4 Ways To Manage Bipolar Disorder in Recovery
If you’ve been diagnosed with bipolar disorder and you're in recovery from addiction, you're not alone. Your experience right now may feel isolating, but there are incredibly high rates of comorbidity between substance use disorders and bipolar disorder (meaning many people have both.)
However, the danger in recovery is that not every single person has experience with debilitating co-occurring disorders such as bipolar disorder. (Particularly co-occurring disorders that precede substance use disorders). Bipolar disorder doesn’t just “clear itself up” once you begin receiving treatment for addiction. It needs to be treated separately, on its own.
If you have bipolar disorder and a substance use disorder, you are fully worthy and capable of experiencing long-lasting recovery. Everyone's recovery journey is unique to their own needs, experiences, and stories. With bipolar disorder, there are certain things you’ll have to do to give yourself an even better chance at experiencing the recovery you’re capable of.
What is bipolar disorder?
Bipolar disorder is a mental health condition characterised by extreme shifts in mood, energy levels, and behaviour. The two most common types of bipolar disorder are Bipolar I disorder and Bipolar II disorder.
Most people with Bipolar I disorder have symptoms of mania and depression, but depressive episodes aren’t required for diagnosis.
Those with Bipolar II disorder typically struggle more with episodes of chronic depression.
Bipolar II is also characterised by symptoms of hypomania, which is essentially a less intense form of mania.
What are the symptoms of bipolar disorder?
Because bipolar disorder is marked by the shift between two extreme mood states - depression and mania - symptoms vary based on each type of episode. The extreme changes in mood and behaviour can make it incredibly difficult for those with this diagnosis to manage their daily lives.
Some of the common symptoms of depression in bipolar disorder are:
- Sleep issues
- Changes in appetite
- Feelings of hopelessness
- Feeling sad or irritable
- Having trouble remembering things
- Difficulty focusing
- Feeling empty or numb
- Experiencing feelings of guilt or shame
- Feeling worthless
- Lack of interest in daily activities
- Lack of motivation
- Suicidal thoughts
On the other end, here are some common symptoms of mania in bipolar disorder:
- Feeling full of new ideas and plans
- Feeling incredibly happy and elated
- Behaving out of character or making decisions others would deem as being risky
- Increased energy
- Racing thoughts
- Poor judgment
- Feeling self-important
- Not wanting to sleep or eat
- Talking quickly
- Becoming distracted easily
- Being delusional or experiencing hallucinations
- Experiencing illogical thinking
The patterns of depression and mania show up differently for different people.
You may experience weeks or months in an episode of depression. Then, you may have a period of feeling “normal,” followed by weeks or months in an episode of mania. Then, the cycle repeats itself.
You may also be dealing with rapid cycling. This is when you experience being in a depressed episode and then rapidly cycle to being in a manic episode. Here, there’s no “normal” baseline in between.
Additionally, you may be experiencing a mixed state, where your episodes blur together. An example of this would be experiencing overactivity with a depressed mood.
Now that you have an idea of what bipolar disorder looks like, let’s take a look at how bipolar disorder and substance use disorders are connected.
How are bipolar disorder and substance use disorders connected?
Research shows that there are high rates of substance use disorders in those who struggle with bipolar disorder. One study was conducted by the National Epidemiologic Survey on Alcohol and Related Conditions on over 43,000 participants. It found that among those with bipolar disorder, 58% struggled with a co-occurring alcohol use disorder while 38% struggled with a co-occurring drug use disorder.
A separate study was conducted on over 20,000 participants. It found that of those with bipolar I disorder, 61% had a history of substance use disorder in their lifetime. That's over half the population who participated in the study. Of those with bipolar II disorder, 48% had a history of substance use disorder in their lifetime. Again, the numbers are nearly half the entire number of participants involved.
Interestingly, some data has shown that those with mixed episodes are far less likely to struggle with addiction. Conversely, those with rapid cycling episodes were more likely to struggle with drug use than those who didn’t experience rapid-cycling episodes.
