Living with a mental health condition can be a daunting journey in itself, but when substance use disorder (SUD) and bipolar disorder coexist, the challenges can become even more complex. Both bipolar disorder and SUDs are serious conditions that require careful management, and when they intersect, individuals often find themselves facing a unique set of obstacles on their path to recovery. If you or a loved one struggles with both of these disorders, let’s learn more about the unique challenges these conditions pose and strategies for overcoming them.

What is bipolar disorder?

Bipolar disorder is a mood disorder characterized by extreme shifts in mood, energy, and activity levels. It typically consists of manic episodes (elevated mood, high energy) and depressive episodes (low mood, loss of interest). Bipolar disorder can affect an individual’s ability to function in daily life.

Bipolar disorder comes in four subtypes that include:

  1. Bipolar 1: characterized by having manic episodes, followed by depressive or hypomanic episodes — which can sometimes lead to a psychotic break from reality.
  2. Bipolar 2: characterized by having depressive and hypomanic episodes but no manic behaviors.
  3. Cyclothymic disorder: You’ve experienced at least two years of less severe depressive and hypomanic episodes.
  4. Others: mostly brought on by other diseases (like Cushing’s, a stroke or others), medications or substance use.

What are the challenges of bipolar and substance use disorder?

When both bipolar disorder and SUDs coincide, it’s known as a dual diagnosis, which presents a unique and often complex panorama that requires an increased level of care. Some of the issues that someone who lives with both conditions can be:

  1. Self-medicating: One of the primary challenges is the tendency to self-medicate. People with bipolar disorder may use substances to cope with the intense mood swings, trying to dull the pain of depression or heighten the elation of mania. This self-medication can lead to a cycle of substance use, making both conditions worse.
  2. Misdiagnosis: The symptoms of bipolar disorder and SUD can sometimes overlap, leading to misdiagnosis or delayed diagnosis of one or both conditions. This can result in inadequate treatment and prolonged suffering.
  3. Medication interactions: Managing medications for bipolar disorder while dealing with SUD can be complicated. Some psychiatric medications used to stabilize mood may interact negatively with other substances they might be taking. This interaction can affect medication efficacy and increase the risk of adverse reactions.
  4. Triggering environments: Environments that foster substance use can exacerbate the challenges — individuals with both conditions may find it difficult to avoid triggers, such as social situations where substances are readily available.
  5. Impulsivity: Both bipolar and SUD can lead to impulsive behavior. The combination can intensify impulsivity, making it harder to resist the urge to use substances or engage in risky behaviors during manic episodes.
  6. Stigma and feelings of isolation: The stigma associated with mental illness and substance use can compound feelings of shame and isolation. This can hinder individuals from seeking help and support.
  7. Relapse risk: Recovery from SUD is often marked by relapses, which can be especially risky for those with bipolar disorder. Relapse can trigger mood episodes, leading to a cycle of worsening symptoms.

Strategies for overcoming the challenges of treating bipolar and substance use disorder

While living with both bipolar and SUD can be incredibly challenging, it is important to remember that recovery is possible. Here are some strategies that can help individuals navigate these unique challenges:

  1. Receive integrated treatment: Seek out treatment programs that specialize in co-occurring disorders. Integrated treatment plans that address both bipolar disorder and SUD simultaneously can be highly effective.
  2. Find a dual support system: Build a strong support system that includes mental health professionals, support groups and loved ones who understand the complexity of your situation.
  3. Find additional education resources: Learn about both bipolar disorder and SUD to understand their effects and triggers better. Knowledge is a powerful tool in managing these conditions.
  4. Make lifestyle changes: Make positive lifestyle changes, including exercise, a healthy diet, and stress management techniques, to support stability and reduce the risk of relapse.
  5. Create a relapse prevention plan: Develop a relapse prevention plan that includes coping strategies for both mood episodes and substance cravings.
  6. Have self-compassion: Practice self-compassion and self-forgiveness. Understand that recovery is a journey with ups and downs, and setbacks do not define your worth.

Living with both bipolar disorder and substance use disorder presents unique challenges, but it’s essential to remember that recovery is possible with the right support and strategies. Seeking professional help, building a strong support system and staying committed to treatment are crucial steps in managing these conditions. Individuals can work towards a more stable and fulfilling life by addressing both disorders simultaneously and holistically.