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Bipolar Disorder and Substance Abuse

couple-insurance-assessment Changes in mood and energy levels are a natural part of life. We all experience peaks and valleys in our emotional lives, but if the ups and downs are unusually intense or prolonged, it may be a sign of bipolar disorder. Once known as manic depression, bipolar disorder is characterized by extreme fluctuations in your emotional state or your energy. These opposite — or bipolar — cycles are known as mania and depression. Some bipolar individuals also experience hypomania, a less extreme form of mania. Substance abuse is extremely common in people with bipolar disorder. Drugs and alcohol represent a form of self-medication for many of these individuals, helping them cope with the intensity of a manic high period or a depressive low state. There is also an association between bipolar disorder and poor impulse control.

Hallmark Symptoms

One of the hallmark symptoms of a manic period is the pursuit of risky yet pleasurable behaviors, such as drinking heavily, using drugs, gambling, compulsive shopping, binge eating or promiscuous sex.

People who struggle with bipolar and substance abuse often feel that their lives are out of control. Between their powerful mood cycles and the compulsive urges of addiction, they may feel that they’ve lost all power of self-determination. Dual diagnosis recovery programs can help individuals with bipolar disorder and addiction overcome both conditions, offering a new sense of hope for the future.

Diagnosing Bipolar

Bipolar disorder (BPD) often goes undiagnosed until the results of a major depressive episode or manic state take a dramatic toll on the individual’s life. People with bipolar disorder may simply be perceived as moody or overly emotional, when they are in fact expressing the symptoms of a serious psychiatric illness. How can you tell the difference between ordinary mood changes and BPD? The emotional fluctuations of BPD are more intense and long-lasting than average. They also have a more profound negative impact on an individual’s life. People with BPD may have trouble holding down jobs, maintaining relationships, finishing projects, or succeeding at school. They may have financial problems, legal troubles, and physical health problems as a result of impulsive behaviors. h The Depression and Bipolar Support Alliance reports that nearly 70 percent of individuals with bipolar disorder receive at least one incorrect diagnosis — such as major depression — before they are correctly diagnosed. It may take as long as 10 years, on average, for an individual to be accurately diagnosed and treated once the onset of symptoms begins. One reason for these delays is that people with bipolar disorder often don’t recognize or report all of their symptoms. They may be more likely to report depressive feelings, such as hopelessness, despair and suicidal thoughts, while overlooking signs of mania, such as irritability or a decreased need for sleep.

Identifying Behaviors

To identify bipolar disorder, it’s important to understand the symptoms of mania and depression. People in a manic phase of their cycle may display behaviors such as:

  • Inflated self-confidence
  • A short temper
  • Rapid thinking or talking
  • Lack of mental focus or distractibility
  • Taking on new projects
  • Excessive physical activity
  • Increased attention to activities like substance abuse, shopping or gambling

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In a depressive episode, moods and behaviors take the opposite turn. An unrealistic sense of self-confidence may be replaced by profoundly low self-esteem or feelings of worthlessness and guilt. Elevated energy levels may give way to an increased need for sleep and signs of physical lethargy. Other symptoms of depression include:

  • Feeling of hopelessness about the future
  • Lack of interest in favorite activities
  • Isolation from others
  • Sleeping too much
  • Suicidal thoughts or gestures
  • Abusing drugs or alcohol

Bipolar disorder is a complicated condition, taking a number of different forms. The major types of BPD include:

Bipolar I.

People who have bipolar I disorder alternate between episodes of mania and episodes of depression. The National Institute of Mental Health suggests that each episode lasts for seven days, and the symptoms are often so severe that the person must be hospitalized for his/her safety and the safety of others. During the mania portion, the person might experience:

  • Feelings of enhanced power or invincibility
  • Irritability
  • Jumpiness or an inability to focus
  • Insomnia
  • Impulsive tendencies, which could manifest in compulsive drug use

The depressive episode that follows is severe, and when it hits, people with bipolar I may feel as though they’ll never be happy or satisfied ever again. They may not be able to focus on work, and they may have no interest in the things that once brought them joy. In some cases, they may think of suicide. Researchers aren’t quite sure what causes bipolar I disorder, but it is clear that the illness isn’t temporary. People who have this condition are likely to have it for the rest of life, and in most cases, they need the help of a team of professionals in order to keep the disorder under control.

Bipolar II.

Both bipolar I and II have similar symptoms:

A key difference between the two disorders is that sufferers of bipolar II experience a less severe form of the mania that plagues bipolar I patients.

