How can I cope with bipolar disorder and addiction?

People have been struggling with bipolar and substance use disorders for a long time. Sixty-five percent of people with bipolar disorder (BD) have a co-existing medical condition. And forty-two percent of people with BD have substance use disorders (SUDs). [1]

The reason people with bipolar disorder have such a high rate of addiction to substances is that they help to relieve pain and other symptoms of bipolar disorder.

For example:

  • A person with BD uses drugs like speed to help them during mania, and also when they are depressed
  • They may use a substance like oxycodone to help with the pain of staying up three days when they are hypomanic
  • Someone with BD may use sleeping pills to deal with the lack of sleep often associated with BD
  • It’s hard sometimes to stay hyper-focused and break away from a task, especially when it comes to doing work you enjoy, so people with BD may use amphetamines to sustain their euphoria

People take drugs to help cope with these scenarios, but there is a risk of becoming stuck in a cycle of using drugs or alcohol to cope with bipolar disorder.

But there is hope. Learning as much as you can about both bipolar and substance use disorders can help you understand how to cope. And remember, you are not alone. There are many influential thinkers and doers who have bipolar and substance use disorders. [2] Many have reached recovery and live productive lives. And so can you!

It starts with acceptance

Accepting that you have a dual diagnosis and finding a way to stop using alcohol or substances is the best thing you can do to cope with and stop bipolar symptoms.

One way to accept your diagnosis and cope is to know your story. Think about What happened to you? What have you experienced in your life? And share that with someone, so you can see for yourself. You cannot chart a course for your recovery until you understand where you are and where you came from.

For example, the Kindling Theory relates to BD and SUDs and can help you reflect. The theory says that added stressors will cause a bigger problem. [3][4] For example, when you make a campfire, you light a bunch of small pieces of wood called kindling. The combination of those small pieces of wood makes a full-blown campfire. Something similar happens to your brain if you have BD and SUDs. Things add up, and it’s hard to cope.

Learning can also help you on your path to acceptance. You can learn by researching and reading articles, watching videos online, or finding others on social media who can relate to your experiences.

You can also find and talk to people like peer support specialists who have similar experiences to your own. Listening to others’ stories and educating yourself about living with both bipolar and substance use disorders can help you see that you are not alone in this journey. And that there is both guidance and healing out there for you.

I have a diagnosis of bipolar disorder. I traveled for my job. I traveled to different cities across time zones. It was stressful. I was out of town all week, and I worked twelve-hour days.

At night, I came back to my hotel room and ordered room service. I ordered wine to help me calm down. I would take something to help me sleep. But I did not sleep well most of the time. I felt alone. In the morning I drank coffee to wake up. I would take something to help me with daytime sleepiness. And would not eat lunch. At the end of the week, I would rush to the airport to get on a plane to fly home. I would have drinks on the plane. I was then back out on the road on Sunday afternoon.

Years of doing that caused me to get sick. The combination of all these things added up. I had a full-blown psychotic episode. I ended up in the hospital, suicidal. Developed rapid cycling. In the hospital I accepted I had a dual diagnosis. I got help. I got into recovery.

Bill, Georgia

Treat both Illnesses

You should treat both illnesses at the same time because certain drugs can worsen the symptoms of bipolar disorder.

There is evidence that if you developed SUDs before BD, you have a better chance of reaching recovery. [1] The impact of both illnesses can make it more difficult to treat, and oftentimes, people misuse substances to relieve the symptoms of bipolar.

There are online and in person groups designed to help support people who have substance use and mental health challenges. You may be able to find local groups by looking up “dual recovery meetings” or “dual diagnosis 12-step meetings.”

Most addictionologists, that are psychiatrists, are trained to treat dual diagnosis patients. You can also go online to find doctors in your community with these credentials. The treatment focuses on the primary illness which usually is bipolar disorder where the addiction is a symptom of bipolar illness. And addiction is treated like other symptoms including depression and mania.

Mental Health America’s choosing a provider resource can help you find more resources online and/or talk with your doctor to find a mental health professional in your area.

Lifestyle changes that can help

Drugs and alcohol are extremely dangerous with bipolar- it’s kind of easy to overdo things with bipolar.

Rachel, Georgia

If you have substance use disorders, you may have spent years using alcohol and drugs. You may have neglected to take care of yourself during those times. You probably weren’t doing things to keep you healthy like eating regular meals, getting enough sleep, and taking your medications.

