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Research into the link between substance abuse and bipolar disorder is scant because studies on bipolar patients tend to screen out users.
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The mood swings, mania, panic, and deep depression experienced by people with bipolar disorder are hard enough to bear. But according to a 1990 study, 56% of bipolar patients also have a substance abuse problem, which can make treatment even more difficult.

Experts say that some bipolar patients are known to self-medicate with drugs or alcohol—though it's not recommended. In fact, they say, it does more harm than good.

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"Using drugs or alcohol is usually a complicating problem because it reduces medication compliance," says Bryan K. Tolliver, MD, PhD, an addiction psychiatrist at the Medical University of South Carolina in Charleston. "Bipolar patients who use [alcohol or drugs] have more frequent mood swings, more hospitalizations, longer hospitalizations, and higher rates of suicide attempts."

The drug of choice for most bipolar patients is alcohol, although cocaine, opioids, marijuana, and methamphetamines are also widely used, sometimes in combination with alcohol. Besides the self-medication hypothesis, research suggests that the impulsivity and poor judgment demonstrated by bipolar patients may predispose them to substance abuse. There is even evidence that drug or alcohol use can "unmask" bipolar symptoms in genetically vulnerable people.

Generations of suffering
While the genetic link between bipolar disorder and substance abuse remains inconclusive, Cheryl Murphy, of Las Vegas, is sure that both burdens run in her family. Murphy, 62, once lost custody of three of her four children and has attempted suicide five times. Now sober for 25 years, she is functioning well. She is also raising her 3-year-old great-grandson because her granddaughter, who also has bipolar disorder, abuses drugs. Murphy's great-grandson, too, was recently diagnosed with bipolar disorder.

"We have six generations of substance abuse in my family and five generations with a mental health disorder," she says. "They say it takes five generations to break a cycle. I am hoping I can be the power of example to them."


A dearth of research
It's been difficult to study the link between bipolar disorder and substance abuse because, traditionally, research on bipolar patients has screened out substance abusers, and vice versa, says Dr. Tolliver. He and other experts would like to see more research into treating patients with both problems; about 20% of people seeking treatment for a mood disorder are also substance abusers. In a 2004 study, 41% of alcohol abusers and 61% of drug abusers who sought treatment for their problem were also found to have a mood disorder such as bipolar.

Meanwhile, many bipolar patients, like Caroline, 25, may not be getting the treatment they need. Caroline has been hospitalized for a manic episode and sees a psychopharmacologist to manage her medications, which have included Seroquel, lorazepam (Ativan), divalproex (Depakote), lamotrigine (Lamictal), methylphenidate (Ritalin), Abilify, and Geodon. Currently unemployed and living in New York City, she has trouble sleeping and drinks heavily two to three nights a week.

"I can drink eight cocktails and be fine," Caroline says. However, her psychopharmacologist is not aware of her drinking, and Caroline doesnt plan to address it, though she is vaguely aware that she's at risk—not only for potential drug and alcohol interactions, but also for unsafe situations.

Three years ago she was in a bar, nearly blacked out, when a stranger attempted to lead her out the door. One of her coworkers confronted the man, who claimed to be Caroline's brother. He left without her, but some rapes were later reported in the same area. "I dodged a bullet," Caroline says.
Last updated: May 01, 2009