Current Psychiatry Online (August 2010) has an excellent article by Bryan K. Tolliver, MD, PhD entitled “Bipolar disorder and substance abuse: Overcome the challenges of ‘dual diagnosis’ patients.” If you are interested in exploring the connection between bipolar disorder and substance abuse, I encourage you to read the article.
Dr. Candida Fink, MD is a board certified child and adolescent psychiatrist who specializes in several areas including mood and anxiety disorders and dual diagnoses of developmental disabilities and mental illness. She treats children, teens, and young adults with a range of concerns including ADHD, anxiety disorders, OCD, autism, pediatric mood disorders, and mental health issues in school settings. Dr. Fink has co-authored two books – The Ups and Downs of Raising a Bipolar Child (with Judith Lederman, Simon and Schuster, 2003) and Bipolar Disorder for Dummies (with Joe Kraynak, John Wiley & Sons, 2005, third edition 2015). She has been featured nationally and locally in broadcast, print, and online media coverage and is a frequent speaker on mental health topics for community and school-based audiences.
Editor: Saad Shaheed
Tolliver includes a table in his article (Table 1) designed to assess the strengths and weaknesses of some of the most common theories of why substance abuse so often accompanies bipolar disorder. One of the most common theories he examines is that substance abuse arises from attempts to self-medicate – to treat the symptoms the individual is experiencing. Tolliver points out three facts that challenge this belief:
- Substance abuse rates are high even during periods of euthymia (mood stability with neither depression nor mania) when there are no particular symptoms to medicate.
- High prevalence of alcohol/depressant use during the depressive phase – making depression worse.
- High prevalence of stimulant use during the manic phase – making mania worse.
I was surprised by this information and suspect many psychiatrists are unaware of these facts and figures. People seem to use substances that make their current symptoms more severe, rather than less so. This is puzzling and adds even more layers to the mystery of what underlies the high rates of substance abuse occurring in bipolar disorder.
Tolliver looks at a number of other frequently cited explanations for the relationship between the two disorders, and he essentially pokes big holes in what has been considered common knowledge about substance abuse and bipolar disorder for many years. I suspect, though, that people with bipolar are much more aware of the actual patterns of substance abuse in bipolar than psychiatrists are, and I would like to hear about your experiences and insights.