Substance use disorder and bipolar disorder often co-occur, and treating one without the other usually does not result in long-lasting stabilization. The phenomenon known as psychiatric comorbidity is quite prevalent. It is the subject of extensive research to understand how the two disorders interrelate and how to get appropriate bipolar disorder treatment.
What Is Dual Diagnosis?
Dual diagnosis entails the presence of a mental illness, including bipolar disorder, as well as a substance use disorder in an individual. People who have bipolar disorder experience changes in their moods that may vary from manic episodes to feeling very low and depressed.
Substance use can complicate the treatment of the mood disorder because of its interaction with the mood changes experienced. When assessing the patient’s condition, the psychiatrist would usually conduct the screening to diagnose any signs of substance abuse in addition to bipolar disorder.
Why Do Bipolar Disorder and Substance Use Disorders Occur Together?
There are several explanations for why the two disorders usually go hand in hand rather than occurring separately.
A large epidemiological study found that individuals with bipolar disorder had a lifetime prevalence of any substance use disorder of 56.1%, with 60.7% for bipolar I and 48.1% for bipolar II, compared with 13.8% in the general population.
During manic or hypomanic episodes, reduced activity in the prefrontal cortex, the part of the brain responsible for judgment and impulse regulation, can make risky behavior, including substance use, more likely. Social stigma around mental health also plays a role in how the connection gets missed, and this is part of why bipolar disorder and addiction cases in India often go unrecognized until a crisis forces the issue. Families sometimes notice the substance use and address that directly, without recognizing the underlying mood disorder driving it.
How Substance Use Can Affect Bipolar Symptoms
It is also common for individuals struggling with undiagnosed or improperly treated bipolar disorder to turn to alcohol or drugs to cope with the symptoms of their illness, which is known as self-medicating.
During manic episodes, when the brain is overexcited, sleep is impossible, and racing thoughts occur, alcohol, marijuana, and sedatives can be used to calm everything down. When depressed, due to fatigue and low mood, drugs or alcohol can be used to experience something, as well as to stop experiencing something. In both cases, however, this is only short-term relief, because mood instability remains unchanged, but is worsened.
This behavior can exacerbate the problem and make bipolar disorder treatment much more complicated in the future. Alcohol and drugs affect the efficiency of psychiatric medication, disturb sleep, and can also cause mood episodes by themselves.
Signs That Someone May Need Dual-Diagnosis Treatment
Identifying when the two have become entangled is challenging, especially for family members trying to understand what is happening. A couple of patterns to look out for include:
- Increased or more severe mood episodes, along with higher levels of substance use
- Substance use to help regulate insomnia, racing thoughts, or depression
- Signs of withdrawal or agitation following the termination of substance use
- A trend where psychiatric medication is introduced and then stopped in favor of continued substance use
- Growing challenges in fulfilling obligations at work and in social interactions
None of these signs alone confirms dual diagnosis, but a combination of them is generally a reasonable indication that a full psychiatric and substance use evaluation is worth pursuing.
What Treatment for Bipolar Disorder and Addiction May Include
Bipolar disorder Treatment and substance abuse should cover both disorders simultaneously rather than sequentially.
If the patient suffers from substance dependence, medically supervised detoxification should be done first, since quitting some substances might cause a sudden mood fluctuation or withdrawal effects, which need medical supervision.
After that, mood stabilization needs to be done with the help of mood stabilizers such as lithium, divalproex, and atypical antipsychotics. It helps stabilize the individual’s mood, making him less likely to self-medicate.
Once this stage is completed, psychotherapy becomes especially important. Cognitive behavioral therapy and dialectical behavior therapy should be considered to identify triggers, change negative thoughts, and learn how to control emotions. Relapse prevention planning, which involves teaching the patient how to cope with stress without falling into substance abuse, is also included.
Another useful step would be engaging the family in the treatment process. Through family therapy and psychoeducation, family members receive information about the biological causes of the disorders, and the process of restoring trusting relationships begins.
Why Integrated Treatment Matters
If bipolar disorder and drug abuse are addressed separately, or in a sequential fashion rather than simultaneously, there will usually be some kind of disconnect. A patient may go through a detoxification process but then discover that their undiagnosed mood disorder symptoms flare up again soon after they are released from the facility.
The process of coordinated treatment, where a single clinical team combines bipolar disorder treatment and an addiction program, is usually more coherent, since both disorders will be taken into consideration. This does not mean that treatment will be easier; it just means it will take into account how these two disorders affect each other.
When Should Families Seek Professional Help?
Families usually avoid seeking treatment, hoping things will get better on their own, and are unsure whether the problem really needs professional attention. Should your family member show symptoms that the treatment of their mood swings and substance abuse is becoming more complicated, the consultation of a psychiatrist should be taken into consideration.
It isn’t necessary to know the exact diagnosis when conducting the first evaluation. Athena Behavioral Health and its qualified psychiatrists in Delhi, Noida, Gurgaon, and Guwahati examine you with care, identify whether there are any two disorders present, and suggest appropriate treatment based on the specifics of the case.
The treatment of both disorders requires the combination of services offered by both psychiatric and addiction clinics. At Athena Behavioral Health, our specialists from both fields collaborate to evaluate and treat both disorders at once. If you observe this combination in your relatives, then it could be a good idea to consider visiting our bipolar disorder and addiction treatment program.