Bipolar Disorder and Addiction

“When I first got diagnosed with bipolar 1 disorder,  I was in denial. For months after hearing doctor after doctor telling me the same thing I would still hide my meds, take drugs and do anything to prove I wasn’t crazy. But the hospital visits and psych ward continued to prove I was wrong. I was crazy.

“But being bipolar doesn’t mean your crazy. The more I learn about my disorder (reading articles, books and even digging into my past) I notice that I am not alone. I notice that these moments of clear insanity have a purpose, they have a name. There are reasons to me madness and now I finally have an opportunity to treat it.

“Its important that we are knowledgable about our (or your loved ones) diagnosis because it gives us the power and courage to live with it. This is an article I have found very helpful to myself as I live with bipolar and co-occurring addiction. It’s informative and concise, clearly describing the highs and lows of bipolar disorder.” -Love, Robyn

Bipolar disorder, once commonly known as manic depression, is a serious mental disorder that is characterized by sudden and intense shifts in mood, behavior and energy levels. Like substance abuse, bipolar disorder poses a risk to the individual’s physical and emotional well-being. Those afflicted with bipolar disorder have a higher rate of relationship problems, economic instability, accidental injuries and suicide than the general population. They are also significantly more likely to develop an addiction to drugs or alcohol. According to statistics presented by the American Journal of Managed Care:

• About 56 percent of individuals with bipolar who participated in a national study had experienced drug or alcohol addiction during their lifetime.
• Approximately 46 percent of that group had abused alcohol or were addicted to alcohol.
• About 41 percent had abused drugs or were addicted to drugs.
• Alcohol is the most commonly abused substance among bipolar individuals.

If you are struggling with bipolar disorder and with a drug or alcohol problem, you may have a Dual Diagnosis of bipolar disorder and substance abuse. Having a Dual Diagnosis, or a co-occurring disorder, can make recovery more challenging. Bipolar individuals may experience periods of intense depression alternating with episodes of heightened activity and an exaggerated sense of self-importance. This emotional instability can interfere with your recovery program, making it difficult to comply with the guidelines of your treatment plan.

Dual Diagnosis rehabilitation programs are designed to meet the needs of clients who are faced with this complex psychiatric condition. Staffed by specially trained and credentialed mental health professionals and addiction specialists, these centers offer care that integrates the best treatment strategies for bipolar disorder with the most effective treatments for addiction.

How Are Bipolar and Addiction Related?

There is no easy explanation for the high rate of substance abuse and chemical dependence among bipolar individuals. One reason for this phenomenon is that a large percentage of individuals attempt to self-medicate with drugs and alcohol in an effort to numb the painful symptoms of their bipolar disorder. Symptoms of bipolar disorder such as anxiety, pain, depression and sleeplessness are so alarming, that many individuals will turn to drugs and alcohol as a means for offsetting the discomfort, if only for a little while. On the other hand, the National Institute of Mental Health notes that drinking and using drugs may trigger depressed or manic moods in someone with bipolar disorder.

Age and gender may play a part in the relationship between bipolar and addiction. According to the journal, Bipolar Disorder and substance abuse is more common in young males than in other population groups.

Young men are more likely than females or older men to take dangerous risks or to act on serious self-destructive impulses. In elderly individuals with bipolar disorder, the incidence of substance abuse is much lower.

Clinical researchers believe that brain chemistry may influence both bipolar disorder and substance abuse. People with bipolar disorder often have abnormal levels of serotonin, dopamine and norepinephrine, according to WebMD. These chemicals affect vital functions like appetite, metabolism, sleep and your body’s response to stress. They also affect mood and emotions. Heavy use of drugs or alcohol can interfere with the way your brain processes these chemicals, causing emotional instability, erratic energy levels and depression. People with bipolar disorder may turn to drugs or alcohol out of an unconscious need to stabilize their moods. Unfortunately, substance abuse has the opposite effect, making the symptoms of bipolar disorder worse.

