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According to the National Institute on Drug Abuse, people who have bipolar disorder are twice as likely to struggle with substance use disorder (SUD). Bipolar disorder and substance use disorder intersect at many levels for various people. Since having bipolar can lead to or worsen SUD symptoms, many people view the two as related.

When a person has a diagnosis of substance use disorder with bipolar, they have co-occurring disorders or dual diagnosis. Even though the term "dual diagnosis" is singular, people with co-occurring conditions must get integrated treatment for each illness for improved life quality.

What Is Bipolar Disorder?

Bipolar is a mental illness that causes people to experience manic episodes and depressive episodes. The condition can cause severe mood swings, making it difficult to function in day-to-day life.

Moods: The Highs and Lows

There are many moods a person can experience, but bipolar is a mood disorder that turns people into uncontrollable energy—experienced as highs and lows—that is difficult to manage.

When discussing bipolar, it's essential to understand the meaning of "high" and "low."

Energy, joy, contentment, confidence, euphoria or feelings of being productive typically characterize a high mood. But it does not mean that these feelings are always present all the time.

A low mood for a person with bipolar can mean a feeling of being overwhelmed, a loss of hope, a loss of motivation, a feeling of being a "failure," or a lack of interest in things once enjoyed. These feelings can be crippling and can have a way of spiraling into worsened and difficult emotions.

How Are Moods Experienced with Bipolar?

The general characteristics of bipolar are mood episodes, which include mania, hypomania and major depression. These periods can last anywhere from several days to weeks at a time.

Mania is by far the most common symptom of bipolar disorder, and it's a state in which you have elevated moods and a lot of energy.
Hypomania is a state like mania in that you have high moods and tons of energy, but unlike mania, it doesn't last as long.
Major depression is when you have lowered moods and little or no energy that lasts for an extended period.

The Connection Between Drugs and Bipolar

Clinical experts link both genetics and brain chemistry to the development of bipolar disorder and addictions. These influences may work together to increase the likelihood of developing either or both conditions. Experts also believe that many people with bipolar have aberrant amounts of neurotransmitters, including norepinephrine, dopamine and serotonin.

People suffering from this bipolar often resort to drugs or alcohol to soothe their emotional turmoil. Usually, people with mood disorders have worse symptoms when they misuse substances.

Depressants

Depressants or "downers" increase serotonin and dopamine concentrations in the brain, which lead to a feeling of relaxation, reduced anxiety and freedom from inhibitions. When people with bipolar experience mania or hypomania, they may drink alcohol or take drugs like oxycodone or heroin to calm themselves down and lessen arousal.

Stimulants

Psychostimulants or "uppers" increase levels of dopamine and norepinephrine, leading to a feeling of euphoria. When in a depressive episode, a person with bipolar may use amphetamines or cocaine to lift their mood. People often use other drugs, like cannabis and nicotine, to manipulate mood responses in their bodies.

Why Do People with Bipolar Self-Medicate?

There are many benefits of self-medicating, but the repercussions may outweigh the rewards. Not only does bipolar disorder present a struggle that the individual must overcome, but it also compromises their ability to lead a healthy life.

Many patients resort to self-medicating their symptoms because prescribed medications don't always work the way they should. For instance, antipsychotics make people less hyperactive but make them even more paranoid.

There are many methods to self-medicate those experiencing mental health issues, like eating certain foods, relaxation therapy or therapeutic drugs.

The Self-Medication Hypothesis

According to the Self-medication Hypothesis established in 1985, self-medication could be a kind of SUD. The theory implies that individuals respond to mental illness by using drugs. A broad range of mental health issues, including depression and bipolar, reportedly compels some individuals to misuse alcohol and substances.

Research shows that self-medicating individuals gravitate to whichever drug relieves their symptoms the greatest. Still, some contend that self-medicating with drugs may lead to the development of mental health symptoms. Some substances, including alcohol and other drugs, may exacerbate anxiety symptoms, according to the Anxiety and Depression Association of America.

Does Self-Medicating Cause Substance Use Disorder?

Substance use disorder is an often-misunderstood mental disorder that may lead to impaired daily functioning, overdoses, a range of health complications, interpersonal problems and other issues—primarily involving alcohol, cannabis, cocaine, heroin, meth, nicotine or opioids.

With bipolar, episodic moods determine how a person responds to life events. Not having immediate control because of the illness can frustrate a person and justify their need to self-medicate.

While it is not definite that self-medication develops into substance use disorder, it is still substance misuse. Self-medication can have a detrimental effect on the mental health of a person with bipolar because using substances like recreational drugs and alcohol does not resolve the root problem.

How Is Bipolar and Substance Use Disorder Treated?

Many professionals and patients regard psychopharmacology as the most popular way of dealing with bipolar, but other treatments can be just as effective. Ones that fall into this group are psychosocial interventions, such as individual psychotherapy, family therapy, social rhythm therapy, peer support groups and intervention groups.

Treatment options for addressing substance use disorder include behavioral, psychosocial, therapeutic and pharmacological approaches. Although these treatment options vary by the severity of the condition or substances used, all treatments focus on decreasing the adverse effects of disordered substance use.

Integrated therapy, which aims to treat bipolar illness and substance misuse concurrently, has quickly gained favorable acceptance in many substance use treatment and recovery facilities.

Psychotherapy comes in several forms that integrate with various treatments. For example, you may have detox or sessions with a substance use expert and have individual therapy with a mental health professional or join therapy and support groups.

Though there are many choices, you should first speak with your doctor or mental health clinician to determine which is best for you. You will get guidance in choosing a therapy that has the most significant possibility of helping you succeed.

R. Antonio Matta

Why are Bipolar Disorder and Substance Use Often Mentioned Together?