Below there are ways that can help you check in with yourself and keep you healthy in your recovery journey:

  •  HALT: In recovery, HALT stands for Hungry, Angry, Lonely, and Tired.[5] If you feel off or like something is wrong, ask yourself if you are experiencing any of these symptoms. Identify the feeling and take steps to fix it. Ignoring these feelings could increase your chance of relapse.
  •  Catch it, Check it, Change it:  This method works to stop negative thinking. Catch it – what are you thinking? Check it against what you know about recovery. And Change it to positive thoughts about being in recovery. You can change your thoughts and set your mind on positive things. Then your emotions will follow what you are thinking.
  •  Know your stressors and triggers/activators: Know your history. Getting upset and stressed-out causes symptoms like mania, depression, and physical health conditions. Stressors are things that can cause a negative reaction. Think about things that might make you feel unwell, uncomfortable, or throw you off track if they happen.
  • Get enough sleep: Sleep disturbance is a core symptom of bipolar disorder. [6] Bipolar disorder medications will not work properly if you are not getting enough sleep. During manic episodes there is a reduced need for sleep. During depression you cannot get out of bed. Substance abuse disrupts sleep and how you sleep. Inadequate sleep makes it harder to stay in recovery.
  •  Find the right medications: Finding the right medications for both bipolar and substance use disorders can take time. But you do need to work with a doctor. They should take a history of your illnesses to determine which medications are best for you. For sleep, anxiety, and pain you need to find non-addictive medications because addictive medications could make your bipolar disorder worse.
  •  Find support: Finding support can help you meet people who can relate to your experience. There are groups that can help you connect with others. The Depression and Bipolar Support Alliance (DBSA) is where you can find support for mood disorders. They have peer-run support groups across America. Double Trouble in Recovery (DTR) is a 12-step support group. It’s for people with a dual diagnosis—mental health challenges and SUDs.

Bipolar disorder is a mental health condition with many symptoms that must be treated. Treating the addiction and getting into recovery from it, is key to the overall success of treatment of both bipolar disorder and addiction.

  1. Goodwin, F. & Jamison, K.F. (2007). Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression. Oxford University Press.
  2. Angst, J., & Marneros, A. (2001). Bipolarity from ancient to modern times: conception, birth and rebirth. Journal of affective disorders, 67(1-3), 3–19. https://doi.org/10.1016/s0165-0327(01)00429-3
  3. Weiss, R. B., Stange, J. P., Boland, E. M., Black, S. K., LaBelle, D. R., Abramson, L. Y., & Alloy, L. B. (2015). Kindling of life stress in bipolar disorder: comparison of sensitization and autonomy models. Journal of abnormal psychology, 124(1), 4–16. https://doi.org/10.1037/abn0000014
  4. Bender, R. E., & Alloy, L. B. (2011). Life stress and kindling in bipolar disorder: review of the evidence and integration with emerging biopsychosocial theories. Clinical psychology review, 31(3), 383–398. https://doi.org/10.1016/j.cpr.2011.01.004
  5. Linney, S. (2022, May 23). What Is HALT? The Dangers of Being Hungry, Angry, Lonely or Tired. American Addiction Centers. https://americanaddictioncenters.org/blog/common-stressors-recovery
  6. Harvey, A. G., Talbot, L. S., & Gershon, A. (2009). Sleep Disturbance in Bipolar Disorder Across the Lifespan. Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association, 16(2), 256–277. https://doi.org/10.1111/j.1468-2850.2009.01164.x
  7. American Addiction Centers. (2023, March 1). History of Drug Abuse and Addiction in the U.S. and Throughout the World. Drugabuse.com. https://drugabuse.com/addiction/history-drug-abuse/
  8. Coles A., George, T.P., & Ming, M. (2018). Understanding and Treating Co-Occurring Bipolar Disorder and Substance Use Disorders. Psychiatric Times, 35 (9), (n.p.) https://www.psychiatrictimes.com/view/understanding-and-treating-co-occurring-bipolar-disorder-and-substance-use-disorders
  9. Georgia Mental Health Consumer Network. (n.d.) Double Trouble in Recovery. GMHCN.org. https://www.gmhcn.org/double-trouble-in-recovery#:~:text=Double%20Trouble%20in%20Recovery%20is,use%20and%20behavioral%20health%20challenges.
  10. Jamison, K.F. (2000). Night Falls Fast: Understanding Suicide. Vintage.
  11. Muneer A. (2016). Bipolar Disorder: Role of Inflammation and the Development of Disease Biomarkers. Psychiatry investigation, 13(1), 18–33. https://doi.org/10.4306/pi.2016.13.1.18
  12. Nelson, A. (2022, August 28). The History of Bipolar Disorder. WebMD. https://www.webmd.com/bipolar-disorder/history-bipolar
  13. Soreca, I., Levenson, J., Lotz, M., Frank, E., & Kupfer, D. J. (2012). Sleep apnea risk and clinical correlates in patients with bipolar disorder. Bipolar disorders, 14(6), 672–676. https://doi.org/10.1111/j.1399-5618.2012.01044.x

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