Examining the connection between bipolar disorder and substance use disorders
Such staggering numbers may prompt you to wonder what the connection could be between bipolar disorder and substance use disorders.
One theory is that the symptoms brought on by bipolar disorder cause people to turn to substances in an effort to self-medicate. This is whether they’re dealing with a manic episode or a depressive episode. Then, substance use can actually make symptoms of bipolar even worse, causing the cycle to perpetuate.
For example, research has found that cocaine use makes the symptoms of bipolar disorder worse. Additionally, it contributes to the progression of the illness.
Another theory is that when someone develops a mental illness, the brain changes that occur make them more susceptible to developing a substance use disorder due to an enhanced rewarding effect, decreased awareness of negative consequences, or the numbing of symptoms brought on by the mental illness, or the medications used to treat it.
On the other end, substance use itself can contribute to the development of a mental illness. The theory is that brain changes and changes in function brought on by chronic substance use trigger an already-existing predisposition to developing a mental illness.
Finally, there are several factors that can contribute to the development of both bipolar disorder and substance use disorders.
Some of these risk factors include:
- Genetic predisposition
- Adverse childhood experiences (trauma in childhood)
- Childhood environment
- Chronic stress
It can be difficult to identify if and when one caused the other when it comes to bipolar disorder and substance use disorders.
Regardless of which condition brought on the other or which came first, it is evident that the comorbidity of these two disorders can have a significant impact on treatment and recovery outcomes.
The consequences of not treating bipolar disorder in recovery
Bipolar disorder can be difficult to manage if you aren’t actively involved in treatment, and this is only amplified if you’re simultaneously in recovery from addiction.
Research has shown that bipolar disorder can pose additional risks for those in recovery. Studies show that people who struggle with both bipolar disorder and addiction are more likely to drop out of treatment early. Those with both are at an increased risk of experiencing depression and have prolonged episodes.
One study shows that those with bipolar disorder and a substance use disorder had decreased treatment compliance as compared with those who had bipolar disorder alone.
Additionally, several studies have shown that those who struggle with bipolar and substance use disorders have an increased risk of suicidal behaviours than those without substance use disorders.
Finally, research shows that bipolar patients with substance use disorders have a lower quality of life than bipolar patients without substance use disorders.
It’s evident that bipolar disorder and substance use disorder are so intrinsically tied, one impacting the other in a vicious cycle.
It’s difficult to define where one ends and the other begins. What’s clear is that managing bipolar disorder is paramount when it comes to maintaining a healthy recovery from addiction.
4 key ways to manage bipolar disorder in recovery from addiction
Because bipolar patients in particular seem to have a high incidence of relapse, both in their condition and in recovery, it’s so important to seek help in an effort to prevent relapse. Working together with someone in recovery who has the same experience and has learned to spot the signs early and manage them can be very powerful in recovery.
In addition to accessing adequate healthcare and medications, it’s also important to learn ways of effectively managing symptoms during addiction recovery to prevent a substance relapse and to intervene before an episode of depression or mania.
Below are 4 key ways to manage bipolar disorder in recovery from addiction:
1. Remain actively involved in treatment
In order to manage symptoms of bipolar disorder, it’s so important to consciously make efforts towards your healing and wellness. If left unmanaged, your symptoms of bipolar can make your life, and your addiction recovery efforts, even more challenging.
Remaining actively involved in treatment means being open, honest, and maintaining communication with your doctor, therapist, or psychiatrist. It’s likely that your needs will change over time, or you’ll need to try different things before finding a method of treatment that works best for you. Your treatment provider is on your side and is there to collaborate with you, so freely share with them what’s working and what isn’t.
If you’ve been prescribed medication, take it as prescribed and discuss any side effects or potential concerns you may have with your doctor. They can easily prescribe you a different medication that is more suitable for you, but they won’t know anything’s wrong or ineffective if you aren’t openly communicating with them.
