Bipolar and Substance Misuse: Integrated Treatment

Substance misuse is often present in individuals with other psychiatric problems. People with bipolar have very high rates of substance misuse that make diagnosing and treating either issue challenging for clinicians. Research has shown that approximately half of individuals who have bipolar will experience alcohol misuse, and many will develop alcohol dependence. Nicotine use is also overrepresented among individuals with bipolar, with dependence on nicotine being three times higher among bipolar clients than among individuals with no history of mental health problems.

The comorbidity of these issues creates an increased risk for financial insecurity, unemployment, aggression, physical health problems, and decreased quality of life. The presence of substance misuse also doubles the risk for suicide in people with bipolar. Additionally, people who have both bipolar and substance use problems are more likely to experience other psychological problems, including panic, anxiety, and posttraumatic stress. Together, these issues place individuals with bipolar at a much higher risk for increased health care needs and early mortality. The onset of substance misuse is critical to diagnosis. Some people use alcohol and drugs to cope with the high and low moods of bipolar. Understanding the history of substance misuse is a key factor to determining the severity and ultimate course of bipolar in people who have a history of both.

Bryan K. Tolliver of the Department of Psychiatry & Behavioral Sciences at the Medical University of South Carolina believes that all of these elements must be addressed individually and collectively to ensure proper treatment. In a recent report, Tolliver underscores the difficulties that these relapsing and remitting conditions present for clinicians. Clients currently using alcohol or drugs may be masking the severity of bipolar symptoms when they present for treatment. This could result in improper diagnosis and over- or undertreatment of symptoms. Clients with comorbidity also have low treatment adherence, further exacerbating their symptoms. Because of the nature of both substance use and bipolar, clients themselves may be perpetuating their own stigma. Tolliver says, “As a result, individuals may be least likely to recognize that they are ill during periods when symptoms are most severe.” He believes that an integrated approach, identifying substance use history, bipolar history, and co-occurring mental health problems, is the most effective way to accurately diagnose, treat and manage all of the challenges these individuals face.

Tolliver, B. K., Hartwell, K. J. (2012). Implications and strategies for clinical management of co-occurring substance use in bipolar disorder. Psychiatric Annals, 42.5, 190-197.

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  • Alice

    May 25th, 2012 at 1:43 PM

    For years I tried to self medicate and get over what I knew deep down inside was depression. I trued using alcohol, cigarettes, and various other things to try to cover up all the pain that I was in, or at least numb the pain a little.

    Needless to say this did not work too well. I never felt like myself or felt like I was being true to myself. And then not only was I dealing with depression, I had other addictions that had to be addressed too.

    Thankfully, I had the chance to work with a wonderful therapist who recognized all of this and gace me some ways to work through all of my issues. It was difficult but I am so thanful that I had this kind of support in my life to help me through it.

  • Madhurendra

    May 25th, 2012 at 7:52 PM

    Do really you Alice suffer from Bipolar diosrder, I feel your language shows that you only are depressed nothing else!!

  • stephen

    May 26th, 2012 at 12:40 AM

    its like a web you get caught into.have seen a cousin go through this and completely destroy his life.theres bipolar and then theres added complications that attack you as a result of the first one.its really pathetic and also goes on to show why its just so important to seek treatment and help at an early stage of a problem.

  • Jameson

    May 26th, 2012 at 5:20 AM

    I would be very interested in knowing how many times addicts exhibit the symptoms of bipolar and vice versa.

  • Working bipolar

    May 26th, 2012 at 6:12 PM

    Madhurenda are you a doctor? Qualified to DX BP? Im BP1 episodes more depressants and mixed states. Don’t judge other people. Cause they aren’t suffering like you. Ive self medicated for years, before DX. It makes it all worse. Stimulants no longer get my mania going.

  • Alice

    May 28th, 2012 at 12:36 PM

    Madhuendra- I don’t think that I even implied that I am bipolar. I am not nor did I mean to imply that I am. I was depressed and had a lot of other issues that I was dealing with as well. Addiction became a big part of that too, but thankfully being bipolar is not something that has touched me. I know that I am very fortunate to not have had to struggle with this. All I meant to do was to share my own story, which I feel like for many of us confirms that there is rarely a time when there is just one issue that most of us have to deal with. Most of us have multiple problems that we are facing, and it is rarely a tidy little package that can be cleaned up easily.

  • Les

    May 30th, 2012 at 4:23 AM

    As with most mental illnesses and addictions, rarely do you find one without something else. It would be nice if most of our issues would fit nicely into a little box, but they don’t. Most of the time one begats another, and even though it may not begin that way, all of the issues that plague the patient have to be addressed and dealt with in order for the patient to find complete ease and resolution in treatment and recovery.

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