Symptoms of Bipolar Disorder

We all go through intense episodes of sadness, elation, anger or despair. But for someone who meets the diagnostic criteria for bipolar disorder, these episodes are all-consuming and uncontrollable. There are four major types of mood episodes that characterize bipolar disorder: mania, hypomania, depression and mixed episodes — each of which has a set of unique symptoms:

Symptoms of Mania

Mania is the “high” end of the mood spectrum for bipolar individuals. Symptoms may include:

• Moments of tremendous optimism and significant pessimism
• Grandiose feelings
• Rapid talking
• Little sleep
• Impaired judgment, irrational behavior
• Delusional behavior
• Hallucinations

Symptoms of Hypomania

Symptoms are similar to those found in manic behavior but less intense. Hypomanic individuals are usually capable of managing their day-to-day lives, but they experience a higher than usual level of happiness, irritability or energy. You may feel that you’re capable of taking on more responsibility, or that you need less sleep. People in your life may find that you’re more talkative or sociable. You may also be more prone to engage in risk-taking behaviors, like substance abuse. Hypomanic periods are extremely productive for some people, and because psychotic symptoms do not occur in hypomania, it might seem that you don’t really have a problem.

Symptoms of Depression

At the “low” end of the bipolar spectrum is depression, an emotional state that is often characterized by sadness, tearfulness and despair. Depression in bipolar disorder may last for days or weeks, depending on your mood cycle. These periods are dangerous for Dual Diagnosis individuals, who have a higher risk of self-injury and suicide when they’re using drugs and alcohol during a low period. When you’re depressed, you may experience:

• Hopeless feelings
• Loss of interest in things that used to make you happy
• Fatigue
• Changes in appetite
• Self-loathing
• Suicidal thoughts

Symptoms of Mixed Episodes

The symptoms of bipolar disorder aren’t always clearly defined. In a mixed episode, behaviors reflect a combination of mania and depression. For example, you may have suicidal feelings and a loss of interest in your daily activities, combined with racing thoughts, pressured speech and a loss of sleep.

You may feel the urge to drink or take drugs in an attempt to balance out these unpredictable mood swings, but intoxication is only a temporary fix that won’t provide permanent relief. To achieve a full recovery, you need professional treatment that helps you stabilize your moods as you deal with the cravings and destructive impulses that characterize addiction.

 

Understanding Withdrawal Symptoms

“Going into a detox facility during withdrawal from drugs and alcohol is not only safer but highly recommended to those who are trying to stop using because you will receive a lot of support. Commonly, after one goes through detox, they will be able to work with staff to determine the next steps in their treatment. This can include inpatient or outpatient programs that will help educate and inspire a life of sobriety. 

“You don’t have to go through withdrawals alone. It can be scary not understanding whats going on with your body. Below are a list of symptoms to look out for to assure that, yes, you are going through withdrawal and yes, you need to seek help. 

“I know that I had no idea that I was going through withdrawals when I first experienced it. I was in denial about my addiction and I wish I sought help immediately before I decided to simply replace my drug of choice, thinking they weren’t as bad as the ones I was using before. ” -Love and light, Robyn

When it comes to alcoholism and drug addiction, going cold turkey is not the right option. Supervised detox is usually safer and may be the best route for you or your loved one.

Treatment for alcoholism or drug addiction involves undergoing therapy to help you mentally and physically recover from theaddiction. In order to get better, you must physically “cleanse” your body of the substance. To avoid a life-threatening reaction brought on by withdrawal from alcoholism or drug addiction, it’s best to seek professional help instead of trying to go it alone.

Ending Drug Addiction: Withdrawal and Detox
Withdrawal — stopping alcohol or drug use — can be extremely dangerous if done on your own, which is why a carefully administered plan for detoxification is the safest way to end your drug or alcohol addiction.

