By skyforbes 
Co-occurring substance use and mental health conditions can complicate treatment — but with support and the right approach, wellness is within reach.
A “dual diagnosis” means having two disorders diagnosed at the same time. It could be any two diagnoses, but typically it refers to the co-occurrence of a mental health condition along with a substance use disorder.
Sometimes people with bipolar disorder may use alcohol or drugs in an attempt to mask symptoms. For racing thoughts due to mania, an alcoholic drink may seem to slow things down. For intense sadness or hopelessness during depression, a drug might offer temporary relief. This “self-medication” may feel helpful at first, but once the effects of the substance wear off, bipolar symptoms often return, sometimes more intensely than before.
Why Is Alcohol Use So Common in People With Bipolar Disorder?
Alcohol is one of the most frequently used and misused substances in our culture. Like the general population, many people with bipolar engage in social drinking. While some are able to limit themselves to one or two drinks, more than half of individuals with bipolar develop significant problems with alcohol.
This tends to occur most often during hypomanic and manic states. Some individuals use alcohol to try to calm mania; others to maintain a euphoric state; and still others associate alcohol with feelings of power and prestige during manic episodes. A common thread in these scenarios is a lack of insight into the problems caused — or worsened — by alcohol use.
Surprisingly, drinking during bipolar depression is less common. However, when it does happen, it may signal a more serious concern related to alcohol.
What About Drug Use?
As with alcohol, people with bipolar may turn to drugs in an attempt to “self-medicate” due to anxiety, depression, or mania, or to “even out” mood swings. There are many readily available substances to “take the edge off,” marijuana being one popular choice. Again, while it can seem to help in the short term, within a few hours, drug use can cause serious problems with fluctuating moods and negative thoughts.
Individuals with bipolar disorder are more likely to develop a drug addiction after casual use, and they find it much harder to quit. In addition, drug use increases the prevalence of an already alarming trend of people with bipolar taking their own lives.
What Are Some Effective Paths for Recovery?
Treating co-occurring bipolar disorder and substance use disorder is more complex than treating either condition on its own. The encouraging news is that there are many paths to recovery.
In the past, conventional thinking suggested that people needed to be fully “clean and sober” before psychiatric treatment could succeed. Today, we know that it’s crucial to address both bipolar disorder and substance use disorder simultaneously through integrated care.
This might include a combination of:
- One-on-one psychotherapy with a mental health professional
- Counseling with addiction specialists
- Dual diagnosis support groups
- Family therapy
- Holistic and wellness-based approaches
There are numerous programs and therapeutic centers across the country that specifically address dual diagnosis.
Self-help programs like Alcoholics Anonymous and Narcotics Anonymous offer free, community-based support for individuals and their loved ones. These organizations can be especially helpful in connecting people with resources and peer encouragement.
Support from loved ones is crucial to any successful wellness management plan. It is helpful to have honest conversations with family and friends regarding the availability and use of alcohol or drugs, and to develop strategies to manage personal and social situations where such substances may be present.
There’s no one-size-fits-all treatment plan — but with professional guidance, personal commitment, and a strong support network, recovery is absolutely achievable.
The Following Organizations Can Provide Additional Information and Help:
UPDATED: Printed as “Ask The Doctor: Dual Diagnosis”, Spring 2015