bipolar 1 and substance abuse disorders

Running head: BIPOLAR 1 AND SUBSTANCE ABUSE DISORDERS 1

Bipolar1 and Substance Abuse Disorders

Jody Marvin, Cathy Lint, Heidi Oconnor, Mickel Malone, and Nicole Hesprich

PSY410

August 12, 2013

Dr. Kristi Husk

BIPOLAR 1 AND SUBSTANCE ABUSE DISORDERS 2

Bipolar1 and Substance Abuse Disorders Bipolar 1 and Substance Abuse Disorder manifest as thoughts, feelings, and behaviors

becoming severe maladaptive patterns transcending into chronic conditions. Disturbances do not

allow a human to function or relate well within society. Moreover, these disruptive patterns

cause serious detriments to the personal, professional, and private relationships in other areas of

life. Mental health issues, once thought to be a cause of the spirit world, are as of the present

known to originate from a variety of elements including biological/medical, psychological, and

sociocultural. In theory, a strong influence exists between cognitive and environmental factors.

Originating in 1952, The Diagnostic and Statistical Manual of Mental Disorders (DSM),

published by the American Psychiatric Association, is the manual (or handbook) for diagnosing

and providing information on the prevalence of each disorder. Although Bipolar 1 and Substance

Abuse Disorders disrupt relationships with others, self-esteem, cause financial and occupational

disintegration, eventually with treatment, there is a substantial reduction or remission in

symptoms of the disorders.

DSMIV-TR for Substance Abuse

“Substance-related disorders are disorders of intoxication, dependence, abuse, and substance

withdrawal caused by various substances, both legal and illegal. These substances include:

alcohol, amphetamines caffeine, inhalants, nicotine, prescription medications that may be abused

(such as sedatives), opioids (morphine, heroin), marijuana (cannabis), cocaine, hallucinogens,

and phencyclidine (PCP)” (American Psychiatric Association, 2000, p. 121). According to the

DSMIV-TR, “all of the substances listed above, with the exceptions of nicotine and caffeine,

have disorders of two types: substance use disorders and substance-induced disorders. Substance

use disorders include abuse and dependence. Substance-induced disorders include intoxication,

http://www.minddisorders.com/A-Br/Amphetamines.html


withdrawal, and various mental states (dementia psychosis, anxiety, mood disorder, etc.) the

substance induces when used” (American Psychiatric Association, 2000, p. 124).

Substance-induced mental disorders included within this section are; induced persisting

dementia, induced delirium, induced psychotic disorder, induced persisting amnestic disorder,

induced mood disorder, induced sexual dysfunction, induced anxiety disorder, induced sleep

disorder, and hallucinations (American Psychiatric Association, 2000).

DSM IV-TR: Bipolar I Disorder

Characterized by the occurrence of one or more manic or mixed episodes that is also known

as a shift in polarity is Bipolar 1. The individual will often have one or more major depressive

episodes that occur within two months of each other. Specifies of Bipolar I Disorder are;

“moderate, mild, or severe without psychotic features, severe with psychotic features, in partial

remission, in full remission, with catatonic features, and also with postpartum onset” (American

Psychiatric Association,). In order for there to be a diagnosis of Bipolar I disorder, the

individual currently has or recently has a hypomanic episode. In addition, there previously has

been at least one mixed or manic episode. The mood symptoms cause clinically significant

distress or impairment in social or occupational areas of functioning. Finally the mood episodes

do not account for schizoaffective disorder.

Biological/Medical Perspectives for Bipolar 1

Biological components include genetics (relatives, twins), hormonal (endocrine), and

chemical (dopamine, serotonin, and nor epinephrine) factors (Hansell, 2008). The Child and

Adolescent Bipolar Foundation noted "If one parent has bipolar disorder, the risk to each child is

15%-30%” (as cited in Bipolar Disorder, 2009, p. 128). Additionally, “When both parents have

http://www.minddisorders.com/Ob-Ps/Psychosis.html

http://www.minddisorders.com/Del-Fi/Dementia.html


bipolar disorder, the risk increases to 50-75%. The risk in siblings and fraternal (non-identical)

twins is 15-25%. The risk in identical twins is approximately 70%” (the CABF as cited in

Bipolar Disorder, 2009, p. 128). Used is the biological test called the Dexamethasone

Suppression Test that tests cortisol levels. Medications that help relieve most if not all symptoms

of depression are Tricyclics, MAO inhibitors, and SSRIS. Electroconvulsive therapy and lithium

are the most widely used interventions for Bipolar I Disorders.