According to James Garbutt, MD, professor of psychiatry at the University of North Carolina in Chapel Hill, and research scientist at the Bowles Center for Alcohol Studies, “Everyone is going to have to go through detoxification to withdraw from a substance. The question is, when is it medically dangerous and when does it require medical oversight?”

Withdrawal from many drugs can bring symptoms such as agitation, sweating, an inability to sleep, and high blood pressure. Opiate and narcotic withdrawal symptoms can be among the most difficult. Opiates and narcotics are classes of drugs that include heroin, codeine, Demerol (meperidine), and Oxycontin (oxycodone), which are taken to achieve a sense of euphoria in those who abuse them.

Other substances that tend to cause more severe withdrawal symptoms, and potentially life-threatening symptoms, are barbiturates, alcohol, and benzodiazepines, according to Stephen Gilman, MD, an addiction psychiatry specialist in New York City. “Withdrawal from these substances should be handled in a hospital.”

Drug Addiction: Symptoms of Withdrawal
Symptoms of withdrawal depend on the object of the addiction. The following symptoms may result:

• For alcohol: sweating, anxiety, tremors, fluctuations in blood pressure and heart rate, seizures, delirium tremens (the “DTs” — a state of extreme agitation, hallucinations, hyperactivity, tremors, and confusion), psychosis and, adds Dr. Gilman, “ultimately death if not treated by a professional.”
• For opiates/narcotics: anxiety, insomnia, dilated pupils, increased heart rate, elevated blood pressure, nausea, and vomiting.
• For stimulants, such as cocaine: excessive tiredness and depression.
• For barbiturates (such as Amytal, Nembutal, Seconal): nausea, fast breathing, increased heart rate, tremors, muscle pain, insomnia, hallucinations, convulsions, and delirium. If withdrawal is not monitored, the consequence could be death.
• For benzodiazepines (such as Xanax, Librium, Valium): delirium, muscle twitches, hallucinations, sensitivity to light, sound, taste, and smell, ringing in the ears, tingling, numbness, and insomnia.

Ending Drug Addiction With Medication
Another reason detox in a controlled setting is important: Medical professionals can administer medications to ease withdrawal symptoms. Ironically, sometimes these are the same drugs that are being abused.

From http://www.webmd.com by Linda Foster, MA and medically reviewed by Cynthia Haines, MD

It Takes a Village

“In the beginning, a lot of us thought we could do this alone. But as recovery programs such as AA, NA and CA prove; we just can’t. A great way people jump-start their recovery is through inpatient and outpatient treatments. These facilities (that can be independent or hospital run) are armed with people to help and guide you through a smooth and successful recovery. Offering therapies and skills that will offer you the chance to lead a happier life. I went to rehab at Gateway for a month and followed up with an intensive outpatient program. Now I have graduated that with over 65 days sober and seeing a therapist regularly (and of course finishing the 90 in 90!). It has been a long journey so far, but everyday I am reminded of my strength and perseverance. I will never give up on my sobriety because that means I would be giving up on myself. Something I never want to do again…” -Thank you, Robyn

Types of Recovery Programs

Not all recovery programs involve a inpatient stays. Some programs involve daily attendance and participation in group programs such as Narcotics Anonymous. Some types of treatments that might be available in your area are outlined below.

• Residential programs involve living in the treatment facility and attending groups, individual counseling and other activities. Long-term or extended programs usually last 90 days, and shorter programs require stays of 28 or 30 days.
• Outpatient rehab programs offer a number of options, often treating individuals for several hours a day over the course of a few weeks.
• Group support or therapy sessions can meet daily, weekly or at other intervals. This type of recovery program is offered by accredited facilities, volunteer organizations, churches and community centers.
• Individual therapy with a Board Certified Substance Abuse Counselor can be the appropriate treatment for some patients and may also be part of an aftercare program following a stay in a residential rehab program.
• Some addictions may require medical intervention, especially during the early days when physical withdrawal symptoms can be dangerous for the person attempting to become sober.

