FACT SHEET: PERSONS WITH BIPOLAR DISORDER COMORBID
WITH SUBSTANCE ABUSE
Fact Sheet:
Persons with
bipolar
disorder
comorbid
with
substance
abuse
by
Nicholas Perfetto
INTRO TO BIPOLAR DISORDER


Bipolar disorder is a serious
mental disorder that is
characterized by sudden
and intense shifts in mood,
behavior and energy levels.

Moods and corresponding
behavior may swing
between extreme mania and
deep depression.

Bipolar disorder was once
commonly known as “manic
depression.”

Bipolar Disorder is
sometimes differentiated as
Bipolar I, Bipolar II, or
cyclothymic disorder, which
are increasingly mild types.

Approximately 4.4% of US
adults have been diagnosed
with bipolar disorder.
Results in 9.2 year
reduction in life expectancy
and 1 in 5 people with
bipolar commits suicide
FACT SHEET: PERSONS WITH BIPOLAR DISORDER COMORBID
WITH SUBSTANCE ABUSE |
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Comorbidity with
SUDs

Bipolar disorders have been
linked to increased
substance abuse at varying
rates.

Most estimates put the rates
of comorbidity at 45-60%.

The more pervasive the
symptoms and diagnosis
(i.e. bipolar I vs bipolar II),
the more commonly
comorbid with substance
abuse disorders (SUDs).

Persons with bipolar may
be seeking to ease the
painful symptoms of their
depression through selfmedication with drugs and
alcohol

During their mania or
hypomania (mild mania),
their false confidence, high
energy and mood, and
increased impulsivity may
make them more inclined to
thrill-seek or make risky
decisions, such as those
involving drugs and alcohol.

Many different substances
are abused, and they may
correlate with different
mood states: for example,
Strakowski, et al. (2000)
found that alcohol use
correlated with depressed
states, but cannabis use
with manic states.
As shown below, bipolar disorder
is comorbid with many other
serious conditions, including
substance abuse disorders.
DISAGREEMENT IN RESEARCH
IN MANY STUDIES, THE RESEARCHERS
FOUND THAT COMORBIDITY RATES
RANGED FROM 14-60%. THIS WIDE
RANGE COULD BE DUE TO A NUMBER
OF FACTORS INCLUDING CONTEXT
AND SAMPLE SIZE (CASSIDY, AHEARN,
& CARROLL, 2001)
FACT SHEET: PERSONS WITH BIPOLAR DISORDER COMORBID
WITH SUBSTANCE ABUSE |
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TREATMENT
AND
PROGNOSIS



While persons with
bipolar disorder may
abuse substances as a
way to gain control or
stabilize their mood, they
actually make the
symptoms worse and
more volatile.
Because the substance
abuse disorders and
bipolar are so closely
connected, they can and
should be treated together.
This integrated
treatment philosophy
allows for flexibility in
treatment.