While the mania of bipolar I causes markedly abnormal behavior that could require hospitalization, the mania of bipolar II (known as “hypomania”) manifests as behavior that is characteristically different but not necessarily abnormal (to the point where the patient needs to be hospitalized). A bipolar II sufferer in a hypomanic stage does not have to take time off work or pose a threat to those around them. A bipolar I patient in a manic stage, however, can be disruptive or dangerous to their environment because they cannot control their boosted mood and energy levels. This sometimes leads people with bipolar disorder II to not feel that they have a mental illness, since their hypomanic stages can be explained as simply being in a great mood. In contrast, the periods of depression in bipolar II disorder tend to last longer than those of bipolar I. That could be why the rate of suicidal thoughts among patients with bipolar II is higher than that of bipolar I.


Cyclothymic disorder can be described as a precursor to bipolar disorder. You would still be at the mercy of emotional highs and lows but not to the extent of the major forms of bipolar disorder (I and II). While the “highs” of bipolar disorder I and II range from having to be hospitalized to a noticeable increase in energy, mood and erratic behavior, the high of cyclothymic disorder is much milder by comparison.

Bipolar disorder I and II bring with them clinical depression, but the “lows” of cyclothymic disorder are not debilitating or dangerous enough to be in that category of depression.

Cyclothymic disorder may present with the full potency of the more well-known forms of bipolar disorder, but it can be just as difficult to live with. The respective phases of cyclothymic depression can last for days, or even weeks. Between phases, you may feel absolutely fine for just as long, perhaps even going months on end without a depressive or hypomanic attack.

Because of this, diagnosing cyclothymic disorder can be difficult, especially when many patients can still lead lives that are not routinely or drastically disrupted by the condition. There is only a 1 percent chance of developing cyclothymic disorder; however, in hospital psychiatric facilities, between 3 and 5 percent of patients have the issue. Because most sufferers never think to get treatment for what appear to be minor spells of happiness or gloominess, or are completely oblivious that their condition is actually a form of bipolar disorder, the chronic depression cycle can devastate their daily functions and interpersonal relationships when it strikes. Only then do patients tend to look for answers and help.

If the cyclothymic disorder remains untreated, it can develop into full-blown bipolar disorder, replete with the emotional ups and downs that would require immediate hospitalization.

Rapid Cycling BPD.

There is a population of bipolar sufferers – roughly 20 percent – who have episodes with an alarming high rate of occurrence. This is known as rapid cycling bipolar disorder, where a patient may experience the cycles of depression and mania four or more times within a single year, and a remission period of only two months. By contrast, people with bipolar type I or type II disorders are subject to episodes of an average of less than one per year. For example, people with classic bipolar disorder can have as many as eight straight months where they are not at the mercy of drastic changes in their moods.

With rapid cycling bipolar disorder, the cycles themselves may be compressed into a few weeks or even a matter of days, leaving the patient to experience the depression and manic cycles of bipolar disorder back to back.

Sometimes, the cycles may be random, so the patient goes through two successive depression cycles, followed by a manic cycle.

Diagnosing Rapid Cycling Bipolar Disorder

While the effects of bipolar disorder can be insidious, rapid cycling bipolar disorder is even harder to diagnose. The depressive cycles tend to be longer than the hypomanic cycles, leading some patients and observers to believe that the hypomania is simply a good mood, unknowingly missing the signs of the alternate phase of the depression. Treatment then erroneously focuses on the depression (and not the bipolar disorder on the whole), since the hypomania has passed so quickly.

Rapid cycling bipolar disorder occurs in women up to three times more than it does men (although men are still prone to it).

This is partly due to hormonal differences, sometimes brought about or exacerbated by medications, menstruation or pregnancy.


Some of the typical signs of an oncoming attack of rapid cycling bipolar disorder are similar to the symptoms of the more standard presentation of the condition:

  • Rapid speech
  • Loss of interest in hobbies or social activities
  • Racing thoughts
  • Fatigue and apathy

BPD Not Otherwise Specified (NOS)

BPD NOS does not meet the diagnostic criteria for the major forms of bipolar disorder; however, this condition is no less disabling. Mania, depression, and mixed states can occur in irregular patterns, leaving the individual highly unstable and vulnerable to destructive behaviors.

How Common Is BPD?

The Centers for Disease Control and Prevention estimates that the prevalence of bipolar disorder in the general population is as high as 4 percent. The disorder is more common among females than males. Most women with this disorder start to experience symptoms by their mid-20s, while most males experience an onset of symptoms by their teens.