Who Should Consider a Rehab Program?

No simple formula exists for providers or patients to determine who should attend what type of drug treatment program. Drug addiction is not a simple issue, so you should ask for assistance from experienced medical or behavioral health professionals to design a treatment plan that is right for your situation. Trying drugs just once does not necessarily indicate an addiction. On the other hand, being unable to say no to substances, taking extreme actions to obtain drugs or finding yourself frequently taking drugs may indicate a need for treatment for drug and alcohol recovery.

Important Information for Effective Treatment

Research over the past 40 years has consistently identified some key information that has helped build effective treatment programs. It is important to understand the following drug recovery information.

• Addiction impacts the function of your brain, which can alter your behavior. Guilt associated with drug-related behavior often keeps people from successful addiction recovery, but you need to be able to separate how you act on drugs from how you want to act.
• Successful treatment programs provide for all aspects of a person’s life, not just a specific addiction. Learning new skills and sharing emotional troubles may help with recovery.
• It is essential that you remain in treatment and comply with follow-up care. Drug addiction is a chronic disorder; some doctors have even compared addiction with asthma or hypertension. You would not stop taking your asthma medicine if it was helping to control symptoms.
• Drug addiction is often closely related to mental illness. A rehab program that can deal with adual diagnosis is essential in these cases.
• Treatment plans should be reevaluated and altered on an ongoing basis to seek continuous improvement. In most cases, the individual struggling with addiction should have the opportunity to provide some feedback.

When you are looking for a drug recovery treatment center, keep the above information in mind. You may also want to ask for a referral or request information about outpatient and residential rehabilitation programs from a counselor, social worker, doctor or psychiatrist.

Aftercare is Essential for Success

One thing that causes people to fall off the wagon after completing a recovery program is noncompliance with aftercare. Some people believe that drug addiction can be treated similarly to a traumatic injury such as a broken arm. The arm is set and it heals, the cast is removed, physical therapy is scheduled and life eventually returns to normal. In most cases, drug addiction cannot be approached in such a manner. Someone struggling with an addiction can appear to heal, only to relapse months or years later because of the chronic nature of the problem. Because of this, following aftercare recommendations, including involvement in group or individual counseling, is essential.

Compiled by Recovery.org

DBT in Recovery

Dialectical behavior therapy (DBT) is a relatively new treatment method that has shown promise for treating both substance abuse and even the most difficult mental health concerns. Targeted dialectical behavior therapy programs work especially for those who:

• Suffer from trauma, life-threatening experiences, abuse or loss
• Try traditional therapy with limited success
• Struggle with co-occurring addiction and mental health concerns
• Struggle with bipolar disorder, an eating disorder, PTSD or borderline personality disorder
• Struggle with self-injury, self-harm or low self-esteem
• Are an adult child of an alcoholic or suffered abuse or trauma as a young person
• Have difficulties coping with emotions or feel that your emotions are overwhelming

How Is Dialectical Behavior Therapy Different?

Dialectical behavior therapy was developed by Dr. Marsha Linehan, a renowned psychologist at the University of Washington. Dr. Linehan specializes in hard-to-treat patients. She found that traditional methods of therapy were not effective, and as a result she developed DBT.

DBT is different, as it does a few things that traditional therapy does not. DBT helps you deal with complicated emotions without putting you “on the spot.” DBT has two types of sessions that include a classroom/group environment and individual therapy sessions. These two types of treatment sessions work together to help you feel more comfortable about the treatment process. DBT provides real-life skills to help you recover from addiction and identify and help yourself get through difficult life moments. Dialectical behavior therapy is different from traditional Cognitive Behavioral Therapy in the following ways:

• DBT works like a class, as you learn more about yourself and how you relate to others
• DBT accepts you as you are and does not pressure you to become someone you are not
• DBT works to help you accept hardships and handle trauma and conflict more effectively
• DBT helps you regulate and control your own emotions
• DBT gives you the skills to release anxiety and live a life you want to live

What Are the Goals of Dialectical Behavior Therapy?

