Substance Use

In this episode, Wendy discusses substance abuse and bipolar disorder.


Don't forget to check out Wendy's novel "Involuntary Hold." It's the story of a girl who wakes up on the psych ward and her struggles to survive. It's available on Amazon and on Audible.

International Helpline Info

 For those living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just got to the internet and type in:

       findahelpline.com/i/iasp

 And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

** Remember if you, or a loved one, is in emotional crisis... Help is just a phone call away. Simply dial 9-8-8 for the Suicide and Crisis Hotline, or text "HOME" to 741741 to chat with someone via text 24/7 across the United States. **

Please contact us at bipolarforlife@myyahoo.com with any questions, suggestions, or comments.

Transcript

Bipolar for Life

Ep 8/S2-Substance Use

Good evening and welcome to “Bipolar for Life.” I’m your host, Wendy Foard, and I’ve managed to live with bipolar disorder for 44 years now. It hasn’t always been pretty, but I’ve survived several suicide attempts, four psychiatric hospitalizations, and one disastrous trip to rehab. Yet, I’m still here!

Let me say up front that I am NOT a medical doctor. I am simply a seasoned manic-depressive trying to help others survive this deadly mental illness through shared information and experiences.  

As we discuss issues, please remember that I am speaking from my own experience; your bipolar experiences may be entirely different. Yet, I suspect highly that we have more in common than not.

Tonight, we need to talk about something that is highly prevalent in bipolar disorder… substance use, and its disorder. Now, don’t think I’m speaking from some high horse. I have a substance use issue, as many of us do, which is why I thought we needed to talk about it. 

Having a bipolar diagnosis is linked to a higher substance use risk for alcohol and drugs. People with bipolar disorder have a 22% to 59% increased chance of being diagnosed with addiction, or substance use disorder, at least once in their lives. According to the Substance Abuse and Mental Health Services Administration (or SAMHSA), alcohol seems to be the most common drug among people with bipolar disorder.

Some research found that:

·     The risk of substance use disorder is nearly doubled among people with bipolar disorder

·     About 42% of people with bipolar disorder are addicted to alcohol

·     While 20% have a problem with cannabis use

According to SAMHSA, people with bipolar disorder may misuse substances for a number of reasons: substance use disorder and bipolar disorder both change the brain areas important to regulating impulsivity, and feelings of reward and pleasure. Another reason is that people with bipolar disorder often self-medicate to manage their mental health condition. 

Self-medicating is defined as taking medication without the advice of a doctor. We all do this when we have a cough and take cough medicine that hasn’t been prescribed by a doctor. That, is technically self-medicating. 

However, the self-medicating that is done by people with bipolar disorder usually involves illegal drugs or alcohol. I typically self-medicate when I begin to feel “off”, or not myself. I drink or smoke to make myself feel more like myself, before the onset of the mood episode. And as the mood becomes worse, so does my substance intake. 

Bipolar disorder can be remarkably hard to manage because of its extreme mood shifts. Partaking in alcohol or other drugs might seem like a reasonable idea at first, to mellow out your mood and changing energy levels. It can also feel like temporary relief from the most unpleasant symptoms. However, it can do a great deal of damage in the long-run, or surprisingly, have the opposite effect on your moods.

In fact, some research indicates that drug abuse and addiction can cause changes in the brain that lead to bipolar disorder. There is some evidence that regular marijuana use can instigate bipolar symptoms in adolescents. In a recent study review, substance use disorder (SUD) increased the risk of bipolar disorder in 43% to 56% of studies, with cannabis being the most commonly co-occurring substance of abuse. 

In some cases, it is believed that early marijuana use during adolescence, during a period when the brain is still developing, may increase the risk of getting bipolar disorder.

In other cases, a history of bipolar disorder may increase vulnerability to substance use, and ultimately, substance use disorder or addiction. It can be difficult to pinpoint the cause of co-occurrence, especially in complex cases, but awareness of the connection is essential for treatment. According to SAMHSA, co-occurring substance use disorders are more common among patients with bipolar disorder than those with any other mental illness. 

Alcohol is the most commonly abused substance for those diagnosed with bipolar disorder, followed by marijuana, cocaine, and opioids. 

Scientists do not yet fully understand the relationship between bipolar disorder and substance use disorders. However, researchers believe there may be several connections between the two. These connections include:

·     Self-medication: Information from SAMHSA notes that people with bipolar disorder may use drugs to self-medicate. For example, a person may use cannabis to reduce manic feelings or take cocaine to feel energized during depressive episodes. This can lead to relying on drugs to feel “normal”

·     Differences in brain structure: Research from 2017 looked into the connection between brain abnormalities, bipolar disorder, and substance use disorders. Researchers suggest that abnormalities in the prefrontal cortex could be responsible for bipolar disorder and substance use disorders. The prefrontal cortex is the part of the brain that plays an important role in attention, impulse control, memory, and cognitive flexibility, or the ability to adapt behavior to the current environment. Researchers found that areas in the prefrontal cortex that may affect bipolar disorder overlap with those that cause substance use disorders.

