Bipolar Disorder and Substance Use Disorder

Reviewed Oct 19, 2017

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Summary

  • The two often co-exist.
  • Dual diagnosis means you are at greater risk.
  • Both need to be treated together.

Many times substance use disorders co-exists with bipolar disorder. When these two illnesses appear at the same time in one person, it is called a dual diagnosis. One study showed that as many as 60 percent of people with bipolar also have a drug problem. Drinking problems were shown to affect twice as many people with bipolar than those who only have depression.

The reason for this is not fully known. It is thought that bipolar and drug use affects the same chemicals in the brain. Some studies suggest that people with bipolar may try to treat themselves, or “self-medicate” through drug use. Also, the impulsivity and raised mood state of mania may support or lead to drug use. Having a bipolar diagnosis is a risk factor for, and may lead to, substance use disorder. At the same time, substance use disorder may create symptoms of bipolar. Also, there may be linked genetic and hereditary factors as both bipolar and drug problems run in families.

Risks

Studies show that people with this dual diagnosis have a greater chance of:

  • Social withdrawal
  • Violence
  • Homelessness
  • Unemployment
  • Hospitalization
  • Incarceration
  • Physical illness
  • Psychosis
  • HIV/AIDS

Treatment is more difficult with two disorders. Medicine compliance is a problem. People who are dual diagnosed are more likely to relapse than those with just one disorder. Problem drinking worsens the symptoms of bipolar. However, these two comorbid illnesses can be successfully treated. Finding the right treatment program, medications, and support of others goes a long way toward progress and stability.

Medications for bipolar disorder

There are three main mood stabilizers used in treating bipolar. These are lithium, carbamazepine (sometimes called Tegretol), and valproate (sometimes called Depakote®).

  1. Lithium is most often used for single diagnosis bipolar. Some studies have shown lithium to be less helpful when there is also a drinking problem.
  2. Carbamazepine is an anticonvulsive used in the care of bipolar. It also helps control withdrawal symptoms.
  3. Valproate, like alcohol, has been linked to liver failure in rare cases. But studies have shown it to be mostly safe and useful for help with bipolar and a drinking problem. Care should be used in young women. Studies have shown a potential for polycystic ovary syndrome or congenital defects  for infants who were exposed to it in the womb.

Mood stabilizing antipsychotics

Some cases of a bipolar disorder call for antipsychotics. They are helpful in controlling acute manic or mixed episodes.

Zyprexa® is useful for treating severe mania. It can be injected to give fast relief of symptoms. Side effects include weight gain and may increase the chance of heart disease and diabetes.

Abilify® and Seroquel® are alternatives to Zyprexa®, and are less likely to give the same such side effects. Latuda® has shown efficacy in bipolar depression. Saphris® has also shown results in bipolar disorder. They are both useful in treating mild or severe cases of acute mania. Other antipsychotics sometimes taken include Risperdal® and Geodon®.

Medication for substance use disorders

Naltrexone is showing some promise in lowering alcohol addiction. It is also used in relapse prevention for opiate use. Other medications indicated for alcohol use disorder are Acamprosate (Campral) and Disulfiram (Antiabuse).  

Unified treatment

Successful treatment for people with a dual diagnosis calls for both to be treated at the same time. This is because bipolar and drug overuse affects each other. Focusing on just one problem may give temporary results. The chances for relapse and a hospital stay greatly increase if both aren’t being treated at the same time.

This includes:

  • Counseling and group therapy
  • Social interaction and support
  • Education and motivation
  • Staying active
  • Accountability
  • Goal setting and monitoring
  • Taking care of stress
  • Behavioral and coping skills

It also includes family and community help. People with bipolar and substance use disorders cannot help themselves alone. Often they do not even know how their illness affects others because they cannot see the results of their actions. Dual diagnosis treatment is a lifelong process. It is vital that family members give nonstop support and seek involvement in treatment.

Patience and support work better than guilt and blame. Positive reinforcement is needed to help people beat the harmful feelings they have toward themselves and their condition. Al-Anon Family Groups offer education and support. With treatment and support bipolar and substance use disorders can be controlled and a healthy, meaningful, and productive life is possible. 

Resources

Al-Anon Family Groups
https://al-anon.org/

The Balanced Mind Foundation
www.dbsalliance.org/site/PageServer?pagename=bmpn_landing

Depression and Bipolar Support Alliance
www.dbsalliance.org

Dual Diagnosis Website
http://users.erols.com/ksciacca/

National Institute of Mental Health Medications Booklet
www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml

By Kevin Rizzo
Source: National Alliance on Mental Illness, /www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23049; National Institute on Alcohol Abuse and Alcoholism, http://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

Summary

  • The two often co-exist.
  • Dual diagnosis means you are at greater risk.
  • Both need to be treated together.

