Within the last few decades there has been a dramatic increase in the prevalence of bipolar disorder among adults in the US. According to the National Institute of Mental Health, an estimated 2.6 percent of the adult population in the United States has been diagnosed with and treated for bipolar disorder. As these numbers show a steady increase, it has come to the attention of mental health professionals that there should be research performed to understand the patterns that may be causing this steadily raising statistic. Through that research there has been a link identified between severe cases of bipolar disorder and substance abuse exhibited by the patient.
Both bipolar and substance abuse have serious consequences on a patient’s overall health and well-being, so understanding the connection between these two disorders is important for those who may be suffering from this specific dual diagnosis.
What Is Bipolar Disorder?
Bipolar is a disorder in which a patient experiences sudden and sometimes extreme shifts in mood, behavior, attitude and energy. These shifts are unpredictable, erratic and can cause a great deal of confusion and distress for both the patient and their close friends and family.
Those who suffer from bipolar disorder will have extreme shifts in their mood, which will typically fit into three major categories:
- Mania – During a manic episode, a patient will experience a high in their overall mood. He or she will feel intense feelings, grandiose emotions, extreme optimism, high energy, rapid thoughts and expressions of thoughts as well as little need for sleep. He or she may act erratically with delusional or irrational behavior, impulsivity and rash judgments. It is not uncommon for a person in a manic episode to make poor and dangerous decisions as they assume they will not or cannot be harmed by potentially harmful situations like drug use. (Not all patients with bipolar will experience a manic episode. Instead, some may experience hypomania, a less-intense episode that scales at the high end of the mood spectrum.)
- Hypomania – Hypomania can be considered to be a “less intense” form of a manic episode. When a person is in a state of hypomania they will exhibit higher levels of energy and active behaviors, but will also experience more emotional irritability while feeling an increased level of enthusiasm, excitability and happiness. During an episode of hypomania a patient may still feel he or she requires less sleep or can take on more challenges, responsibilities and personal risks, but the more grandiose and psychotic symptoms will be absent.
- Depression – A patient with bipolar disorder will have depressive episodes, which serves as the low end of the spectrum. In a state of depression, the patient may experience a flat affect or absence of emotions or feelings. He or she may also feel deep feelings of sadness, distress, anxiety and despair. It is not unusual for a person who is in a depressed episode to have crying spells, feel an intense lack of energy and fatigue and have suicidal thoughts. There may also be an increased risk of the patient hurting or harming himself or herself, a lack of interest in socializing and engaging in enjoyable activities as well as low motivation or ambition. Feelings of hopelessness and high-risk behaviors like substance abuse and self-harm are common during a depressive episode.
It can help to think of these episodes in the form of a wave in the ocean. The very top of the wave is mania, the swell where the wave curves is hypomania, the base of the water level is a neutral state and the dip under the water level created by the movement and formation of the wave is the depressed state. A surfer will ride the white swell that serves as the mood indicator, moving fluidly through the waves of each episode.
What Happens When a Person With Bipolar Disorder Uses Drugs?
Bipolar disorder is caused by a number of different factors, but regardless of whether it is the result of genetics or environment, a patient who suffers from bipolar disorder will experience shifts in their neurochemistry (chemical balances in the brain). These chemical shifts in the brain result in the mood swings that are exhibited by the patient. They also result in the more alarming and upsetting symptoms, like psychosis, hallucinations, mania and depression.
Of course, if the brain chemistry is impacted severely by bipolar disorder, it is understandable why any more manipulation or disruption of the chemical balance can put a patient at high risk for some serious side effects. This is why actively using mood-altering substances like alcohol, marijuana, cocaine, methamphetamines, opiates and hallucinogenic drugs all severely impact the severity of someone’s bipolar disorder.
Mood-altering substances like drugs and alcohol will have a major impact on the patient’s bipolar symptoms. The most significantly affected symptoms of the condition will be the rate, prevalence and intensity in which a patient experiences manic, hypomanic and depressive episodes. Sometimes, patients will use drugs to cope with these episodes and the stress that they bring in to their lives. This behavior is called self-medicating. It is not uncommon for drug-using bipolar patients to self-medicate with drugs.
Many people tend to believe that self-medicating helps them feel better. Depending on the drug of choice, they may feel like they are pulling out of a depressed episode or calming down from a manic episode. What they often fail to realize is that the concoction they are using to self-medicate during their episodes is only bringing temporary relief of symptoms, while gearing up the brain to experience a crash that will bring more severe mood swings as the brain chemistry is brought even further out of balance.
Why Do People With Bipolar Use Drugs Despite the Consequences?
It’s clear that the use of mood-altering substances when suffering from bipolar disorder can have a severe negative impact on overall mental health, so it can be difficult to understand why people with bipolar would risk using drugs. Of course, each case is different, and the reason for the continued drug use in dual diagnosis bipolar patients will be based on their individual condition. However, there are common trends that contribute to the patient’s continued drug use. These may include:
- Self-medicating to relieve stress associated with bipolar disorder
- Impaired judgment that a bipolar patient displays during episodes
- Grandiose beliefs of safety and distorted perceptions of self-awareness that cause a patient to believe he or she is safe and largely unaffected by continued drug use
- Addictions that are just as difficult to cope with as in a patient without a dual diagnosis of substance abuse and bipolar disorder
- High impulsivity and engagement in high-risk behavior during a manic or hypomanic episode
- A maladaptive means to cope with the uncomfortable and upsetting symptoms of bipolar disorder
- Poor education and lack of awareness about how using drugs will aggravate a pre-existing case of bipolar disorder
Schean Barrett is the Director of Admissions for Nsight Psychology & Addiction located in Newport Beach, California. He is passionate about helping people who are struggling with trauma, anxiety, depression and/or substance abuse find their path to recovery and new possibilities.