Bipolar Disorder

What is the connection between bipolar disorder and addiction?

People with alcohol and other substance use disorders often suffer from coexisting mental health issues. If untreated, these can make recovery more difficult.

For some people withdrawal from alcohol and drug use can cause symptoms that mimic bipolar disorder. In these cases, the manic or depressive symptoms may be substance-induced and will subside with prolonged abstinence. For other people bipolar symptoms may persist or worsen with prolonged abstinence, making recovery more difficult. For these individuals, bipolar treatment options are available.

What is bipolar disorder?

Bipolar disorder is an illness that consists of extreme mood swings and behavior changes ranging from mania to depression.

Symptoms of mania include:

hyperactivity
decreased need for sleep
flamboyant, outrageous manner
loud speech
racing thoughts
poor judgment
grandiosity
unrealistic optimism
distractibility
pursuit of pleasurable activities that may have painful consequences (such as spending sprees)

Symptoms of depression include:

ongoing sad, anxious, or “empty” moods
feelings of hopelessness, pessimism, guilt, or worthlessness  loss of interest or pleasure in hobbies or activities
decrease in energy; fatigue
difficulty concentrating, remembering, or making decisions
insomnia, early morning awakening, or oversleeping
appetite and/or weight loss, or overeating and weight gain
restlessness and/or irritability
persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, or perhaps chronic pain
thoughts of death or suicide; suicide attempts

If you have been diagnosed with bipolar disorder, please understand that, like addiction, this is an illness, not a reflection of personal weakness, lack of willpower, or poor moral character. You are not responsible for the disorder, but you are responsible for getting help.

You can’t wish away the symptoms any more than you can wish away your substance use disorder. But there is hope. You don’t need to live with bipolar symptoms. You can get help.

How common is bipolar disorder?

Among the general population, an estimated 0.4 to 1.6 percent meet the criteria for bipolar disorder. Research suggests that 56 percent of individuals with a bipolar disorder also have a substance use disorder.

How is bipolar disorder diagnosed?

The effects of many chemicals can mimic the symptoms of bipolar disorder. For example, cocaine and other stimulants can create symptoms of mania, and withdrawal from them can result in feelings of depression, including fatigue, loss of energy, excessive sleeping, loss of interest in activities, restlessness, irritability, and change in appetite or weight. People with addiction or substance use disorders should have a careful and thorough assessment by a mental health professional with expertise in addiction.

What can you do to recover from or manage bipolar disorder?

Just as with addiction, there are things you can do to recover from bipolar disorder. You will need to practice acceptance, abstain from alcohol and illegal drugs, maintain an active recovery program, and develop strategies to take care of yourself. In addition, you will most likely need to take a prescription medication for bipolar disorder and participate in psychotherapy.

Acceptance

One of the first steps in recovering from bipolar disorder is accepting the fact that you have it. Without acceptance, you are likely to deny there is a problem or blame yourself for not being strong enough to overcome your manic or depressive feelings. Accepting your disorder is an important first step that can set you on the road to recovering a life that is healthy and whole.

Abstain from alcohol and illegal drugs

Another important step is to remain abstinent from alcohol and illegal drugs. Using these substances will only make both issues, substance use disorder and bipolar disorder, worse. By using chemicals to avoid dealing with your manic or depressive symptoms, you will only delay getting the help you need. If you have been prescribed a medication for bipolar disorder, make sure you are safeguarding your abstinence. Mixing these medications with alcohol or other drugs can be dangerous to your health.

Maintain an active recovery program

Stay active in a recovery program and take action to get some help. Waiting for your manic or depressive symptoms to go away on their own will only threaten your ability to stay sober.

Reach out and get support from others. This can be particularly hard when you are experiencing the depressive side of bipolar disorder, but it is a key to recovering from both a substance use disorder and bipolar disorder. Attending Twelve Step meetings is important. You are probably involved with Alcoholics Anonymous (AA) or another similar program for your addiction. Emotions Anonymous is an organization that addresses emotional issues such as bipolar disorder.

You should find nonjudgmental support at your Twelve Step meetings. Occasionally you may hear someone in a meeting discourage the use of medications to treat mental health disorders. You should know that taking medications for a condition such as bipolar disorder is not incompatible with Twelve Step philosophy. Look for those in the program who will support your efforts to deal with both your substance use disorder and bipolar disorder. You should be able to find them.

Let your sponsor know that you are dealing with bipolar disorder and ask for feedback on the issue. Find a sponsor who understands that bipolar disorder is an illness, accepts your need for medication, and can provide extra support in your recovery.

