and learn from other people with the same challenges. This is just as true for people with bipolar disorder and co-occurring substance use disorders. A combination of group, individual and complementary therapy can help people with bipolar disorder connect to others, improve their coping skills and express their creativity.
Integrated treatment is essential for an effective medical response to co-occurring disorders. This means that each individual component of a treatment plan should serve the same goals and be coordinated by professionals who communicate regularly with one another. Integrated treatment rests on the principle that treating mental health and substance use disorders at the same time leads to better outcomes for each.
Living with bipolar disorder can be challenging, especially for people who are also struggling with addiction. Struggling with the disorder can lead to severe substance abuse as a means of self-medication, but relying on drugs or alcohol to relieve bipolar disorder symptoms can be extremely risky, even life-threatening. However, with the right treatment for their substance use disorder, people with co-occurring mental health conditions can make lasting and meaningful changes to help them live happier lives.
If you or a loved one are struggling with bipolar disorder or another co-occurring mental health disorder in addition to substance use, contact The Recovery Village. A representative can discuss integrated treatment options with you and help you or your loved one find the best place to start or continue the recovery journey.