A Dual Diagnosis

closeup of woman holding man's hand in support - bipolarThe symptoms of bipolar disorder can often be masked by active substance abuse, but these conditions are two separate mental health issues. For a lasting recovery, both must be treated simultaneously.

If your loved one has been diagnosed with both bipolar disorder and a substance use disorder, educating yourself on this dual diagnosis can help you provide the support necessary for a successful recovery.

About Bipolar Disorder

Bipolar disorder, previously known as manic depression, is a type of mental illness that causes alternating periods of extreme high and low moods. During episodes of depression, a person may be listless, withdrawn, and exhibit a generally pessimistic outlook. During episodes of mania or hypomania, the person will seem extremely energetic and have little need for sleep. Agitation and irritability can also be seen during manic episodes in some individuals.

The DSM-V (Diagnostic and Statistical Manual of Mental Disorders) identifies four different types of bipolar disorder: bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar disorder not otherwise specified (BP-NOS). These classifications are based on patterns in the duration and intensity of the depressive and manic episodes. However, some researchers believe these distinctions are artificial and that the condition can best be described as a spectrum illness.

Bipolar disorder affects about one percent of the general population. About 85 percent of the cause is thought to be genetic, but environmental factors such as exposure to stress and childhood trauma also play a role. Men and women are equally affected.

Bipolar disorder is associated with high risk of self-harm. It’s estimated that 30 to 40 percent of people with this illness have tried to hurt themselves, with six percent attempting suicide.

Bipolar disorder is treated with a combination of antipsychotics and mood stabilizers. Benzodiazepines can be used to treat agitation or combativeness during manic episodes.

Psychotherapy is necessary to develop a better understanding of symptoms and effective coping strategies. In cases where a person is at risk of self-harm, involuntary hospitalization may be required.

The Relationship Between Bipolar Disorder and Substance Abuse

People with bipolar disorder often struggle with addiction to drugs and alcohol, which may have begun as a way to self-medicate the depressive symptoms of the illness. Individuals who enjoy the mania associated with their disorder may abuse stimulants to try to extend manic episodes.

It’s thought that over 50 percent of people with bipolar disorder have struggled with addiction to alcohol or drugs at some point in their lives. Many may also have process addictions such as food, gambling, or sex addiction, since these activities provide the same dopamine boost associated with substance abuse.

Ways to Help a Bipolar Addict Stay Sober

Although you can’t control your loved one’s behavior, there are a number of steps you can take to help a bipolar addict remain in recovery.

  • Go to appointments with your loved one. Even though doctor patient confidentiality prevents disclosing all details regarding your loved one’s care, you can attend appointments to express concerns and report issues you are having as a caregiver.
  • Enforce medication compliance. Taking prescribed medication is non-negotiable, since medication often helps to keep cravings under control in addition to stabilizing a person’s mood. The medications that treat bipolar disorder need to be taken for life, even when the person feels fine and insists that side effects are bothersome.
  • Stress the importance of therapy. Medication can play a big role in managing the symptoms of bipolar disorder, but there’s no magic pill. Ongoing therapy needs to be a part of your loved one’s continuum of care, especially during the first year of recovery.
  • Keep the lines of communication open. Even though your loved one has a dual diagnosis, don’t assume that he or she is incapable of understanding the situation. Let your loved one explain what he or she needs, as much as possible.
  • Pay attention to environmental triggers. Keeping a journal is one way to note patterns of behavior associated with your loved one’s illness. If you make an effort to better understand what triggers erratic mood swings and impulsive behavior, you can develop a plan of action to provide support.
  • Create a stable environment. Stability is essential to reducing mood swings. A set schedule for work, chores, exercise, meals, and socializing also promotes the healthy habits necessary to sustain sobriety.
  • Set realistic limits. Depending upon your loved one’s past behavior, it may be necessary to set limits such as restricting access to credit cards or taking away car keys to avoid reckless driving.
  • Have a crisis plan. It’s unpleasant to think about, but you must be prepared for the worst-case scenario. Everyone in your loved one’s life needs to know what to do in the event of a relapse or attempt at self-harm.
  • Use humor to diffuse tense situations. A lighthearted approach can often do wonders to calm your loved one, as long as your humor isn’t mocking or judgmental.
  • Get support for yourself. Loving someone struggling with bipolar disorder and a substance use disorder can be very stressful. Joining a support group can help you feel less alone. Visit BipolarCaregivers.org for additional information.

To learn more about SJI, PA mental health and addiction recovery center, and our programs, please contact us at (888) 352-3297.