Bipolar disorder and substance abuse are so frequently dually diagnosed that many clinicians wonder whether the two can, at times, really be one disorder that is manifesting overlapping symptoms. A growing body of research, including that of the National Institute on Alcohol Abuse and Alcoholism, suggests that the link between mental illness and substance abuse is far greater than previously considered. It is often difficult to determine whether the drug abuse precipitates the highs and lows that resemble bipolar disorder, or whether substance abuse becomes a pattern of behavior in order to self-medicate a preexisting mental health problem like bipolar disorder.
Cycles of mania followed by depression are often symptoms of drug abuse. This is especially true of methamphetamine, cocaine and other stimulant abuse. The initial high that is experienced from these two drugs is often followed by an episode of deep depression. This pattern of alternating euphoria followed by an emotional downturn mimics the mania and depressive states of bipolar. It is also true however, that patients diagnosed with bipolar disorder tend to self-medicate with alcohol, barbiturates and marijuana in order to alleviate the anxiety and hyperarousal often associated with the manic phase of bipolar disorder. In fact, Michael’s House, a leading inpatient treatment center for dual diagnosis patients, reports that approximately 56% of all those treated for bipolar disorder report substance abuse. Self-medication is more common among teenagers and young adults who suffer with recurring mood swings but have either not been properly diagnosed or have discontinued prescribed medication against doctor’s recommendation. Bipolar patients follow a frequent pattern of believing that they no long have a problem after a period of emotional stability and then going off of medication necessary to maintain emotional health.
Although there is no substantial evidence, researchers hypothesize that substance abuse may trigger a latent genetic predisposition toward a mental illness. But even while this theory is worthy of further exploration, there is solid evidence to support the fact that abusing certain substances does result in mood swings similar to those of bipolar disorder.
Regardless of whether substance abuse predates bipolar disorder or becomes a way of self-medicating this mental health problem, the greater challenge is the complication that arises when trying to treat these two co-morbid conditions. Continuing to abuse substances while taking prescription drugs can mean an increase in both mania and depression and even result in death due to drug interactions and overdosing.
Studies, to date, show that individuals who abuse alcohol and other substances prior to a diagnosis of bipolar disorder are often older. This raises the question of how frequently prolonged abuse might lead to the development of bipolar disorder. On the other end of this spectrum, practitioners face the challenge of helping a younger population, diagnosed first with bipolar disorder, understand the importance of continuing to take mood stabilizers and avoiding falling into a pattern of substance abuse.
Substance abuse and bipolar disorder appear to be linked in not just one, but potentially several ways. The following questions need to the answered before a dually diagnosed population can be effectively treated.
1. Is it necessary to identify the antecedent condition in order to properly treat the patient?
2. Does the order in which symptoms of the two conditions emerge, change the chances of effective treatment?
3. Does every substance abuser run the risk of developing a form of bipolar disorder?
4. How can medical and mental health professionals best educate their patients to understand and avoid the pitfalls associated with the co-morbid conditions of bipolar disorder and substance abuse?
Understanding the underlying pathology that exists between substance abuse and bipolar disorder is essential to determining both diagnosis and treatment. Clinicians who treat dual diagnosis(mental health problem coupled with substance abuse) patients should be aware of the propensity for individuals who have been diagnosed with bipolar disorder to also be substance abusers. Bipolar patients should always be screened for substance abuse, particularly adolescents, before prescribing any form of mood stabilizer. When indicated, psychotherapy for bipolar patients should also include drug and alcohol counseling.