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Bipolar Disorder and Addiction

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“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

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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.

 

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Understanding Withdrawal Symptoms

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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

withdrawal

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