Realize that the Twelve Steps can be applied to bipolar disorder as well as substance use disorders. Step One teaches us to admit that we are powerless over substances and bipolar disorder. It’s realizing that no matter how hard we try, we cannot make ourselves feel better. Step Two and Step Three tell us there is hope and we can get help. Step Four and Step Five involve realizing ways in which your bipolar disorder may have caused problems for us and others. It also reminds us that some of our problems may be unfounded, due to our manic or depressive thinking.

Be real in working your Twelve Step program. If you aren’t real about your struggles with bipolar disorder, it will affect your recovery from substance use disorders as well. Be honest with your sponsor. Be honest with others in your Twelve Step group, and be honest with yourself. If you are struggling, seek the help you need. Make your recovery from both addiction and bipolar disorder your number one priority.

Take care of yourself

You can do many things to take care of yourself that will help in managing your bipolar disorder. Here are some ideas:

Maintain a regular schedule as much as possible, to avoid excessive behaviors of the manic side of bipolar.
Monitor your mood each day and learn to distinguish your bipolar symptoms from normal day-to-day mood swings.

Learn to cope with the impact of bipolar disorder on your life. Manic behaviors such as impulsivity and high-risk pursuits can cause problems both for you and those around you. Develop strategies—perhaps with a psychotherapist’s help—to avoid these behaviors as you are managing your disorder.

Participate in psychotherapy

Typically bipolar disorders are treated with behavioral therapy (which focuses on changing specific actions and uses several techniques to stop the unwanted behaviors) as well as cognitive-behavioral therapy (which teaches individuals to understand and change their thinking patterns so they can react differently to situations that cause manic or depressive feelings). Often coupled with

medication, psychotherapy can help teach you ways to cope with the symptoms of bipolar disorder and to overcome the manic or depressive thought processes. Find a qualified psychotherapist who is familiar and comfortable working with people in recovery who have both a substance use disorder and bipolar disorder.

Consider a bipolar disorder medication

To treat bipolar disorder effectively, a prescription mood-stabilizer medication is needed. Nonaddictive medications are available that have helped millions of people. These prescription mood stabilizers control both the manic and depressive mood swings, although in more severe cases, a psychiatrist or other medical person may prescribe an additional antidepressant or anti-anxiety medication.

Mood stabilizers take a while to begin working, so if you don’t see results right away, be patient. It may also take a little while to determine the appropriate dose. While you are waiting for the medication to take effect, seek support from your sponsor, Twelve Step friends, and others. These medications may have side effects. Ask your doctor for a list of these side effects, so you can be prepared to handle them.

Take your medication only as prescribed, and take it consistently. Never quit your medications “cold turkey” without a doctor’s approval. This is especially true if you start feeling better. Many people mistakenly think they can quit the medication once they start feeling good. But the medication may be what’s making them feel good.

What should you do if your bipolar disorder becomes significantly worse?

In most cases, bipolar disorder is a chronic condition in which symptoms may return, even after periods of relief. Preparing for this possibility puts you in a position to take quick action and improves your chances of getting back on track quickly. Sadly, some live with the recurrence for months before they get help. Here are some early warning signs of bipolar disorder:

Early signs of mania:

less need for sleep
increased physical activity
beginning multiple projects
racing thoughts
difficulty relaxing

Early signs of depression:

difficulty motivating yourself to do things you used to enjoy
making excuses to get out of planned activities or obligations
sleeping more or waking up more often during the night
preoccupation with mistakes or things that haven’t worked out
feeling tired and lethargic

Recovery action step

Identify and list some of the relapse warning signs related to your bipolar disorder. What three strategies might help you reduce the risk of relapse when these warning signs appear? Write them down. Keep this information in your Big Book or in a place that will remind you to monitor your progress regularly.

If your bipolar symptoms worsen or return, seek help right away from your therapist or psychiatrist. If you become severely manic, depressed, or suicidal, or cannot take care of your basic needs for food, shelter, or safety, seek help from a psychiatric hospital.

Let members of your support system know how to help you if these emergencies occur. Put your plan in writing to serve as a reminder.

Use your journal to write down the following:
1. The steps you can take if you have a psychiatric emergency or feel suicidal

2. A list of your family or members of your support network who can help you in an emergency

Recovery from the co-occurring disorder of both addiction and bipolar disorder takes time, effort, and a plan of action. Progress with one disorder does not guarantee progress with the other. Recovery requires you to acknowledge and accept both disorders.

Recovery also means stabilizing your mood and the other symptoms of bi- polar disorder, addressing the problems that contribute to (or result from) the disorder, being alert to warning signs of relapse, and coping with life problems without using alcohol or illegal drugs.

Web resources

National Institute of Mental Health (NIMH)

NIMH is a U.S. government organization, an agency of the Department of Health and Human Services, dedicated to research and education in the field of mental health. Its website is a great resource of information about specific mental health disorders including ADHD, depression, and bipolar disorder.