Alcohol and marijuana are
most commonly abused by
persons with bipolar disorder,
but narcotics and other hard
drugs are also commonly
abused.
Psychosocial interventions
can be mixed with medical
treatments, and can be
administered by a team of
professionals, in a group
setting, etc.
Medical Treatment
Pharmacotherapy
Treatment
Pharmacotherapy
Treatment
Options
Options
Options
 Lithium
o Treatment for mania and
impulsivity
o Can be paired successfully
with anticonvulsant drugs
 Lamotrigine
 Valproate
 Depakote
 Antipsychotics
o Clozapine
o Aripiprazole
o Olanzapine
 Antidepressants
o Fluoxetine
 Drug combinations of the above
as prescribed
Psychosocial
Treatment
Psychosocial
Treatment
Psychosocial
Treatment
Options
Options
Options
 Cognitive Behavioral Therapy
(CBT)
 Dialectical Behavior Therapy
(DBT)
 Psychotherapy for managing
emotions
 Group and peer counseling
 Specialized Relapse Prevention
 Support groups such as
Alcoholics Anonymous or
Narcotics Anonymous
FACT SHEET: PERSONS WITH BIPOLAR DISORDER COMORBID
WITH SUBSTANCE ABUSE |
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o
o
o
o
Many patients receiving simultaneous treatment dropout of treatment
Many also have serious social barriers or conditions, such as homelessness
or serious medical issues
Simultaneous treatment may involve complicated pharmacotherapeutic
combinations
o It also requires heavy communication and collaboration between
physician/psychiatrist and counselor/addiction counselor
Bipolar is often misdiagnosed as depression or other mood disorders, and
drug use can complicate symptoms and increase the chance of misdiagnosis
The following websites, along with local addiction centers and support groups
such as AA and NA chapter, can be consulted for bipolar and bipolar comorbid
with SUDs.
o https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Bipol
ar_Disorder_Resource_Center/Home.aspx
o http://www.isbd.org/advocacy-and-patient-resources/patient-resources
o http://www2.nami.org/Template.cfm?Section=Bipolar1&Template=/Conte
ntManagement/ContentDisplay.cfm&ContentID=130663
o http://www.dbsalliance.org/site/PageServer?pagename=home
o http://psychcentral.com/lib/resources-for-bipolar-disorder/
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References
Bipolar disorder (n.d.) University of Colorado, Colorado Springs. Retrieved July 17, 2015.
http://www.uccs.edu/biology-educational-resources/mood-disorders/bipolar-disorder.html
Bipolar disorder and addiction. (n.d.). Dual Diagnosis. Retrieved July 17, 2015.
Bipolar disorder and substance abuse - Are they connected? (2014, March 27). RehabCenter.net. Retrieved July
17, 2015.
Brown, E. S., Jeffress, J., Liggin, J. D., Garza, M., & Beard, L. (2005). Switching outpatients with bipolar or
schizoaffective disorders and substance abuse from their current antipsychotic to aripiprazole. Journal of
Clinical Psychiatry.
Cassidy, F., Ahearn, E. P., & Carroll, B. J. (2001). Substance abuse in bipolar disorder. Bipolar Disorders, 3(4),
181-188.
Feinman, J. A., & Dunner, D. L. (1996). The effect of alcohol and substance abuse on the course of bipolar
affective disorder. Journal of affective disorders,37(1), 43-49.
Geller, B., Cooper, T. B., Sun, K. A. I., Zimerman, B., Frazier, J., Williams, M., & Heath, J. (1998). Double-blind
and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance
dependency. Journal of the American Academy of Child & Adolescent Psychiatry, 37(2), 171-178.
Goldberg, J. (n.d.). Bipolar Depression and Substance Abuse: Which Is the Driving Force? Retrieved July 17, 2015
Goldberg, J. F., Garno, J. L., Leon, A. C., Kocsis, J. H., & Portera, L. (1999). A history of substance abuse
complicates remission from acute mania in bipolar disorder. The Journal of clinical psychiatry, 60(11),
733-740.
Levin, F. R., & Hennessy, G. (2004). Bipolar disorder and substance abuse. Biological psychiatry, 56(10), 738748.
FACT SHEET: PERSONS WITH BIPOLAR DISORDER COMORBID
WITH SUBSTANCE ABUSE |
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Ozten, M., Erol, A., Karayilan, S., Kapudan, H., Orsel, E. S., & Kumsar, N. A. (2015). Impulsivity in bipolar
and substance use disorders. Comprehensive psychiatry, 59, 28-32.
Prevalence and age of onset of bipolar disorders in the general population. (n.d.). Bipolar Lab Retrieved July 17,
2015.
Salloum, I. M., & Thase, M. E. (2000). Impact of substance abuse on the course and treatment of bipolar
disorder. Bipolar disorders, 2(3p2), 269-280.
Strakowski, S. M., DelBello, M. P., Fleck, D. E., & Arndt, S. (2000). The impact of substance abuse on the course
of bipolar disorder. Biological psychiatry, 48(6), 477-485.