Many times substance use disorders co-exists with bipolar disorder. When these two illnesses appear at the same time in one person, it is called a dual diagnosis. One study showed that as many as 60 percent of people with bipolar also have a drug problem. Drinking problems were shown to affect twice as many people with bipolar than those who only have depression.

The reason for this is not fully known. It is thought that bipolar and drug use affects the same chemicals in the brain. Some studies suggest that people with bipolar may try to treat themselves, or “self-medicate” through drug use. Also, the impulsivity and raised mood state of mania may support or lead to drug use. Having a bipolar diagnosis is a risk factor for, and may lead to, substance use disorder. At the same time, substance use disorder may create symptoms of bipolar. Also, there may be linked genetic and hereditary factors as both bipolar and drug problems run in families.

Risks

Studies show that people with this dual diagnosis have a greater chance of:

  • Social withdrawal
  • Violence
  • Homelessness
  • Unemployment
  • Hospitalization
  • Incarceration
  • Physical illness
  • Psychosis
  • HIV/AIDS

Treatment is more difficult with two disorders. Medicine compliance is a problem. People who are dual diagnosed are more likely to relapse than those with just one disorder. Problem drinking worsens the symptoms of bipolar. However, these two comorbid illnesses can be successfully treated. Finding the right treatment program, medications, and support of others goes a long way toward progress and stability.

Medications for bipolar disorder

There are three main mood stabilizers used in treating bipolar. These are lithium, carbamazepine (sometimes called Tegretol), and valproate (sometimes called Depakote®).

  1. Lithium is most often used for single diagnosis bipolar. Some studies have shown lithium to be less helpful when there is also a drinking problem.
  2. Carbamazepine is an anticonvulsive used in the care of bipolar. It also helps control withdrawal symptoms.
  3. Valproate, like alcohol, has been linked to liver failure in rare cases. But studies have shown it to be mostly safe and useful for help with bipolar and a drinking problem. Care should be used in young women. Studies have shown a potential for polycystic ovary syndrome or congenital defects  for infants who were exposed to it in the womb.

Mood stabilizing antipsychotics

Some cases of a bipolar disorder call for antipsychotics. They are helpful in controlling acute manic or mixed episodes.

Zyprexa® is useful for treating severe mania. It can be injected to give fast relief of symptoms. Side effects include weight gain and may increase the chance of heart disease and diabetes.

Abilify® and Seroquel® are alternatives to Zyprexa®, and are less likely to give the same such side effects. Latuda® has shown efficacy in bipolar depression. Saphris® has also shown results in bipolar disorder. They are both useful in treating mild or severe cases of acute mania. Other antipsychotics sometimes taken include Risperdal® and Geodon®.

Medication for substance use disorders

Naltrexone is showing some promise in lowering alcohol addiction. It is also used in relapse prevention for opiate use. Other medications indicated for alcohol use disorder are Acamprosate (Campral) and Disulfiram (Antiabuse).  

Unified treatment

Successful treatment for people with a dual diagnosis calls for both to be treated at the same time. This is because bipolar and drug overuse affects each other. Focusing on just one problem may give temporary results. The chances for relapse and a hospital stay greatly increase if both aren’t being treated at the same time.

This includes:

  • Counseling and group therapy
  • Social interaction and support
  • Education and motivation
  • Staying active
  • Accountability
  • Goal setting and monitoring
  • Taking care of stress
  • Behavioral and coping skills

It also includes family and community help. People with bipolar and substance use disorders cannot help themselves alone. Often they do not even know how their illness affects others because they cannot see the results of their actions. Dual diagnosis treatment is a lifelong process. It is vital that family members give nonstop support and seek involvement in treatment.

Patience and support work better than guilt and blame. Positive reinforcement is needed to help people beat the harmful feelings they have toward themselves and their condition. Al-Anon Family Groups offer education and support. With treatment and support bipolar and substance use disorders can be controlled and a healthy, meaningful, and productive life is possible. 

Resources

Al-Anon Family Groups
https://al-anon.org/

The Balanced Mind Foundation
www.dbsalliance.org/site/PageServer?pagename=bmpn_landing

Depression and Bipolar Support Alliance
www.dbsalliance.org

Dual Diagnosis Website
http://users.erols.com/ksciacca/

National Institute of Mental Health Medications Booklet
www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml

By Kevin Rizzo
Source: National Alliance on Mental Illness, /www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23049; National Institute on Alcohol Abuse and Alcoholism, http://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

Summary

  • The two often co-exist.
  • Dual diagnosis means you are at greater risk.
  • Both need to be treated together.

Many times substance use disorders co-exists with bipolar disorder. When these two illnesses appear at the same time in one person, it is called a dual diagnosis. One study showed that as many as 60 percent of people with bipolar also have a drug problem. Drinking problems were shown to affect twice as many people with bipolar than those who only have depression.

