Substance Abuse and Bipolar Disorder – A Manic Addiction?

Hi, my name is Natalee and I’m an alcoholic. I’ve also been diagnosed with bipolar disorder.

Bipolar disorder is a common mental illness in which the sufferer experiences extreme highs (euphoria, energy) and extreme lows (depression and fatigue). This is the standard conception of the illness. However, I must note that extreme highs may also manifest themselves as anxiety – which are most of the highs that I have, unfortunately.

My moodiness began early on – especially depression and anxiety. Later, I found myself able to get very worked up and angry at the drop of a dime. I knew a little about what was called then “manic depressive” and I suspected it might be me. I never sought help, however, and didn’t realize the extent of it until much later.

My bipolar disorder is also characterized as anxious distress. This means to have anxiety, such as feeling keyed up, tense or restless, and having trouble concentrating because of worry. Moreover, fearing something awful may happen, or feeling out of control.

So what is the link between substance abuse and bipolar disorder, these two commonly co-occurring afflictions?

Well, it’s true that bipolar patients tend to use and abuse drugs and alcohol at rates far above both the psychiatric population and the population in general. But why?

According to statistics presented by the American Journal of Managed Care:

  • About 56% of those with BP who participated in a national study had experienced drug or alcohol addiction during their lifetime.
  • Approximately 46% of that group had abused or were addicted to alcohol.
  • About 41% had abused or were addicted to drugs.
  • Alcohol is the most commonly abused substance among bipolar individuals.

Here are some common blanket theories, that may, in part, explain some of the overlap.

#1: Self-Medication

pillspoonThis is pretty much the most popular reason given for any mental illness that is comorbid with substance abuse. Basically, we feel like something is wrong, and we are trying to make it better.

The problem is, one would think that bipolar people would be self-medicating to achieve the opposite – that is, if they are manic they would be taking depressants.

On the other hand, if they were depressed, they should be taking stimulants.

However, this is not always the case. In fact, when I am at my most depressed is when I typically reach for the bottle – and alcohol is a depressant.

So, unfortunately, this theory does not completely explain the connection because substance abuse and bipolar disorder.

#2: Genetic Risk Factors

I suspect that my mother was undiagnosed bipolar or at least borderline personality disorder. However, if so, does that explain how I became the way I am? Does her hypochondria explain why I am so hypersensitive to the things going on in my body, and why I am always freaking out?

Well, the theory is compelling, but unfortunately there is a lack of studies, or at least some consistency in research to support this idea of genetic linkage.

#3: Substance Abuse is a Symptom of BP

This is a real problem, because the truth is, most bipolar patients do not have substance abuse problems. For those who do, there seems to be a weak correlation in terms of onset.

#4: Substance Abuse is a Trigger for BP

binge drinking | Addicts HelplineThis theory seems suspect right off the bat, but for kicks and giggles, let’s talk about it. There is actually evidence against bipolar disorder appearing after substance abuse.

Usually, BP onset precedes the development of abuse, especially during adolescence. Thus, if there is any cause-and-effect correlation, it would have to be the other way around.

So actually, none of these really explain the link between substance abuse and bipolar disorder.

So what’s the answer? While the jury is still out, experts believe that the same factors which contribute to BP may also contribute to substance abuse.

#5: Brain Chemistry Influences Both Conditions

Many experts maintain that brain chemistry may influence both bipolar disorder and substance abuse. For example, people with BP commonly have abnormal levels of serotonin, dopamine and norepinephrine. These chemicals affect many vital functions, include appetite, metabolism, sleep, and stress responses. Additionally, they are largely response for moods and emotions.

Alcohol Poisoning | Addicts HelplineHeavy alcohol use often interferes with the manner in which the brain processes these chemicals. And yes, the sufferer may be self-medicating, even though the manner in which they go about it may be counter-intuitive or make BP worse.

In fact, there is a high co-occurrence between many other mental illnesses and substance abuse – such as generalized anxiety, depression, and post-traumatic stress disorder.

Depression and alcoholism also go hand in hand, which again, it exactly the opposite of how we think one would attempt to self-medicate.

There must be a reason for this, and it likely lies in the brains of sufferers. It is believed that the same mechanisms which make people prone to risk-taking and impulsive behavior may also be responsible for substance abuse. This is found within the brain structure, namely, a relatively thin cortex. BP sufferers are commonly impulsive in this way, and that could partially explain the high level of co-occurrence between substance abuse and bipolar disorder.

~ G. Nathalee Serrels, M.A., Psychology