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Substance Use Disorder and Bipolar Dual Diagnosis

Bipolar disorders can co-occur with substance abuse disorders. Dual diagnosis involves coordinated and integrated treatment strategies for individuals diagnosed with both bipolar disorder and substance abuse disorders. Bipolar disorder affects a significant number of individuals globally, and a variety of effective treatments are available to manage symptoms and improve quality of life.

Last Medical Reviewer On: March 31, 2024
Updated On: Dec 21, 2023
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Written by:

Amanda Stevens, B.S.

Medical Review by:

Dr. Po Chang Hsu MD, MS

Substance Use Disorder and Bipolar Dual Diagnosis
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    What you will learn
    • Bipolar disorder, characterized by mood swings between depression and mania/hypomania, often co-occurs with substance abuse disorders, necessitating a dual diagnosis approach for integrated treatment.
    • Key symptoms of bipolar disorder include mood swings, depressive episodes, and manic or hypomanic episodes characterized by behaviors such as increased talkativeness, racing thoughts, and engagement in risky activities, with diagnosis criteria considering the nature, duration, and severity of these episodes.
    • Bipolar dual diagnosis involves treating both bipolar disorder and a co-occurring substance abuse disorder, as the symptoms of each can intensify the effects of the other, creating a cyclical pattern of dependency and depression.
    • Treatment options for bipolar disorder encompass a broad spectrum, including medication (such as Lithium and Valproate), psychotherapy (like Cognitive Behavioral Therapy), and, for severe cases, residential treatment programs. The cost of these treatments can vary significantly, depending on the type and duration of care required.

    What is Bipolar Disorder

    Bipolar disorder is a mental illness that involves swings in a person’s mood, energy, activity levels, and concentration. It’s constituted by alternating episodes of depression and mania/hypomania.[1]

    Mania is the more severe version of hypomania, but they both involve extreme energy episodes. Depression involves extreme episodes of lethargy and irritability. The swings back and forth from energy to lethargy constitute “Bipolar Disorder.”

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    Common Symptoms of Bipolar Disorder

    A professional must diagnose bipolar disorder. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for manic episodes within Bipolar I and Bipolar II disorder constitute the following seven criteria:[2]

    • Extravagant behavior
    • Staying up through the night in a “feverish” energetic state
    • Rushed or endless talking
    • Racing thoughts
    • Lack of attention or focus
    • The movement that has no purpose
    • Indulging in risky behavior

    At least three (3) out of seven (7) criteria must be met to qualify as a manic episode:

    • If an individual experiences a hypomanic episode that lasts at least four consecutive days, this may indicate Bipolar II Disorder, provided the criteria for hypomania are met without the symptoms being severe enough to cause significant impairment in social or occupational functioning.[3]
    • A manic episode that lasts for more than seven consecutive days or is severe enough to require hospitalization indicates Bipolar I Disorder, regardless of whether there has been a depressive episode.[4]

    Bipolar Psychotic Breaks

    Bipolar psychotic breaks are a severe form of bipolar disorder. People who experience psychotic breaks are disconnected from reality.

    They may experience delusions, hallucinations, paranoia, poor insight, anxiety, agitation, and hostility.[5] People experiencing a psychotic break can be a danger to themselves and others. Those experiencing a psychotic break have an increased risk of suicidal thoughts and ideation.

    Bipolar Disorder Statistics

    Bipolar Disorder is a chronic mental illness characterized by significant mood swings, including manic/hypomanic and depressive episodes, not merely a side effect of medication. It can affect individuals over a lifetime, with symptom severity and frequency variations. 4.4% of adult Americans have reported experiencing bipolar disorder at some point in their lives.[6] That’s nearly 15 million people in 2023.

    In the last year, 2.9% of men and 2.8% of women have reported experiencing bipolar disorder.[7] Regarding bipolar-induced impairment, the numbers are heavily skewed towards “serious” impairment.[8] 82.9% of people with bipolar disorder report a “serious” degree of impairment, versus just 17.1% who reported a “moderate” degree of impairment.

    Bipolar Dual Diagnosis

    Bipolar dual diagnosis involves the diagnosis of a secondary co-occurring disorder alongside bipolar disorder. Such as substance abuse and bipolar disorder co-occurring. The symptoms of each disorder can intensify the effects of the other.

    For instance, the deep periods of acute bipolar depression could trigger the need to experience euphoria via substance abuse. After the euphoric highs are achieved during substance abuse, the withdrawal period could launch the sufferer right back into acute bipolar depression. This depression could trigger the desire for substance-related relief, and so on.

    Bipolar Residential Treatment

    There are many options for treatment centers for bipolar disorder, and one is residential or inpatient treatment. Residential programs for bipolar disorder are where patients live as “residents” in a structured environment and receive intensive, 24-hour support and therapy from medical professionals.

    In these environments, residents are generally restricted to the campus day and night with some approved outings. Residential treatment centers may be a good option for those with severe or extreme disorders who need constant supervision or who have failed to complete outpatient treatment in the past.

    Medication For Bipolar Disorder In Adults

    Valproate (Epilim) is a popular antiseizure medication with mood-stabilizing properties for adults.[9] Other similar drugs for bipolar disorder could include:

    • Divalproex sodium (Depakote)
    • Lamotrigine (Lamictal)
    • Lithium (Lithobid)
    • Carbamazepine (Tegretol, Equetro)

    Lithium therapy via Priadel or Camcolit has been shown to help stabilize moods.

    CBT for Bipolar Disorder

    While medication plays a crucial role in managing bipolar disorder, integrating psychotherapeutic approaches like Cognitive Behavioral Therapy (CBT) is essential for comprehensive treatment and long-term recovery. Cognitive Behavioral Therapy (CBT) is a type of talk therapy where you identify unhealthy thought patterns contributing to your bipolar disorder.

    It involves structured therapy sessions with a trained therapist who can help identify and replace your negative, subjective thoughts with more realistic, objective ones. Incorporating CBT into a Bipolar Dual Diagnosis could be an effective way to manage a co-occurring substance abuse disorder.

    Other common dual-diagnosis treatments for bipolar disorder and substance use disorder may include:

    If you require further information, have inquiries, or seek assistance regarding potential treatments for bipolar disorder, don’t hesitate to contact our Nashville mental health treatment center.

    Cost of Dual Diagnosis Treatment for Bipolar Disorder

    The cost of bipolar dual-diagnosis treatment can depend on several factors. Your needs, history, and desired lifestyle during treatment greatly affect the cost.

    The higher level of care you need, the more expensive it will be to treat you. The length of stay, intensity of care, and different kinds of therapies chosen will all play a part in determining the cost.

    Frequently Asked Questions about Bipolar Disorder

    Is bipolar disorder permanent?
    How should I treat bipolar disorder without medication?
    What are some therapeutic activities for bipolar disorder?
    Is there a natural treatment for bipolar disorder?

    [1][2][3][4] Bipolar disorder – statpearls – NCBI bookshelf. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK558998/

    [5] Chakrabarti, S., & Singh, N. (2022, September 19). Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World journal of psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9521535/

    [6][7][8][10][11] U.S. Department of Health and Human Services. (n.d.). Bipolar disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/bipolar-disorder

    [9] Medicines used in bipolar disorders. (n.d.-b). https://www.ncbi.nlm.nih.gov/books/NBK143764/