Bipolar Disorder and Substance Abuse

In a multimedia cyber world, the awareness of Bipolar Disorder continues to grow. You can go on the internet and search "Celebrities with Bipolar Disorder" and some names that will pop up are Britney Spears, Mel Gibson, Ben Stiller, Kurt Cobain, Ozzy Osbourne, Macy Gray, Axl Rose, Virginia Woolf, Linda Hamilton, Sting, Jean-Claude Van Damme and many more. Because celebrities are in the public eye, and constantly under the close watch of the media, any unusual behaviors are seen and scrutinized.

Many individuals with Mood Disorder can recall years or manic and depressive behaviors. They did not seek help until there was a notable impairment of function of their daily activities. Prior to seeking help, some individuals with mood disorder try to cope with their manic depressive mood swings either through exercise, hobbies, yoga, art, music or talking with close friends or family. Unfortunately, most individuals choose to self medicate with alcohol and illicit drugs. 60% of individuals with bipolar disorder will develop a substance abuse disorder at some point in their lifetime.

Bipolar disorder is categorized as a mood disorder wherein a person will cycle between a manic state (hyperactivity, distractibility, decreased need for sleep, grandiose behavior, flight of ideas, racing thoughts, pressured / rapid speech, impulsivity, poor judgment, hypersexuality, spending sprees, dangerous behaviors and unrealistic optimism) and depressive state (sadness, crying spells, decreased sleep, loss of interest or pleasure in activities or hobbies, excessive guilt, low energy / motivation, weight gain, feelings of helplessness/hopelessness/worthlessness, restlessness or irritability, poor concentration and suicidal thoughts or attempts).

The prevalence of Bipolar Disorder in the United States is 1 -2 % of the general population. The age of onset is around 19 years old with most cases presenting between ages 15 - 20 years old. The Incidence between male and females with bipolar disorder is equivalent with no general association with a socioeconomic class or ethnic group. Only one-third of those with Mood Disorder are formally diagnosed by a physician and of the one-third, approximately 25% is actually treated. Untreated Bipolar Disorder has a lifetime risk of completed suicide of 15%.

An individual with Mood Disorder may look very different when manic or depressed thus making the disorder frequently misdiagnosed. In regards to substance abuse, often times an individual may deal with their depression by using cocaine to elevate their mood. When dealing with their mania, an individual may consume alcoholic beverages, benzodiazepines or opiates to bring down their mood. The question that one should ask is if the substance abuse is a result of the Bipolar Disorder or if the signs and symptoms of Bipolar Disorder (mood swings of mania and depression) are a result of the substance abuse. Such individuals may be bounced back and forth from Psychiatric inpatient hospitals or Drug Rehabilitation Centers. Often times, individuals are refused treatment or are become frustrated with the system that they no longer pursue treatment.

To help better manage this question, Dual diagnosis or Mental Illness and Chemical Addiction (MICA) Units were developed. These units recognize both "Mental Illness" (Major Depression, Bipolar or Schizophrenia) and "Substance Abuse." These units are comprised with Psychiatrists, Nurses, Psychologist, Therapist, Social Workers and various other support staff. Such programs provide a medically supervised and safe detoxification process; individual treatment plan addressing both psychiatric illness and substance abuse and a central location limiting disruption and enhancing continuity of care.