Additionally, engage in therapy. Treatment for addiction and bipolar disorder are not the same, and require different interventions to facilitate healing. Seeking counselling or therapy specifically for bipolar disorder and being actively involved in your sessions will help you tremendously. It’s important to remain open, consistent, honest, and patient when it comes to therapy. Also, your connection with your therapist matters. It’s okay for you to change practitioners if you don’t feel a strong rapport with your current therapist.
2. Maintain awareness of your moods
When it comes to managing bipolar disorder, it’s crucial to become aware of your moods and emotions so you can do things to prevent an episode of mania or depression. By the time your more overt symptoms of mania or depression present themselves, you’re already in the thick of an episode and it poses more difficulty to get out of. By noticing when shifts are happening internally ahead of time, you can help prevent an episode from developing.
Become aware of what your triggers are and how your behaviours start shifting when you’re on the precipice of an episode. Some common triggers are stress, relationship issues, work problems, or financial issues. Some common shifts in behaviour for a depressive episode are that perhaps you’ve stopped cooking your own meals or spending time with friends. Common shifts in behaviour for a manic episode could be that you find yourself having more energy than usual or you feel more irritable.
After you figure out what has triggered you before prior episodes manifested, start monitoring your moods throughout the day. Just check in with yourself and see how you’re feeling. You can start logging your feelings in a journal, or even on your phone which is often quick and easy to access.
Keeping this daily log can help you maintain awareness of your mood and can help you notice patterns. Doing this can help you become more aware of whether you’re on the verge of an episode, and allows you to do something about it ahead of time.
3. Manage stress ahead of time
It’s important to be aware of your moods so you can intervene before experiencing a full-blown manic or depressive episode. When you notice a shift in your mood, do things that help you to feel better and more relaxed. It can be difficult to come up with ideas in the moment and when you’re struggling, so having a list of go-to’s prepared can be a great asset to have.
Some things on your list can include:
- Talking to a close friend
- Reaching out to your therapist, counsellor, or doctor
- Doing things that help you unwind, like reading a book, watching a movie, or stepping into nature
- Doing something that’s fun for you
- Writing, painting, or doing something creative
- Attending a support group meeting
- Making sure you’re getting enough sleep
- Being mindful of your sugar and caffeine intake
- Asking your loved ones for help
In addition to engaging in healthy coping skills before your mood shift spirals into an episode, it’s also important to regularly manage your stress levels.
You can do this by creating a structured schedule for your day-to-day life, and incorporating exercise into your routine. This can be as simple as going for a walk outside.
Additionally, you can develop a meditation practise, or explore yoga.
You can also make more time for the things that are fun for you, such as hanging out with friends, going for a bike ride, or watching funny movies.
Self-care is incredibly important for your mental and emotional wellness and, as you can see, comes in many different forms. Including destressing activities into your schedule can significantly help you manage your moods on the day to day.
4. Connect with people
It’s so important to have people in your life who see you, and who care for you. Just talking with someone you care about and being in their presence can help elevate your mood. It isn’t about being with loved ones who have the exact right thing to say or are there to solve your problems – sometimes just having someone you can vent to takes such a weight off of you.
Isolating yourself will only contribute to depression, so remember to engage with those closest to you on a regular basis. It takes true strength to be able to be vulnerable, and you are not a burden for existing and having feelings. Your loved ones care about you and want to know how you’re doing, so be sure to lean on those closest to you.
Additionally, joining a support group for those with bipolar disorder can be extremely helpful. There’s an added layer of comfort, support, and normalcy when you’re around people who truly get the ins and outs of what you’re going through. You can learn from others in a support group, they can learn from you, and you can rid yourself of feelings of isolation.
Lastly, Recoverlution offers round-the-clock community and support, where you can connect with others who know what you’re going through or jump into meetings if you want support.
You’re not alone, and with patience, conscious effort, and grace towards yourself, you can experience a long-lasting and healthy recovery.
Author - Thurga