The reason for this is not fully known. It is thought that bipolar and drug use affects the same chemicals in the brain. Some studies suggest that people with bipolar may try to treat themselves, or “self-medicate” through drug use. Also, the impulsivity and raised mood state of mania may support or lead to drug use. Having a bipolar diagnosis is a risk factor for, and may lead to, substance use disorder. At the same time, substance use disorder may create symptoms of bipolar. Also, there may be linked genetic and hereditary factors as both bipolar and drug problems run in families.

Risks

Studies show that people with this dual diagnosis have a greater chance of:

  • Social withdrawal
  • Violence
  • Homelessness
  • Unemployment
  • Hospitalization
  • Incarceration
  • Physical illness
  • Psychosis
  • HIV/AIDS

Treatment is more difficult with two disorders. Medicine compliance is a problem. People who are dual diagnosed are more likely to relapse than those with just one disorder. Problem drinking worsens the symptoms of bipolar. However, these two comorbid illnesses can be successfully treated. Finding the right treatment program, medications, and support of others goes a long way toward progress and stability.

Medications for bipolar disorder

There are three main mood stabilizers used in treating bipolar. These are lithium, carbamazepine (sometimes called Tegretol), and valproate (sometimes called Depakote®).

  1. Lithium is most often used for single diagnosis bipolar. Some studies have shown lithium to be less helpful when there is also a drinking problem.
  2. Carbamazepine is an anticonvulsive used in the care of bipolar. It also helps control withdrawal symptoms.
  3. Valproate, like alcohol, has been linked to liver failure in rare cases. But studies have shown it to be mostly safe and useful for help with bipolar and a drinking problem. Care should be used in young women. Studies have shown a potential for polycystic ovary syndrome or congenital defects  for infants who were exposed to it in the womb.

Mood stabilizing antipsychotics

Some cases of a bipolar disorder call for antipsychotics. They are helpful in controlling acute manic or mixed episodes.

Zyprexa® is useful for treating severe mania. It can be injected to give fast relief of symptoms. Side effects include weight gain and may increase the chance of heart disease and diabetes.

Abilify® and Seroquel® are alternatives to Zyprexa®, and are less likely to give the same such side effects. Latuda® has shown efficacy in bipolar depression. Saphris® has also shown results in bipolar disorder. They are both useful in treating mild or severe cases of acute mania. Other antipsychotics sometimes taken include Risperdal® and Geodon®.

Medication for substance use disorders

Naltrexone is showing some promise in lowering alcohol addiction. It is also used in relapse prevention for opiate use. Other medications indicated for alcohol use disorder are Acamprosate (Campral) and Disulfiram (Antiabuse).  

Unified treatment

Successful treatment for people with a dual diagnosis calls for both to be treated at the same time. This is because bipolar and drug overuse affects each other. Focusing on just one problem may give temporary results. The chances for relapse and a hospital stay greatly increase if both aren’t being treated at the same time.

This includes:

  • Counseling and group therapy
  • Social interaction and support
  • Education and motivation
  • Staying active
  • Accountability
  • Goal setting and monitoring
  • Taking care of stress
  • Behavioral and coping skills

It also includes family and community help. People with bipolar and substance use disorders cannot help themselves alone. Often they do not even know how their illness affects others because they cannot see the results of their actions. Dual diagnosis treatment is a lifelong process. It is vital that family members give nonstop support and seek involvement in treatment.

Patience and support work better than guilt and blame. Positive reinforcement is needed to help people beat the harmful feelings they have toward themselves and their condition. Al-Anon Family Groups offer education and support. With treatment and support bipolar and substance use disorders can be controlled and a healthy, meaningful, and productive life is possible. 

Resources

Al-Anon Family Groups
https://al-anon.org/

The Balanced Mind Foundation
www.dbsalliance.org/site/PageServer?pagename=bmpn_landing

Depression and Bipolar Support Alliance
www.dbsalliance.org

Dual Diagnosis Website
http://users.erols.com/ksciacca/

National Institute of Mental Health Medications Booklet
www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml

By Kevin Rizzo
Source: National Alliance on Mental Illness, /www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23049; National Institute on Alcohol Abuse and Alcoholism, http://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

The information provided on the Achieve Solutions site, including, but not limited to, articles, quizzes, and other general information, is for informational purposes only and should not be treated as medical, health care, psychiatric, psychological or behavioral health care advice. Nothing contained on the Achieve Solutions site is intended to be used for medical diagnosis or treatment or as a substitute for consultation with a qualified health care professional. Please direct questions regarding the operation of the Achieve Solutions site to Web Feedback. If you have concerns about your health, please contact your health care provider.  ©2017 Beacon Health Options, Inc.

 

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