·     Genetics: Both bipolar disorder and substance use disorders can occur in families, leading researchers to believe that they may have genetic causes. The research from 2017 found that there may be common genetic links to bipolar disorder and substance use disorders. However, the researchers note that further study is necessary to confirm these findings. Research from 2021 noted that alcohol use disorder (AUD) was most common in people with bipolar disorder and substance use disorder. 

As I said earlier, it seems that substance use can cause bipolar symptoms. Research shows you can develop some symptoms of mania and depression as a side-effect when you’re actively using a drug, are intoxicated, or are going through withdrawal.

You may be more likely to experience manic symptoms when you’re using stimulating substances or engaging in prescription medication misuse. You may find that you need less sleep, become easily distracted, or even act out in ways that can have social, work, relationship, sexual or legal consequences. 

You’re more likely to have depressive symptoms during withdrawal from alcohol use. You might experience hopelessness, fatigue, or disinterest in activities that you used to enjoy.

People with drug-induced bipolar disorder have similar symptoms as people with bipolar disorder. The difference between the two, is that people with drug-induced bipolar disorder symptoms tend to have those symptoms disappear one month after stopping the drug use, while a bipolar diagnosis is a life-long battle.

People with bipolar disorder may use the same substances in both manic and depressive episodes or use multiple substances with different effects. Drugs like alcohol and marijuana can help people feel calmer during manic episodes or may act to heighten feelings of creative inspiration. Alcohol can also numb the pain associated with a depressive episode. Whereas stimulants can temporarily boost energy.

 Co-occurring bipolar disorder and alcoholism are common. Approximately, 46% of people with bipolar disorder have had an alcohol use disorder in their lives. People with bipolar disorder often use alcohol to regulate their thinking and mood during both manic and depressive episodes.

 Combining bipolar disorder and alcohol use can be especially dangerous. For people with the disorder whose symptoms are otherwise controlled, alcohol can induce a serious depressive episode. It can also complicate manic episodes and make people more likely to act on delusions, or have other psychotic symptoms. 

 People who drink also tend to be more irritable and volatile. Using alcohol can make some people with bipolar disorder have less stable moods. It can also make them more likely to become aggressive and angry, even to the point of having what is sometimes termed “bipolar rage,”—which is a topic we will look into in the next episode.

 Marijuana and bipolar interact in a similar way as alcohol and bipolar disorder. Cannabis can have a calming effect that makes it easier to rest and focus during episodes of anxiety or mania. Unfortunately, it can just as easily trigger severe anxiety, paranoia and panic.

Under the influence of marijuana, bipolar symptoms are more likely to progress into psychosis. Research shows marijuana can trigger psychotic symptoms, especially in people with mental health conditions. In addition, marijuana use is linked to longer and more frequent mood episodes for people with bipolar disorder. 

 People use stimulants for many reasons. In small doses, stimulants can increase mental energy and focus. They can also induce feelings of mild euphoria or empowerment that make challenging activities more engaging and less stressful. 

For people with bipolar disorder, stimulants have additional risks. They can trigger manic symptoms and episodes even in people whose symptoms are managed with mood-stabilizing medications. This is why people with co-occurring bipolar and ADHD are rarely prescribed stimulants. For example, Adderall and bipolar disorder do not mix well. Despite the risks, people with bipolar disorder frequently abuse stimulant drugs, often in an attempt to prolong the more pleasant symptoms of hypomania.

 People with bipolar disorder are 14 times more likely to abuse drugs and 6 times more likely to have alcohol dependence than the general population. Substance abuse in people with bipolar disorder is also linked to higher rates of suicide, hospitalization, and accidents, as well as lower rates of participation in treatment. 

 Bipolar disorder is rooted in genetic and biological factors and cannot be caused solely by environmental factors or adult behavior like substance abuse. However, using substances can trigger mood episodes in people who already have the disorder. In addition, substance use in adolescence may cause people who are vulnerable to develop bipolar disorder more rapidly or to become symptomatic.

 Some signs and symptoms of Substance Use Disorder (SUD) include:

·     Reduced productivity and attendance in school or work

·     Frequently getting into trouble

·     Using substances in dangerous situations, such as driving

·     Changes in appetite or sleeping patterns

·     Sudden mood swings

·     Changes in personality

·     Agitation

·     Giddiness

·     Hyperactivity

·     Lack of motivation

·     Anxiety or paranoia for no reason

·     Bloodshot eyes

·     Unusually large pupils

·     Sudden weight loss or gain

·     Physical deterioration

·     Tremors

·     Slurred speech, and

·     Impaired coordination

 If a person notices these signs in themselves, or in others, they should seek medical advice, or call the Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline. The SAMHSA helpline number is 1-800-662-4357. The hotline number is a free and confidential, 24/7, 365 days a year treatment referral and information service in English and Spanish, for individuals and families facing mental health and/or substance use disorders. Again, that number is 1-800-662-4357. You can also go to FindTreatment.gov for numbers to other Helplines and information. 

