Bipolar disorder is already challenging to manage. The fact that over 40% of patients end up addicted to alcohol or drugs can make the road to recovery seem even bumpier.
Fortunately, treatment is still possible. You can even find it nearby without having to cross state lines.
Read on to learn more about co-occurring bipolar disorder, how it’s diagnosed, the valid treatment options, and how Recreate Life Counseling can help.
The Relationship Between Bipolar Disorder and Addiction
Let’s start by exploring the relationship between bipolar disorder (BD) and the different substance use disorders (SUDs).
Common BD and Addiction Pairings
Alcohol and cannabis are the two most commonly abused substances among people with BD. Cocaine and opioid addictions are also frequently abused, but they’re not as common as alcohol or weed.
BD has been associated with an increased risk for behavioral addictions in general. Gambling is one such behavioral addiction. One study estimates that 1 in 10 BD patients is at moderate-to-severe risk of problem gambling.
Another study indicated a higher susceptibility to problem smoking, with a lower quitting rate.
Over 68% of all BD patients were currently smoking and 82.5% smoked at some point in their lifetimes. In comparison, only 22.5% of people with no diagnosed mental illness were current smokers and around 39% were lifetime smokers.
The quit rate for non-mentally ill participants was 42.5%. Meanwhile, the BD group had a quit rate of a mere 16.6%! This was actually the lowest quit rate among other mental health conditions, including major depression, dysthymia, generalized anxiety disorder, and PTSD.
Correlation or Causation
It’s perfectly normal to wonder whether bipolar disorder and addiction had anything to do with one another or just exist independently.
After all, the high prevalence between BD and substance abuse indicates that one is perhaps causing the other. And there is some science behind this idea.
Research from the Royal College of Psychiatrists explores two possible interactions:
- Self-medication
- Shared neurobiology
The self-medication angle is built on the idea that people with BD may resort to alcohol or drugs to ease the symptoms. Keep in mind that restlessness, mood swings, racing thoughts, sleep disturbances, and difficulty focusing are all common symptoms of BD.
The research also points out that 25% of BD patients increase their alcohol use during manic episodes. As for depressive episodes, there was no significant increase in alcohol consumption.
This indicates that the self-medication mechanism is possible but not really all that common, at least not when it comes to BD and alcoholism.
So let’s focus on the second possibility for now.
Experts believe that the subtle changes in brain chemistry/function that put people at risk of BD can also make it easier for addiction to develop.
For instance, hypomanic symptoms are a sign that the person is at higher risk of developing BD. However, there’s evidence that people with high rates of hypomanic symptoms also have dampened alcohol responses, which can contribute to alcohol misuse over time.
Genetic predisposition can also increase a person’s risk of developing both BD and SUDs.
Side Note: It’s also worth noting that substance abuse itself can cause a mood disorder. This can be referred to as a substance-induced condition.
Outcome Changes
Even if addiction doesn’t directly cause BD, it can make its symptoms worse. Plus, it can affect the clinical outcomes and make treatment more complicated.
For one, research from the Royal College of Psychiatrists reveals that addiction is associated with more intense manic episodes and higher relapse rates among BD patients.
But that’s not to say that recovery isn’t possible.
People can and do recover. It takes dedicated treatment programs, though.
The Integrated Approach to Treatment
When you’re dealing with co-occurring disorders, you can’t really ignore one aspect. It won’t help to blame BD only for all your problems or address addiction only and hope everything else sorts itself out.
Sequential treatment (treating one condition, then the other) isn’t the most effective option, either. In fact, experts consider it to be a barrier to quality care.
So, what’s the better route? For most people, it’s the one that acknowledges the existence of both conditions and addresses them at the same time.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are three models for delivering treatment to patients with a dual diagnosis. They are:
- Coordinated
- Co-located
- Fully integrated
Currently, SAMHSA recommends the fully integrated approach to care.
Integrated care tackles both conditions concurrently in a stepwise, individualized approach. More often than not, clients are offered multiple treatment formats, and we’ll get to the different formats in a minute.
Who to See for a Dual BD-Addiction Diagnosis
The idea of integrated care is heavily dependent on the care team’s expertise. Guidelines state that the treatment providers have to be trained in both disorders.
So, the best treatment facility for you is one with experts in substance abuse and BD specifically. They should be familiar with how addiction exacerbates the symptoms of BD and how BD medications may interact with addiction treatment medications.
Bipolar Disorder Screening at Rehab Centers
Most addiction treatment facilities now screen for mental health issues on admission. So, if there’s any co-occurring condition (be it BD or something else), they’ll be able to detect it early and adjust the treatment plan accordingly.
