Author: Jillian LaFrance
The rollercoaster of emotions, the dizzying highs and crushing lows – this is the reality for many living with bipolar disorder. But what happens when this already complex mental health condition intersects with substance use? The answer is a vicious cycle where substance use, often intended as a form of self-medication, only serves to intensify the challenges of bipolar disorder, making recovery even more difficult.
Bipolar disorder is a mental illness characterized by extreme shifts in mood, energy, activity, concentration, and behavior. These shifts can range from periods of elevated mood (mania or hypomania) to periods of profound sadness and hopelessness (depression). While the exact causes of bipolar disorder are still being researched, it’s believed to involve a combination of genetic, biological, and environmental factors. There are different types of bipolar disorder, including Bipolar I (characterized by manic episodes), Bipolar II (characterized by hypomanic episodes and major depressive episodes), and cyclothymia (a milder form with less severe mood swings).
The relationship between bipolar disorder and substance use is often intertwined. Substance use could trigger bipolar episodes and distressing symptoms of bipolar disorder can lead to individuals self-medicating with drugs or alcohol. Many individuals with bipolar disorder turn to substances as a way to cope with their symptoms. They might use alcohol to numb the pain of depression or stimulants to boost their energy during a depressive episode. Others might seek the euphoria of mania through drugs, unaware of the consequences. However, this perceived relief is temporary and ultimately leads to a downward spiral.
One of the biggest challenges is that substances can mask or mimic the symptoms of bipolar disorder. For example, stimulants can induce a manic-like state, making it difficult to distinguish between drug-induced euphoria and a true manic episode. This can lead to misdiagnosis and inappropriate treatment, further delaying recovery. Furthermore, substance use can significantly interfere with the effectiveness of medications prescribed for bipolar disorder. This can destabilize mood and lead to more frequent and severe episodes.
Different substances can affect bipolar symptoms differently. Alcohol, while initially seeming to ease anxiety or depression, is a depressant that can worsen mood swings. It increases impulsivity, predisposes individuals to risky behaviors during manic or hypomanic episodes, and disrupts sleep. Most alarmingly, alcohol use elevates the risk of suicidal ideation and attempts, a serious concern for those with bipolar disorder.
Stimulants like cocaine and amphetamines can trigger manic or hypomanic episodes. The initial surge of energy and euphoria can escalate into a full-blown manic episode, marked by racing thoughts, inflated self-esteem, and reckless behavior. The subsequent “crash” can plunge individuals into a deep depression, exacerbating bipolar symptoms. Stimulant use also carries a high risk of addiction. Depressants, such as benzodiazepines and opioids, although potentially used for anxiety or insomnia, can worsen depression over time and lead to dependence and addiction. Combining depressants, especially during manic episodes, is extremely dangerous and increases overdose risk.
The effects of cannabis on bipolar disorder are still under investigation, but there’s growing concern that it can trigger or worsen psychotic symptoms, particularly in those predisposed to psychosis. This is a significant risk for individuals with bipolar disorder, as psychosis can occur during mood episodes. Cannabis use may also impair cognitive function and contribute to mood instability.
The dangers of self-medication cannot be overstated. Although the desire to alleviate bipolar symptoms is understandable, self-medicating with substances is not a sustainable or effective solution. It provides only a temporary illusion of control, masking underlying issues and ultimately leading to worsening symptoms, addiction, and delayed treatment.
The key to breaking this cycle lies in integrated treatment, addressing both the substance use disorder and bipolar disorder simultaneously. Effective treatment typically combines several approaches. Medication management, using mood stabilizers, antidepressants, and antipsychotics, can help regulate mood and prevent episodes. This medication should be prescribed and monitored by a psychiatrist experienced in treating both bipolar disorder and co-occurring substance use disorders. Therapy, such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), can equip individuals with coping mechanisms, stress management skills, and the ability to identify triggers for both mood episodes and substance use. Therapy also addresses underlying issues contributing to both disorders. Support groups, like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or dual recovery groups, offer a sense of community and combat feelings of isolation. Connecting with others who understand the challenges of co-occurring disorders is invaluable. For severe substance dependence, inpatient or outpatient rehabilitation programs may be necessary for detoxification and developing strategies for maintaining sobriety.
Recovery from both bipolar disorder and substance use disorder is possible. It requires commitment, hard work, and a strong support system. Breaking free from this cycle is the first step towards a healthier and more fulfilling life.
Jillian has a PhD in psychology, specializing in forensics. She works with inmates who have severe and chronic mental illnesses and substance use disorders, preparing them for success after release. Jillian has a bipolar disorder diagnosis, which provides her with personal insight. She is a strong mental health advocate.
Photo Credits: Jessica Knight Photography
The content of the International Bipolar Foundation blogs is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician and never disregard professional medical advice because of something you have read in any IBPF content.
