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.

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.

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Exploring the Bipolar Disorder Substance Abuse Connection | Health News (September 16, 2010)

    Last reviewed: 16 Sep 2010