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An image of a woman sitting alone at a lake dealing with bipolar and addiction

Bipolar and addiction are both aggravating conditions. When bipolar disorder and substance use disorder co-occur, though, this is known as a dual diagnosis and requires specialized and integrated treatment.

Previously labeled manic depression, bipolar disorder is characterized by pronounced mood swings from one emotional extreme to the other.

NAMI (National Alliance on Mental Illness) reports that an estimated 7 million people in the United States meet the criteria for bipolar disorder, almost 3% of the general population. Data from NSDUH 2020 shows that 40 million U.S. citizens have substance use disorder (the clinical descriptor for addiction).

While it can be intensely challenging to deal with bipolar and addiction intersecting, favorable treatment outcomes are possible with the right therapy and medications.

Co-Occurring Bipolar Disorder and Addiction

Bipolar disorder involves dramatic mood swings. Bipolar episodes may last for a few days or persist for several weeks. Episodes can occur frequently or on isolated occasions.

As well as causing extreme mood swings, bipolar disorder can also trigger impairments to focus and energy levels.

Due to the wide-ranging and distressing nature of bipolar symptoms, many people with bipolar – especially when undiagnosed – self-medicate those symptoms with addictive substances. Research shows that lifetime prevalence of substance use disorders is at least 40% among those with bipolar I (the more severe form of bipolar disorder). The most abused substances by those with bipolar are:

  • Alcohol
  • Marijuana
  • Cocaine
  • Opioids

This study exploring the interrelated nature of bipolar and addiction draws on data from NESARC (National Epidemiologic Survey on Alcohol and Related Conditions), the study involved 43,000 respondents in the U.S. with bipolar I or bipolar II. 58% of respondents experienced co-occurring bipolar disorder and alcohol use disorder (alcoholism), with 38% reporting a dual diagnosis of bipolar disorder and substance use disorder (drug addiction).

Occasionally, those with no history of mental health issues may develop bipolar disorder as a result of substance abuse – more on substance-induced bipolar below.

Although self-medication may be commonplace among those with bipolar, both alcohol and illicit drugs tend to inflame bipolar disorder symptoms.

There are three primary hypotheses for the co-occurrence of bipolar and addiction:

  1. Self-medication hypothesis: According to Khantzian’s self-medication hypothesis, people abuse substances to alleviate psychological suffering, with the substances of abuse specific to the suffering experienced.
  2. Overlapping disorders hypothesis: Swann theorizes that bipolar disorder and substance use disorder can be viewed as overlapping brain disorders, both impacting areas of the brain responsible for motivation, reward, and impulsivity.
  3. Shared vulnerability hypothesis: The shared vulnerability model suggests that bipolar and addiction co-occur due to an underpinning genetic susceptibility to these conditions.

Regardless of why bipolar disorder and addiction co-occur, SAMHSA reports that substance use disorders can:

  • Precede bipolar disorder.
  • Trigger bipolar disorder.
  • Inflame bipolar disorder.
  • Be a result of bipolar disorder.
  • Have separate causes of bipolar disorder.

When bipolar and addiction co-occur in a dual diagnosis, this complicates both diagnosis and treatment.

An image of a person struggling with bipolar and addiction

Substance Induced Bipolar Disorder

The sustained use of addictive substances causes structural and functional changes to the brain.

Among those changes, the most notable is the way habitual substance use impacts the reward system of the brain, causing drug use to feel intensely pleasurable. Over time, this can lead to anhedonia (inability to feel pleasure in normal things), and it can also trigger compulsive drug-seeking and drug-taking behaviors, both properties of addiction.

Long-term substance use can also affect other areas of the brain, especially those responsible for governing mood and behavior.

In some cases, substance abuse and addiction can trigger brain changes that lead to the development of bipolar disorder. This is known as substance-induced bipolar disorder.

The following substances can all provoke substance-induced bipolar:

  • Alcohol
  • Benzodiazepines
  • Prescription opioid painkillers
  • Hallucinogens (PCP, LSD, psilocybin)
  • Blood pressure medications
  • Antidepressants
  • Decongestants
  • Heart medications

Are Bipolar Medications Addictive?

Medications are typically central to the treatment of bipolar disorder, but are these medications addictive?

The most commonly prescribed medications for bipolar treatment are:

  • Lithium and other mood stabilizers: Addictive substances produce feelings of euphoria, induce cravings to use more of the drug, and cause tolerance to build so you need more of the drug to deliver similar effects. Mood stabilizers like Lithium do not have these properties. That said, you may still experience withdrawal symptoms if you suddenly stop using the medication after your body has become accustomed to the substance. That said, withdrawal symptoms are usually mild. The greatest risk of discontinuing mood stabilizers is the return of bipolar symptoms.
  • Benzodiazepines: Benzodiazepines like Xanax and Klonopin have a strong potential for abuse and addiction. Dependency on benzos can start developing in as little as a month. This medication is normally only prescribed for short-term use to prevent tolerance building and to mitigate the risk of benzodiazepine addiction.
  • Antipsychotics: Antipsychotics are not addictive, although your body may become accustomed to the presence of the substance, leading to mild withdrawal symptoms when you discontinue use.
  • Anticonvulsants: The main reason for the use of anticonvulsants among those with substance use disorders is their lack of addictive potential.

Dual Diagnosis Treatment at Los Angeles Therapy Network

Research shows that the most effective outcomes for treating co-occurring mental health conditions and addictions are achieved through the simultaneous treatment of both conditions.

Before you address the psychological component of substance use disorder and bipolar disorder, you must first detox from the addictive substance. Here at Los Angeles Therapy Network, we can connect you with a licensed medical detox center near you. With around-the-clock emotional and clinical care alongside medications to streamline withdrawal, detox will be as safe and comfortable as possible.

After a week or so, you will be substance-free and ready to engage with a treatment program that provides the appropriate level of structure and support for your circumstances and co-occurring disorder. This may take the form of an IOP (intensive outpatient program) or a PHP (partial hospitalization program), or residential rehab, depending on the severity of the dual diagnosis.

Our dual diagnosis programs will allow you to participate in either drug rehab or alcohol rehab while receiving simultaneous therapy for bipolar disorder. All treatment programs draw from these research-backed therapies:

Take the first step toward initiating your recovery by calling Los Angeles Therapy Network today at 833.604.1287.

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