In fact, over 85% of the substance use treatment facilities in Florida screen for mental disorders.
Much like many other mental disorders, BD is diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders (DSM). Besides confirming the diagnosis, psychiatrists and therapists at rehab centers rely on the DSM to figure out the exact classification of the disease.
There are actually a few types of bipolar disorder. The guidelines acknowledge two major ones: bipolar I disorder and bipolar II disorder.
Evidence-Based Treatment Formats
As we’ve clarified earlier, integrated care has to be personalized. The treatment plan for one client doesn’t have to match the next. Yes, even if they both have similar addictions and confirmed BD diagnoses.
That being said, there are a few common evidence-based therapies used often in integrated care.
Medications
BD is one of the mental health disorders that typically requires medication management as the first-line treatment.
Depending on the case specifics, psychiatrists might prescribe drugs, such as:
- Mood stabilizers: Lithium
- Anticonvulsants: Carbamazepine, lamotrigine, or valproate
- Antipsychotics: Quetiapine, risperidone, aripiprazole, or cariprazine
Therapy
Psychotherapy is likely going to be included in the treatment plan in multiple forms and for several reasons.
For one, it’s essential for addiction treatment. Plus, it’s also considered an adjunct to medications for treating BD.
Expect to see both individual therapy and group therapy sessions incorporated into the plan. Some sessions might teach coping skills, while others might use cognitive behavioral therapy (CBT) to challenge negative thought patterns.
Note that CBT can address depressive symptoms of BD as well.
The Ideal Treatment Setting for Co-Occurring BD
Treatment for co-occurring BD and addiction usually takes place over a range of settings.
Patients start with the highest levels of care found in inpatient/residential treatment programs. There, they receive round-the-clock support as they:
- Detox their body from the addictive substance.
- Stabilize their mental state between mania and depression.
As patients progress along the treatment plan, their needs drop. They no longer need 24/7 monitoring or strict schedules. In fact, they might not need to stay in the treatment facility at all.
At this point, stepping down to a lower level of care is a smart choice. And the next step along the line is usually an intensive outpatient program (IOP) or a partial hospitalization program (PHP).
Cure vs. Treatment
Both substance use and bipolar disorders are treatable. They’re not curable, though. This means that you’ll have to continue managing the cravings/symptoms even after you’re done with the rehab phase.
That’s why aftercare planning is an essential step for relapse prevention. Patients will likely continue receiving therapy and attending some sort of support group for a long time.
How Recreate Life Counseling Can Help
Located in Boynton Beach, Recreate Life Counseling is a certified and accredited addiction treatment provider.
Our multifaceted teams can address dual diagnosis cases in both PHP and IOP settings, making our facility an ideal choice for step-down care after stabilization.
FAQs
How long does bipolar disorder treatment take?
Mood stabilizers alone need a minimum of two weeks to take effect. Antidepressants, on the other hand, can take 4–6 weeks.
Is inpatient treatment better for BD than outpatient programs?
Inpatient treatment offers a higher level of care, which makes it a better fit for patients who need stabilization. Yet, most individualized treatment plans will include step-downs to lower levels of care as needed.
How to make diagnosis easier and more accurate?
Seeking help from multifaceted teams with experience in both BD and substance abuse is important.
But it’s also important to be honest and open with your care teams. Remember that no one is here to judge you.
How to help a loved one with bipolar disorder?
If you know someone with a co-occurring BD, you might not be able to fully understand their struggle. Still, you can:
- Educate yourself on their mental illness and how it relates to addiction.
- Offer to take them to their appointments.
- Offer to participate in family therapy.
- Offer to handle some of their responsibilities (like pet care) as they finish their residential program.
- Stop being an enabler.
Keep in mind that there might be a point when cutting ties becomes the right move. However, there’s no need to jump to that conclusion without evaluating the relationship, setting boundaries, and trying to get your loved one help.
Does insurance cover co-occurring BD treatment?
Under the Affordable Care Act, insurance providers are required to cover mental health and substance abuse treatment services.
That said, the coverage level will vary depending on the bipolar disorder treatment center and the selected treatments. HMO plans might not be accepted, too.
At Recreate Life Counseling, we offer free insurance verification. Simply fill out a form to find out more about your (or your loved one’s) coverage.
Choose Early Detection and Integrated Care
Recovering from co-occurring bipolar disorder and addiction is possible. To boost the chances, look for facilities that offer integrated, comprehensive, and person-centered treatment.
With a combination of mood stabilizers, psychotherapy, and peer support, patients can learn to manage both conditions and regain control of their lives.
Always remember that early detection can make a major difference.
