Bipolar and Addiction: The Dual Diagnosis

Bipolar disorder and addiction often go together. As many as 60 percent of people with bipolar disorder will have some form of substance abuse during their lifetime, and research is underway to better understand this “dual diagnosis” — the term used for the combination of addiction and a mental disorder. Both of these disorders tend to first emerge during the teenage years, says Ken Duckworth, MD, medical director of the National Alliance on Mental Illness (NAMI), and studies have found that teens with bipolar disorder are more likely to experiment with drugs and alcohol.

Those with bipolar may turn to depressants — such as alcohol or pain pills — to try to manage their mania, or to stimulants — such as cocaine or methamphetamines — to cope with depression. In both cases, the usual result is that the substance abuse kicks the bipolar disorder into the opposite state — depression or mania — rather than fixing anything. “Short term, drugs and alcohol do change how you feel,” notes Duckworth. “But long-term it tends to be very counterproductive.”

Bipolar and Addicted: One Woman’s Story

For Jacqueline Castine, alcohol was a part of life. While growing up, everyone in her family drank. So when she became an adult, her own drinking didn’t seem that out of the ordinary in comparison.

Castine recalls drinking heavily on a daily basis for years, all while being a self-described overachiever with a high-profile career, a “perfect family,” and the “perfect marriage.”

“I was a functional alcoholic, from a family of functional alcoholics,” she says. “We didn’t realize what we were really doing was self-medicating for a mood disorder.”

Castine followed her twin sister’s lead into the world of sobriety at the age of 48. Around the same time, she also divorced and left her high-profile corporate position. That’s when “the dragon I always kept on the back porch,” as she describes it, wouldn’t stay outside any longer.

For seven years, she struggled to manage her swings between depression and mania with willpower and denial, but after a period of mania and some risky financial decisions, Castine’s life came crashing down and she lost her home, her life savings, and her grasp on reality. “I was homeless, suicidal, and psychotic,” she says. “That was the point where I realized I needed help.”

Castine was hospitalized, diagnosed with alcoholism and bipolar disorder, and began taking mood-stabilizing medication. “I was ready for treatment,” she says. “I knew that I was sick and I was willing to take the medication.”

Bipolar and Addicted: Getting Help

If you have bipolar disorder and think you may have a problem with drugs or alcohol, says Duckworth, both issues should be addressed together — in fact, he believes that anyone with substance-abuse issues should be screened for bipolar disorder or other mood disorders. Mood-stabilizing medications won’t fix the struggles with addiction, but they may reduce the drive toward it once the mania and depression are addressed.

Jacqueline Castine is living proof of this approach. Although she continues to struggle with managing the ups and down caused by her bipolar disorder, she believes it is now mostly under control. Today, at age 68, Castine has rebuilt her financial life, has written several books about her experiences (including Recovery From Rescuing and I Wish I Could Fix It, But…), and has a career she’s passionate about: She works as a community education specialist to raise awareness of mental-health issues and as a spokesperson for the Depression and Bipolar Support Alliance.

More information on bipolar disorder, including information about bipolar disorder and addiction, living with bipolar disorder, treatment options, support groups, advocacy, resources, and educational programs and events, can be found at the web sites of the Depression and Bipolar Support Alliance and the National Alliance on Mental Illness.

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