 Overall, about 14.5% of the population in the United States, or about 40.3 million people, aged 12 and over, had a substance use disorder in 2020. 

Lifetime prevalence of bipolar disorder in adults across the U.S. is between 1% and 3% for Bipolar I and another 1% for Bipolar II disorder. Research indicates that 30% to more than 50% of people with Bipolar I, or Bipolar II, disorder will develop a substance use disorder in their lifetime. 

Studies also show that Bipolar I disorder has a higher rate of co-occurrence with substance use disorder, and as many as 65% of people with Bipolar I disorder experience substance use disorder. 

 Chronic drug and alcohol abuse can change the way the brain functions by altering its structure. A synapse is a structure of the brain that allows signals to pass from one nerve to another. These signals are known as neurotransmitters. Dopamine is an example if a neurotransmitter that elicits positive emotions and reward like feelings. 

 If you use drugs and alcohol for a long period of time the mind will become tolerant to the release of dopamine. The brain will no longer produce the same amount and you will need to use drugs and alcohol to receive normal levels of dopamine.

 When you stop using drugs and alcohol, your body and mind go into withdrawal. Since the brain does not have normal levels of dopamine, you may experience a manic episode or depression. 

Dual diagnosis means having both a substance use disorder and a mental health disorder at the same time. 

Bipolar disorder is only one type of mental health disorder that can co-occur with substance use disorder. Other conditions that commonly co-occur with substance use disorders are:

·     Depression

·     Anxiety disorders, like PTSD, or panic disorder

·     ADHD

·     Schizophrenia

·     Personality disorders, like Borderline Personality Disorder (BPD) or Obsessive-compulsive disorder (OCD)

 When a person has a dual diagnosis of bipolar disorder and a substance use disorder, it is becoming the standard to integrate care and treat both disorders at the same time. Studies show that integrating treatment of both disorders concurrently is far superior to treating each type of disorder separately. Treatment for co-occurring bipolar and substance use disorders usually involves a combination of psychotherapy and medications. 

Several therapies used in addiction treatment have also shown to be effective in treating bipolar and substance use disorders. These therapies include:

·     Cognitive-behavioral therapy (CBT): CBT is a type of behavioral therapy where people learn to challenge ineffective thoughts, replace them with more helpful ones, and change their behaviors

 ·     Dialectical behavioral therapy (DBT): DBT is an approach that incorporates mindfulness and increases the management of difficult emotions. DBT can also teach people skills to manage destructive, self-harming behaviors, and suicidal urges

 ·     Integrated Group Therapy (IGT): This type of therapy was specifically developed for patients with co-occurring bipolar disorder and substance use disorders. It treats both disorders at the same time by helping patients understand how the two disorders relate to each other, and how recovery and relapse are linked to thoughts and behaviors.

 A person may be able to reduce the chances of developing a substance use disorder alongside bipolar disorder by following their doctor’s advice. Taking bipolar medication as a healthcare professional advises can help keep symptoms under control. This may also help reduce the need to self-medicate with drugs and alcohol.

It can be difficult for a person to have both bipolar disorder and a substance use disorder at the same time. However, by following their treatment plan, a person can help manage their own symptoms. 

 Those with both bipolar and substance use disorders may be prone to relapses, so it is vital that they follow their treatment plan. Speak with your doctor if you’re having problems staying on your treatment plan. 

 Substance abuse has negative effects on everyone. Even people who do not have a history of mental illness experience mood swings, exhaustion and anxiety after long periods of drug and alcohol use. 

For a person who suffers from bipolar disorder, the side-effects are compounded. If not controlled, it can lead to the following behaviors:

·     More severe mood swings

·     A higher number of poor judgement decisions

·     Longer episodes of emotional instability

·     Increased number of suicide attempts

·     A worse quality of life, and

·     Severe irritability or hostility

 As is the case with any disease, there are decisions that will make the condition worse. For people with bipolar disorder, drugs and alcohol are one of these decisions. If you have the disorder, you cannot drink alcohol or use drugs in excess. It will put your health and life at risk. Abstinence is the best policy! 

 If you, or a loved one, find yourself in immediate need of emotional help due to a crisis in your life, or a mental health condition, call 9-8-8 and talk to someone at the Suicide and Crisis Lifeline. They are available 24/7 and are ready to help. They even speak Spanish! Or, if you’d rather not get that personal, you can chat with a crisis counselor via text. Just text H-O-M-E to 741741 and find the help you need. Or, if the person is in danger of harm, please go to your local emergency room. 

 For those living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just go to the internet and type in, all lowercase:

      findahelpline.com/i/iasp

 And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

Again, that’s:

        findahelpline.com/i/iasp

 Thank you so much for joining me this evening.  It has been a pleasure! As always, be safe in all your travels, and until we meet again on “Bipolar for Life,” good night.