Dialectical behavior therapy helps you become more present, mindful and at peace with the world. By combining Buddhist principles with traditional psychotherapy and life skills, DBT works to help patients in the following four core areas:

• Emotion regulation: Helping patients learn how to manage mood changes and impulsive decisions naturally
• Distress tolerance: Teaching patients how to cope with trauma, distressing feelings and reactions
• Mindfulness: Learning how to observe the situation and accept yourself and others as they are, and learning how to enjoy life just as it is and not how you would like it to be
• Interpersonal effectiveness: Helping patients cope with difficult situations and difficult people to create healthy boundaries and build happier relationships

Take a Quiz to Judge How Well You Manage Your Bipolar Disorder

“Check out this link to take a test that evaluates how well you are controlling your bipolar disorder. It offers some insight that you might not have been able to see and educates you on the steps you can take to improve your situation.

I took the test, these were my results: ” – Shanti, Robyn

Your Bipolar Disorder May Not Be Well Controlled

Perhaps you’ve been dealing with symptoms for a while but are afraid to talk to a doctor, or you’ve been diagnosed but don’t like taking medication. Sometimes lifestyle factors like your support system or dietary habits play a part. Whatever the reason, your responses indicate that it’s time to get things in order. Start here:

See a Qualified Medical Professional

When it comes to getting a proper diagnosis and treatment plan, it can sometimes take a few tries. If your primary doctor hasn’t addressed your concerns or has prescribed a medication that isn’t helping, you may need to seek out a psychiatrist to diagnose and treat your bipolar disorder. Your regular doctor or local hospital should be able to recommend one.

Educate Yourself and Your Family and Friends

There’s a wealth of information available to help you get a better understanding of the condition, whether online, through mental health organizations, from self-help books, or from your doctor’s office. Sharing this information with family and friends can help them understand too, and may even open up a dialogue about how they can best support you.

Know Your Treatment Options

A number of therapies are available to help alleviate the symptoms of bipolar disorder. Your doctor can tell you about medication options, which range from mood stabilizers to antidepressants. Talk therapy is also often useful, and some complementary therapies, like acupuncture, may be incorporated into your plan.

Inform Your Workplace or School

If you find yourself struggling to keep up at work or school, it might be necessary to inform human resources, your union, or school administration that you’re managing a medical condition. That way you can learn about your options should you need to take time off, and you can file any necessary paperwork.

An Introduction to Acupuncture and Psychiatric Disorders

“I have studied oriental theories and traditional Chinese medicine at Pacific College. Before I took any pills to treat my bipolar disorder, I inquired about other, more holistic approaches to treat my condition. Sure enough, yoga and meditation can compliment Western treatments for mood disorders and acupuncture can also help a great deal. This is a great article briefly describing Eastern theories and how they approach mental illness.” – Peace and Love, Robyn

Acupuncture is an ancient form of traditional Chinese medicine. It works on the principle of stimulating points in the body to correct imbalances in the flow of energy (Qi) through channels known as meridians. This belief is based on the interaction of the five elements (wood, fire, earth, metal and water) and having profound effects on internal organs, which are either yin or yang.

Traditional Chinese medicine also recognizes the mind and body interacting as one, meaning that emotions have a physiological effect on the body. Five emotions are represented by the five elements:

• Water (fear)
• Wood (anger)
• Fire (happiness)
• Earth (worry)
• Metal (grief)

Western medical practitioners traditionally have questioned the validity of traditional Chinese medicines such as acupuncture. More recently, acupuncture has been recognized as a legitimate treatment for some conditions and is growing in popularity.

ANXIETY 

Anxiety is one of the most common mental illnesses worldwide. Many people suffer some form of anxiety occasionally but others cannot manage this natural response to a stressful situation. When a person experiences a highly stressful or threatening scenario, the mind can be overloaded and fail to develop ways of coping.

