Bipolar and addictions (Dual Diagnosis)

According to, 56% of people with bipolar disorder suffer(ed) from addiction to drugs or alcohol at some point. According to, the rate for general population (in America) is 8.9 percent.

Obviously there is something about bipolar disorder that correlates with high addiction rate. While I am not a medical professional or addiction counsellor, I will hazard a guess that bipolar makes you predisposed to addiction, not the other way round. There are some drugs that can trigger a bipolar episode (in particular marijuana and LSD), but they do not create bipolar disorder in a mentally healthy person. They may only make it manifest earlier.

There are a few obvious reasons why bipolars tend to become addicts. One of them is self-medication. I used to self-medicate my depression with alcohol for years – it seemed to be the only way to make the black dog go away for a few hours. I knew that alcohol is a depressant and on some subconscious level I probably realised that I am making things worse for myself long term, but at those times the only thing that counted was quick relief which the bottle provided. The same scenario happened daily: I’d be terribly depressed, I’d get drunk, depression would be replaced by euphoria, I would do some really stupid things, go to sleep, get up in the morning and scream “F–K!!!” (I never blacked out; I always remembered what I did the day before, and it was always terrible and make me more depressed.) Repeat. Repeat.

Then the mania would come in and make us feel like social beasts. We’d go out every night, wear too few clothes, flirt, then hook up with completely wrong people, and be filled with this amazing feeling that consequences don’t exists. Why exactly would we avoid alcohol or drugs in this state? Other people might get addicted, but we are kings and queens of this world filled with mere mortals. In my period of mania I didn’t see the reason to avoid illicit substances. They were fun! Until the effect wore out, that is, but there was a simple way of solving this problem: use more! Befriending bartenders enabled me to drink far more than I actually paid for. And this time I didn’t wake up screaming “F–K!” because I was still running out on the strongest drug: hypomania. Everything I did, sober or not, was amazing. And if it was risky? The more the better! Hypomania loves risk. It feeds on it.

When you suffer from both bipolar disorder and substance abuse problem, you have a dual diagnosis. In the past, doctors would insist that you “clean up” and stay clean for a period of time – say, three months – before they would do anything with your BP. Unfortunately for some people, mainly depressives, it meant they were losing the only thing they knew that could keep them over the surface of constant low. Nowadays, at least in most countries, dual diagnosis is recognised as something that needs to be worked on as a whole: there is no addicted half and bipolar half of you that can be neatly split and medicated/counselled separately. Bipolar triggers the addiction, and addiction triggers the bipolar. Working only on one of the parts is akin to removing only half of the cancer tissue and hoping the other half goes away on its own.

If you suspect you have a substance abuse problem in addition to your bipolar, I strongly recommend you come clean (sic) to your psychiatrist. It will affect the way you are taken care of. You might need to stay at specialised rehab facility – one where both of your afflictions will be treated at the same time, and you will indeed become clean of drugs of alcohol, but not at the price of incredible suffering. In many countries there are DDA (Dual Diagnosis Anonymous) groups – try to join one and see if you feel well there; those are people who have gone through exactly the same pains as you.

Conquering your addiction, at least to the point where you are clean for a few months, will greatly improve your chances of getting your bipolar in check as well. Medication will work better; you will no longer wake up terrified by the memories of the night before; your sleep pattern will improve.

I will be writing more about marijuana use in bipolar patients soon. Till then, big hugs – World Bipolar Day was yesterday. I hope you celebrated it by feeling exceptionally stable.

Photo: “Red RX Drugs Sign” by Joel יוֹאֵל (CC 2.0)

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