Addiction is a ‘cunning, baffling and powerful disease’. Sometimes it is also accompanied by another serious mental health issue. Bipolar disorder, also known as bipolar affective disorder (manic-depressive illness), is a mental disorder characterized by periods of elevated mood and periods of depression. Other mental health issues such as anxiety disorder and substance use disorder are commonly associated. The combined chemical dependency and bipolar disorder are known as co-occurring disorders or dual disorders. It is important to recognize that both addiction and bipolar disorder are considered diseases, just like diabetes, cancer, alzheimer’s and other medical problems.
Common factors between these two disorders are genetic predisposition, involuntary loss of control, and subsequent negative consequences. This pattern is seen in the progression of co-occurring disorders. Comparing the two diseases we find that there are quite a few overlapping factors. Chemical dependency or addiction is caused by alcohol and other drug use, leads to further changes in brain chemistry and brain function and is also strongly influenced by heredity and environmental factors. Similarly, bipolar disorder is triggered by stress and loss of relationships and status, leading to cyclical changes in brain chemistry and function and like addiction, is also significantly influenced by heredity and environment.
It is important to understand that bipolar disorder is genetic. For most of the people with this illness, the first episode usually occurs during the early 20s. The first episode is usually triggered off by a major stressful situation or relationship. After that, it takes less stress to trigger off further episodes. The severity of each episode depends on the amount of stress, the duration and mostly, the brain chemistry. Once triggered, further episodes may be triggered by both stressful and happy occasions. For some, bipolar disorder occurs on a cyclical basis and is not completely related to life events. While it is tempting to look at the emotional upheaval, insecurity and irrationality as the result of the person’s temperament, it is important to recognize that these are emotional and cognitive symptoms of the disorder.
So how does this relate to addiction? Drinking or using is often a response to an emotional trigger. When a chemically dependent person is unable to adequately process their feelings, they turn to mood-altering substances like alcohol and drugs to help them feel better. Thus, a person experiencing mood swings in bipolar would attempt to stabilize them using chemicals. Unfortunately, an understanding of neurochemistry reveals that not only does this coping mechanism not help, it serves to further disrupt the processes which cause the mood swings in the first place, making them last longer and become more unpredictable and damaging.
It is important to realize that in early recovery from addiction, it is common to experience some mood swings and erratic behaviour. This by itself does not indicate the presence of bipolar disorder. However those who have bipolar disorder continue to experience mood swings post withdrawal from chemicals. Bipolar disorder is often hidden by drugs and alcohol during the using period. While bipolar is episodic, sometimes the stress of withdrawal and early recovery can trigger mood swings in an untreated bipolar illness. In a person with bipolar experiences mania, the impulse to drink is strong. Hence relapses are common during this period. When people relapse, they usually already have reached such an advanced stage of addiction that it is dangerous for them, to safely drink for even one day.
The first and most essential step in recovery for addiction is abstinence from all mood altering substances. Often people with a dual disorder need inpatient treatment initially. It is also important to engage with support groups such as alcoholics/narcotics anonymous and meet with a counsellor regularly.
Lithium is one of the most popular mood stabilizers used in bipolar disorder. It is often considered the miracle drug for mood disorders. It helps to stabilize the levels of neurotransmitters in the brain, the fluctuations which case the euphoric highs and the depressive lows a person with bipolar disorder experiences. Alongside this, one cannot underestimate the importance of social support, regular levels of exercise and psychotherapy.
It is important to understand that when a person suffers from a dual disorder, they also need to go through dual recovery. Each disorder affects the other. Thus treatment also focuses on both equally. Finally, if the recovery programme is followed thoroughly, people with addiction, bipolar disorder or both can lead meaningful and productive lives and become useful members of society.
Hope Trust in India has vast experience in dealing with dual disorder cases, since over 13 years. The therapy team includes a psychiatrist and psychologist, apart from counsellors.
- Raisa Luther, Addiction therapist, Hope Trust