Although the symptoms can be as manageable as an ominous feeling in the pit of the stomach, some suffer much worse. Anxiety can trigger the following responses:

• physical, such as an irregular heartbeat
• cognitive, which can cause negative thoughts
• behavioral, which may include uncharacteristic aggression or restlessness
• emotional, such as fear.

Depending on which of these symptoms are suffered, different anxiety disorders may be diagnosed. These include:

• generalized anxiety disorder (GAD)
• panic disorder
• social anxiety disorder
• post-traumatic stress disorder (PTSD)
• obsessive-compulsive disorder (OCD)

There are a variety of causes of anxiety; all have different treatments. A person’s personality, behavior or thinking style can cause them to be more susceptible to anxiety. Research has proven it also can be hereditary. Biochemical factors such as a chemical imbalance in the brain also has been proven to cause anxiety.

Traditional Chinese medicine relates anxiety to an imbalance of the heart and kidney. Fire represents the heart and joy according to the five elements. The diagnosis is that too much heat in the heart will imbalance the interaction with the kidney (represented as water and fear). This will result in the water organ failing to contain the fire organ rising up to the mind, leading to anxiety. Acupuncture on points around the heart, kidney, spleen and ear are used to treat anxiety.

In a comprehensive literature review appearing in a recent edition ofCNS Neuroscience and Therapeutics, it was proved that acupuncture is comparable to cognitive-behavioral therapy (CBT), which psychologists commonly use to treat anxiety (Errington-Evans, 2011). Another study published in the Journal of Endocrinology in March 2013 discovered stress hormones were lower in rats after receiving electric acupuncture (Eshkevari, Permaul and Mulroney, 2013).

DEPRESSION

It is estimated that approximately one in five people will experience clinical depression at least once in their lifetime. Although it is natural to feel sad and down at times, especially after experiencing loss, these slight effects can be managed with gradual lifestyle adjustments. Clinical depression, however, refers to a long-lasting and intense emotional, physical and cognitive state that greatly affects day-to-day life. Symptoms include:

• Loss of positive associations and sense of achievement (lack of interest in normally pleasurable activities)
• Negative thoughts (often worrying about the future)
• Irritability, agitation and exhaustion
• Changes in sleeping patterns (too much or too little)
• Hopelessness (feeling trapped or suicidal)

The causes of depression are known to be similar to the causes of anxiety. It is traditionally treated with antidepressant medication, psychological methods or a combination of both.

Depression is considered to be a problem with circulating Qi around your body, according to traditional Chinese beliefs. The main organ responsible for circulating Qi is recognized as the liver with the heart and spleen playing supporting roles. The most common acupuncture treatment used to increase the flow of Qi is known as The Four Gates. This involves stimulating source points on both hands between the thumb and index finger and both feet between the big toe and second toe.

Anxiety and depression remain two of the most common mental disorders worldwide. As further research continues, acupuncture and other forms of complementary therapies are gradually being proved to be legitimate treatments for anxiety, depression and other illnesses. Perhaps more important than anything for our health is varying our lifestyles by trying alternative therapies, including exercise, yoga and meditation. It is important, however, to always get a second opinion and consult a doctor any time complementary therapies are tried.

References

Errington-Evans, N. (2011). Acupuncture for anxiety. CNS Neuroscience and Therapeutics, 18(4), 277-284. doi: 10.1111/j.1755-5949.2011.00254.x

Eshkevari, L., Permaul, E., & Mulroney, S.E. (2013). Acupuncture blocks cold stress-induced increases in the hypothalamus–pituitary–adrenal axis in the rat. Journal of Endocrinology, 217(1), 95-104. doi: 10.1530/JOE-12-040

Source:

http://psychcentral.com/lib/acupuncture-anxiety-depression/00017321