Comorbidity: Treating Bipolar Disorder and Substance Abuse at the Same Time
Bipolar disorder seems like enough trouble for one person to deal with, but research is increasingly showing that individuals suffering from bipolar disorder are more likely to suffer from a host of other diagnoses, such as an anxiety disorder, impulse control disorder, and perhaps most dangerous of all, a substance use disorder. The presence of both bipolar disorder and a substance use disorder in an individual is especially dangerous because it can increase the risk of injury, contracting an infectious disease, and possibly suicide.
According to SAMHSA, roughly 30 – 50% of people with bipolar disorder will develop a substance use disorder at some point during their lives. In the worst case scenario, if either one or both disorders are left untreated, they will gradually worsen and exacerbate one another. This is why it’s vital for healthcare providers and the general public to understand and properly diagnose comorbidity for these disorders.
Who Has This Comorbidity?
Anyone can develop comorbidity for substance use and bipolar disorder, but men are more likely than women to have the former. As such, they are also more likely to have an addiction problem if they have been diagnosed with bipolar disorder. According to one meta-analysis of behavioral health treatment providers, of those with bipolar disorder, alcohol use was the most commonly abused drug of choice followed by cannabis, illicit narcotics, and amphetamines.
One possible reason for why this comorbidity rate is so high is that individuals may turn to substance use as a means of self-medication for their disorder. This creates a vicious cycle in which drug abuse gradually worsens mental health symptoms and leads to greater strain and turmoil in the individual’s life. The 2014 National Survey on Drug Use and Health showed that nearly 7.9 million people in the United States have some type of mental disorder in addition to a substance use disorder.
How Do We Diagnose This Comorbidity?
Because of the fact that both disorders share symptoms such as impulsivity, erratic behavior, depression, anxiety, and mania, it can be difficult to distinguish one from the other. As such, clinicians generally rely on a combination of family history, childhood anxiety, mood lability, and poor response to antidepressants. They may also conduct brain imaging scans to check for increases in gray matter density in the right inferior frontal gyrus, considered an early identifier for people likely to develop bipolar disorder.
How Do We Treat This Comorbidity?
Generally, a combination of therapy and pharmacotherapy is the best route for treating this particular comorbidity. However, the process must be approached delicately, as using the wrong medication could put patients at risk of developing worse psychological symptoms, inflicting self-harm, overdose, and possibly suicide. Findings in one particular study found that patients with opioid prescriptions who were also prescribed benzodiazepines were nearly twice as likely to suffer an accidental overdose than those who were solely using opioids.
There is no single treatment option that works best for everyone when it comes to comorbidity with bipolar disorder and substance use disorder. Clinicians will generally prescribe some form of psychiatric medication in tandem with a professional counselor or therapist who can help teach coping skills, offer emotional support, and work through any issues that may arise from medication. Patient’s may also be referred to treatment facilities that specialize in this particular comorbidity. Common phases of treatment include:
In the detoxification process, patients are required to undergo medically supervised withdrawal from the substance they have been reliant on. Typically, patients will remain on premises during this time, which may last anywhere from 3 – 10 days. Staff may also administer tapering medication to help ease the patient’s withdrawal and lessen the painful side effects.
Any individual struggling with addiction while also battling mental illness could greatly benefit from the type of safe and supportive environment offered by inpatient rehabilitation facilities. In rehab, patients can receive medical care and supervision while participating in group and individual therapy sessions designed to help address each individual’s circumstances.
Outpatient Support/Sober Housing
While inpatient rehab can do an excellent job of helping individuals with comorbidity to get back on their feet, the true process of recovery begins with learning to acclimate and develop a healthy ongoing lifestyle. In outpatient treatment, patients will learn daily skills for dealing with living with their diagnoses while participating in daily therapy sessions.
Cognitive behavioral therapy (CBT) is usually part of an effective treatment plan for bipolar and substance use disorders. CBT helps patients with learning to cope and how to change behaviors and thought patterns that increase risk of substance use.
Medication Assisted Treatment
Some common medications used for the treatment of substance use and bipolar disorder include antidepressants such as SSRI’s, anticonvulsants, and antipsychotic medications. Individuals may respond differently to different treatment modalities, but typically some combination of medication, therapy, and consistent follow-up support is the best option for treatment of this comorbidity.
Comorbidity with substance use disorder is often found in patients suffering from bipolar disorder. Clinicians should conduct a thorough assessment of patient history to uncover substance use disorder, as the treatment of one disorder will be incomplete without fully addressing the other.
Boyle, M. (2018). Comorbidity: Treating Bipolar Disorder and Substance Abuse at the Same Time. Psych Central. Retrieved on April 1, 2020, from https://psychcentral.com/blog/comorbidity-treating-bipolar-disorder-and-substance-abuse-at-the-same-time/