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Bipolar Disorder and Substance Abuse

In the multimedia cyber world, awareness of bipolar disorder continues to grow. You can go online and search for “Celebrities with Bipolar Disorder” and some of the names that will come up are Britney Spears, Mel Gibson, Ben Stiller, Kurt Cobain, Ozzy Osbourne, Macy Gray, Axl Rose, Virginia Woolf, Linda Hamilton, Sting, Jean-Claude Van Damme and many others. Since celebrities are in the public eye and constantly under the watchful eye of the media, any unusual behavior is seen and scrutinized.

Many people with mood disorders can remember years or years of manic and depressive behaviors. They did not seek help until the function of their daily activities was significantly impaired. Before seeking help, some people with mood disorders try to cope with their manic-depressive mood swings either through exercise, hobbies, yoga, art, music, or talking with close friends or family. Unfortunately, most individuals choose to self-medicate with alcohol and illicit drugs. 60% of people with bipolar disorder will develop an addiction disorder at some point in their lives.

Bipolar disorder is categorized as a mood disorder in which a person cycles between a manic state (hyperactivity, distractibility, reduced need for sleep, grandiose behavior, flight of ideas, racing thoughts, pressure/rapid speech, impulsivity, poor judgment, hypersexuality, leisure spending, dangerous behavior and unrealistic optimism) and depressed mood (sadness, crying spells, reduced sleep, loss of interest or pleasure in activities or hobbies, excessive guilt, low energy/motivation, weight gain, feelings of helplessness/hopelessness/worthlessness, restlessness or irritability, poor concentration, and suicidal thoughts thoughts or attempts).

The prevalence of bipolar disorder in the United States is 1-2% of the general population. The age of onset is around 19 years, with most cases occurring between the ages of 15 and 20. The incidence between men and women with bipolar disorder is equivalent with no general association with socioeconomic class or ethnic group. Only one-third of those with a mood disorder are officially diagnosed by a doctor, and of that one-third, approximately 25% actually receive treatment. Untreated bipolar disorder has a lifetime risk of outright suicide of 15%.

A person with a mood disorder can look very different when they are manic or depressed, which is why the disorder is often misdiagnosed. In terms of substance abuse, often an individual can deal with their depression by using cocaine as a mood booster. When coping with their mania, an individual may consume alcoholic beverages, benzodiazepines, or opiates to bring down their mood. The question that needs to be asked is whether substance abuse is the result of bipolar disorder or whether the signs and symptoms of bipolar disorder (mood swings of mania and depression) are the result of substance abuse. Such individuals may be bounced back and forth from psychiatric hospitals or drug rehabilitation centers. Often, individuals are denied treatment or are frustrated with the system and are no longer receiving treatment.

To better address this issue, Dual Diagnosis or Mental Illness and Chemical Dependence (MICA) units have been developed. These units recognize both “mental illness” (major depression, bipolar or schizophrenia) and “substance abuse”. These units consist of psychiatrists, nurses, psychologists, therapists, social workers and other support staff. Such programs provide a medically supervised and safe detoxification process; an individualized treatment plan that addresses both psychiatric illness and substance abuse and a central location that limits disruption and improves continuity of care.

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