In 2014, the National Institute of Mental Health (NIMH) reported that bipolar disorder, which is sometimes called manic-depressive disorder, affects 2.6 percent of the adult population in the United States, or 5.3 million people over the age of 18. NIMH estimated that 51 percent of those suffering from bipolar disorder go untreated in any given year. Despite the prevalence of bipolar disorder, those suffering from it and their families do not always know how to get the help they need.
The National Alliance on Mental Illness defines bipolar disorder as a chronic illness that causes intense shifts in mood, energy, and activity levels. Those who have bipolar disorder suffer from mania and depression, which are much more intense than the highs and lows that those without the disorder typically experience. There are four types of bipolar disorder. NIMH defines them as:
- Bipolar I disorder: Bipolar I disorder is defined by manic episodes that extend for at least seven days or manic symptoms so severe that the person needs immediate hospitalization. With bipolar I disorder, depressive episodes typically last for at least two weeks at a time. It is also possible to experience depressive and manic symptoms at the same time.
- Bipolar II disorder: Doctors define bipolar II disorder as a pattern of depressive episodes interspersed with sporadic hypomanic episodes, which are not as intense as the full-blown manic episodes that those with bipolar I disorder experience.
- Cyclothymic disorder: Often called cyclothymia, cyclothymic disorder is defined by multiple periods of depressive symptoms and multiple periods of hypomanic symptoms that last for at least two year in adults and at least one year in children and adolescents.
- Other specified and unspecified bipolar-related disorders: There are other disorders that have symptoms similar to those of bipolar disorder but do not fall under the categories above.
Signs and Symptoms
In general, people suffering from bipolar disorder experience extremely powerful highs and incredibly intense lows. They may also experience changes in their sleeping patterns and activity levels, similar to the deviations that those with depression experience. Bipolar disorder is categorized by distinct episodes, which may be manic or depressive. Signs of a manic episode include:
- Feeling extremely elated
- Having a lot of energy
- Feeling jumpy or wired
- Having trouble sleeping
- Feeling more active than usual
- Talking really quickly about multiple subjects
- Feeling agitated or irritable
- Having racing thoughts
- Doing risky things, like spending a lot or money or engaging in reckless sex
People suffering from bipolar disorder are just as likely to have depressive episodes as well. Signs of a depressive episode include:
- Feeling sad and hopeless
- Having little to no energy
- Having trouble getting out of bed
- Feeling unhappy, even during favorite activities
- Feeling worried, empty, and alone
- Having trouble concentrating
- Forgetting important things
- Eating too much or too little
- Having suicidal thoughts
A study published in the National Center for Biotechnical Information explored the prevalence of bipolar disorder, and researchers found that substance abuse occurred more frequently in those who had bipolar disorder than in those who had any other axis I psychiatric disorder. Axis I psychiatric disorders include ADHD, anorexia nervosa, schizophrenia, anxiety disorders, autism spectrum disorders, and depression.
Part of the reason those with bipolar disorder have such a high risk of substance abuse is because it can be challenging for them to find relief. For those who seek help, there are a variety of ways to treat both the manic and depressive symptoms, and they can lead happy, fulfilling lives; however, those who remain undiagnosed are at risk of substance abuse because they often try to treat the symptoms in any way that they can.
It’s important to remember that it’s never too late to seek help. Whether a loved one is showing symptoms of bipolar disorder or those of substance abuse in an attempt to cover up any symptoms, there are programs that can help.
The Depression and Bipolar Support Alliance reminds families that treatment typically takes a multipronged approach. People suffering from bipolar disorder often find relief in a combination of medications that stabilize their mood, therapy, and peer support groups.
According to the Anxiety and Depression Association of America, doctors typically prescribe a mood stabilizer first to treat bipolar disorder. Prescribing an antidepressant before an individual’s mood has been stabilized can actually worsen symptoms and even trigger manic episodes. Benzodiazepines, which are often used to treat anxiety disorders, can effectively treat bipolar disorder; however, they are highly addictive and could lead to dependence down the road. People with bipolar disorder who have suffered from alcohol or substance abuse in the past are more likely to develop a dependence on benzodiazepines during treatment, but if the medication is closely monitored, it can be highly effective.
Therapy also plays an important role in treating bipolar disorder. Cognitive Behavioral Therapy, family therapy, and social rhythm therapy are just a few types of therapy that can benefit someone with bipolar disorder.
No single treatment option will work for everyone, and finding the right combination of treatments might take time, but it’s always worth the effort in the long run. Unfortunately, those with undiagnosed bipolar disorder often try to treat the symptoms themselves, and that can lead to substance abuse.
Signs of Substance Abuse
The National Institute of Drug Abuse (NIDA) reports that substance abuse often compounds problems stemming from bipolar disorder. People with bipolar disorder who also abuse drugs or alcohol benefit less from any treatment they are receiving, recover more slowly from violent mood swings, and are more likely to commit suicide. A study published by NIDA found that participants with bipolar disorder were most likely to abuse marijuana, followed by cocaine, sedatives, and then opioids, but alcohol is actually the most commonly abused substance among all those suffering from bipolar disorder.
If a loved one has signs of substance abuse, it’s never too late to seek help. Signs of substance abuse for those with bipolar disorder include:
- Isolation from family and friends
- Loss of interest in favorite activities
- Unusual or disruptive sleep patterns
- Changes in appetite
- Increased irritability
- Excessive fatigue
- Intense energy levels
The Road to Recovery
If a loved one has bipolar disorder and demonstrates signs of substance abuse, it’s critical to address the substance abuse before attempting to ease any manic or depressive symptoms. Medications that doctors commonly prescribe to treat bipolar disorder can have the opposite of the intended effect when mixed with drugs or alcohol, which will only serve to exacerbate symptoms.
The first step on the road to recovery is entering a detox program. An ambulatory detox program can be effective for clients who need to undergo a supervised medical detox without the restrictive environment, which can be stressful for those with bipolar disorder. After completing detox and getting medical clearance, people can then undergo an intensive outpatient program, which may include Cognitive Behavioral Therapy, Motivational Interviewing, and complementary therapies. The ultimate goal of the program is stability on all fronts, and that includes addressing issues with substance abuse and all co-occurring disorders, including bipolar disorder.
Following an intensive outpatient program, clients can enter a standard outpatient program, where they will partake in various types of therapies and continue to have access to a supportive environment for that stage of recovery.
Confronting substance abuse may not be easy, but it will improve life immensely for those suffering from bipolar disorder and for their families. Comprehensive treatment can help those suffering from bipolar disorder and co-occurring bipolar disorder; reach out for the help that’s needed today.