According to the Archives of General Psychiatry, a significant number of Americans experience a less extreme form of bipolar known as “subthreshold bipolar disorder.  Subthreshold bipolar is characterized by extended periods of hypomania without a major depressive episode. The prevalence of this disorder may be as high as 2.4 percent, but because this condition often goes undetected, it may be even more common than we realize. Subthreshold bipolar disorder can take a serious toll on an individual’s ability to function. It can also increase the risk of substance abuse.

Causes of Bipolar

There are several major theories about what causes bipolar disorder. The condition often runs in families, which indicates that it has a strong genetic component. Chemical imbalances in the brain may be passed along from one generation to the next, resulting in the appearance of symptoms in close family members.

Differences in brain structure may account for some of the symptoms of bipolar disorder, notes the National Institute on Mental Health. Brain imaging studies show that the prefrontal cortex, the part of the brain that controls higher functions like problem-solving and decision-making, operates differently in people with bipolar. In addition, individuals with BPD often have lower levels of neurotransmitters like serotonin, which regulate mood, energy and behavior. Substance abuse does not cause bipolar disorder, but heavy drinking or drug use can worsen bipolar episodes. Ironically, the same substances that are used as a form of self-medication can turn against the user, causing increased depression, anxiety, irritability or hyperactivity. Certain medications and common stimulants like caffeine or nicotine can trigger or intensify manic behaviors. Substance abuse can also interfere with recovery, making it harder to benefit from psychotherapy.

Treating Bipolar Disorder

When bipolar disorder is accurately diagnosed and adequately treated, it is possible to lead a stable, productive life.

Successful approaches to treatment include a combination of therapies, including:

  • Pharmaceutical therapy with antidepressants, anti-anxiety medications, atypical antipsychotic medications, and/or mood stabilizing drugs;
  • Individual psychotherapy that emphasizes coping strategies for emotional fluctuations;
  • Self-help groups to build support networks and acquire new coping strategies;
  • Family and marriage counseling to educate loved ones and build stronger, healthier home environments;
  • Lifestyle changes to minimize bipolar symptoms, such as dietary modifications, regular sleep schedules, physical exercise, and stress reduction classes.

People with bipolar disorder can benefit from regular routines, adequate rest and sleep, and physical exercise. Self-help groups can be extremely valuable, not only for the person suffering from the disorder, but for family members and partners. This complicated psychiatric disorder can be hard to understand — for everyone involved. When substance abuse is involved, emotional cycles become even more intense and more challenging. Bipolar counseling programs and education can help family members build empathy and approach the disorder with patience and compassion.

BPD and Substance Abuse Statistics

Bipolar significantly increases the risk of developing a problem with drugs or alcohol. Addictive behavior can be part of both manic and depressive states. It can also intensify the severity of both types of episodes. The results of a study published in Bipolar Disorders confirm that over half of those with BPD abuse drugs or alcohol. In this study of 100 individuals with BPD, nearly 58 percent abused or were dependent on alcohol and at least one drug. Over 28 percent abused or were dependent on alcohol and two other drugs. girls-staring According to the National Institute on Alcohol Abuse and Alcoholism, substance abuse can worsen the progression of bipolar disorder. Substance abusers with BPD showed symptoms earlier in life, were hospitalized more frequently, and had more severe mood swings. In many people with bipolar disorder, substance abuse masks the symptoms of this severe mental illness for years before the condition is finally diagnosed and addressed.

Dual Diagnosis Recovery

Recovering from bipolar disorder and substance abuse requires a specialized approach to treatment. If the symptoms and consequences of bipolar disorder are not addressed at the same time as the substance abuse disorder, the individual is unlikely to remain sober after rehab. Like other serious mental health conditions, bipolar disorder increases the risks of noncompliance, early discontinuation of treatment, and relapse. Dual diagnosis recovery programs include a comprehensive range of integrated treatment services. Behavioral modification therapies like dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT) have proven to be effective at helping dually diagnosed patients cope with the emotional triggers that can lead to substance abuse. These intensive forms of therapy, combined with 12-step support groups, family counseling, stress management therapies, and relapse prevention training, can maximize the chances of success for individuals struggling to overcome substance abuse and BPD. The treatment programs at Futures of Palm Beach are based on the results of intensive neuropsychological testing. From the intake phase through rehab and beyond, we recognize the importance of integrated, evidence-based treatment for co-occurring disorders. For answers to your questions about BPD and information about our exclusive rehab facility in Palm Bach County, FL, we encourage you to call our toll-free number at any time.

Some services listed may not be included in our core program. An admissions counselor will be able to provide you a complete list of core services. Information provided for educational purposes. Premium services or programs may be arranged through your therapist or case manager.