Bipolar disorder is a serious mental illness that impacts around 5.7 million American adults each year. According to the Depression and Bipolar Support Alliance, bipolar disorder is the sixth leading cause of disability in the world.1
Bipolar disorder often co-occurs with a substance use disorder, which worsens bipolar symptoms and may dramatically increase the risk for suicide. Here, we take a closer look at bipolar disorder, co-occurring disorders and how treatment can help you restore your mental health and reclaim your life.
What Are Signs and Symptoms of Bipolar Disorder?
Bipolar disorder is characterized by alternating episodes of high and low moods. The four types of mood episodes associated with bipolar are mania, hypomania, depression and mixed episodes, which are a combination of symptoms of mania, hypomania, and depression.
Signs and symptoms of a manic episode include:
- Moments of elation alternating with moments of pessimism
- Feelings of grandiosity and self-importance
- Rapid talking
- Reduced sleep
- Engaging in high-risk behaviors
- Impaired judgment
- Irrational behaviors and thoughts
Hypomania symptoms are similar to those of mania, but they’re far less intense and don’t involve psychosis. During periods of hypomania, you:
- Feel happier and more energetic than usual
- May be more irritable than normal
- Are capable of managing your daily activities
- Feel able to take on more responsibilities at home, work or school
- Need fewer hours of sleep
- Are likely to engage in high-risk behaviors, including substance abuse
- Feel like your bipolar disorder is under control
Phases of depression that occur with bipolar disorder are characterized by severe lows. Signs and symptoms of a depressive phase include:
- Feelings of hopelessness and helplessness
- Feelings of sadness, guilt and self-hatred
- A loss of interest in activities you used to enjoy
- Increased sleep
- Appetite changes
- Thoughts of suicide or death
What are Types of Bipolar Disorder?
The symptoms of bipolar disorder aren’t always cut-and-dry. Five types of bipolar disorder are diagnosed by mental health professionals.
Bipolar I disorder
Bipolar II disorder
Bipolar II disorder is characterized by a deeper depression than that which occurs with bipolar I. It’s diagnosed after at least one major depressive episode and at least one hypomania episode.
Bipolar Not Otherwise Specified
Bipolar with Rapid Cycling
Treating Bipolar Disorder
Bipolar disorder is treatable. The best course of treatment involves both medication and counseling. Medications used to treat bipolar disorder depend on unique symptoms and may include mood stabilizers, antipsychotics, antidepressants, anti-anxiety medications or combination medications that contain both a mood stabilizer and an antidepressant.
Counseling helps individuals with bipolar disorder cope with their symptoms and better understand and manage their bipolar disorder. For example, cognitive behavioral therapy helps you identify and evaluate dysfunctional thought and behavior patterns and recognize the signs that point to an episode shift. Dialectical behavior therapy reduces suicidal ideations and helps regulate emotions, tolerate painful situations, practice mindfulness and maintain boundaries and self-respect.
Bipolar Disorder and Substance Use Disorders
When a mental illness and a substance use disorder are both present, it’s known as a dual diagnosis, or co-occurring disorders. Bipolar disorder commonly co-occurs with addiction. According to the U.S. National Comorbidity Survey, 71 percent of people who have bipolar disorder report a lifetime history of at least one substance use disorder.2
- Self-medication: People with a mental illness are likely to use drugs or alcohol to deal with unpleasant symptoms. While drugs and alcohol may seem to alleviate symptoms initially, they almost always make bipolar symptoms worse.
- “Kindling” :Repeated disruptions in the brain sensitizes brain cells, and an increase in sensitivity can lead to more frequent alcohol or drug use over a short period of time. It can also lead to worsened symptoms and more frequent cycling of bipolar disorder.
- Genetics: Both substance use disorders and mental illnesses have genetic risk factors. Additionally, families who have a member with a mental illness are also more likely than those without to also have members who abuse substances, and vice versa.
- High-risk behaviors: One symptom of mania and hypomania is engaging in high-risk behaviors, which include drug and alcohol abuse.
Treating Co-Occurring Disorders
If you have bipolar disorder and a drug or alcohol use disorder, addressing only one condition will not be effective for treating either condition. Co-occurring disorders require integrated treatment that addresses each disorder in the context of the other. Integrated treatment is essential for successful recovery.
A high-quality treatment program will use a variety of research-based therapies to treat both bipolar disorder and addiction at the same time. Each individualized treatment plan is a collaboration among various caregivers, including psychiatrists, therapists, physicians and counselors.
Therapies commonly used in a dual diagnosis treatment program include:
- Pharmacotherapy, which is the use of medications to treat either the bipolar disorder or the addiction, or both.
- Traditional “talk” therapies, such as cognitive-behavioral therapy, dialectical behavior therapy and acceptance and commitment therapy. These therapies help people change their thought and behavior patterns and develop essential coping skills.
- Complementary therapies, such as art therapy, restorative yoga and biosound healing therapy. These therapies help individuals express difficult emotions, develop mindfulness and self-confidence and look at old problems in new ways.
- Family therapy, which helps to restore function to the household.
- Psychoeducational classes, which help individuals with co-occurring disorders understand both conditions and develop coping skills for a variety of challenges.
- As-needed interventions, which may include vocational or educational assistance, help finding safe housing or assistance navigating the legal system.
Therapy helps individuals in dual diagnosis treatment:
- Better understand bipolar disorder and its symptoms
- Identify dysfunctional thought and behavior patterns and develop new, healthier ways of thinking and behaving
- Address underlying issues behind the addiction, which may include chronic stress, family dysfunction or a history of trauma
- Develop essential skills and strategies for coping with stress, negative emotions, cravings and other addiction relapse triggers
- Repair damaged relationships
- Address problems stemming from the bipolar disorder and addiction, including legal issues or problems with finances, relationships or health
A holistic approach to treatment that addresses issues of body, mind and spirit promotes whole-person healing and offers the best outcomes of treatment, according to the Substance Abuse and Mental Health Services Administration.4
Dual diagnosis treatment works for most people who fully engage with their treatment plan and stay in rehab for an adequate period of time. According to the National Institute on Drug Abuse, treatment lasting less than 90 days is of limited effectiveness.5
During treatment, a combination of medication and therapy helps to reduce symptoms of bipolar disorder. Dual diagnosis treatment will help restore function to all areas of your life and improve your quality of life and sense of well being. Treatment works, and it can work for you, too.