The second are cognitive components such as negative cognitive triad, which is the negative

irrational thinking of oneself, others, and the world in general. Negative automatic thoughts are

thoughts negative in schemas and cognitive distortions, such as irrational belief processes.

Behavioral therapy helps to change the negative thinking he or she has about himself or herself,

others, and the world. Consecutively, the psychodynamic component roots in loss, anger,

disappointment, and is unconscious in thought. This self-criticism is similar to hurting an

individual's ego. Interventions for the psychodynamic approach are therapy that helps address

and identify what the causes are, while learning to cope with the issues at hand. Finally, the last

approach is the interpersonal interventions, which are support systems in the family with friends

and with peers. Interpersonal psychotherapy (IPT) focuses on mood, personal events, object

relations, behavior, and cognitive theories (Hansell, 2008).

Biological/Medical Perspective for Substance Abuse

The biological/ medical perspective for substance disorder mirrors the perspective for

Bipolar 1. Substance abuse can reach various ages, genders, and classes. Biological approach is

the treatment as well as the explaining or an attempt to explain why individuals may abuse

certain substances more than others. Considered are genetics and environmental influences.

Medical interventions, such as substitution and maintenance therapy, are used to treat these types


of disorders. Behavioral components, such as operant and classical conditioning including social

learning modeling, help in explaining and treatment of substance abuse. Medical interventions

help relieve tension and stress in the individual, desensitization, aversion therapy, and

contingency management to treat substance abuse (Hansell, 2008).

Cognitive approach includes research and treatment of substance abuse. Expectations of the

individual’s effects of drug of choice are the main focus of this type of approach. Restructuring

is one way to help in the treatment in cognitive approach. Sociocultural such as family support

systems and interventions also help in the treatment of an individual's drug dependence.

Psychodynamic approach looks at the individuals emotions and what specific emotional factors

cause the individual to misuse drugs. Hypothesis, coping, therapy, and intervention help in the

recovery process but emotion such as self-esteem, ego, self-acceptance, and relationship

concepts can help in the reduction of substance abuse.

Psychological Perspectives for Bipolar I

“Mental illnesses, like Bipolar Disorder are generally viewed as harmful and associated

with notable stigma. This is unfortunate because mental illness is common, and bipolar disorder

is one of the most common severe mental illnesses,” (Galvez, Thommi, & Ghaemi, 2011,

para. 2). Most researchers believe a chemical imbalance within the brain is caused bipolar

disorder. This mental illness has lasting effects on one’s emotions, physique, and cognitive

abilities. Although this disorder is treatable, this mental illness can be life threatening as well as

disabling.

When one has Bipolar I Disorder, he or she will go through high and low mood cycles.

People who seem to go through more mania cycles are diagnosed with bipolar I disorder.

However, most individuals who suffer from bipolar I disorder go through a cycle of depression.


Manic episodes usually include an elevated self-esteem, irritability, increased energy, and excess

motivation. Individuals suffering a manic cycle will talk very fast and switch from one topic to

another (Hansell & Damour, 2008).

Mania inhibits the person’s ability to think rationally. Manic episodes may cause people

to spend large sums of money quickly, or engage in thoughtless acts. Usually the manic moods

will move quickly to irritability. These episodes can sometimes lead to psychosis, in which the

person will hallucinate or have delusions. Manic episodes usually happen quickly and will last a

week or longer. The episode will stop as quickly as it started and may be followed by a

depressive cycle.

Psychological Perspective for Substance Abuse Disorder

Some of the psychological symptoms involved with addiction are compulsiveness to

continue using the substance, lying about using the drug, using the substance in secret, failure to

stop using, and stealing to support the addiction. In most cases addicts develop a mental or

psychological dependence on the drug of choice.

The physical as well as the mental dependencies on drugs or other substances the addict

may experience deterioration in relationships. In many cases the person’s performance in school

or work will decline. In many instances the person with the addiction will see the decline but will

not be able to control it. The addict usually will believe guilt or ashamed because of his or her

failures, which usually leads into depression.

The psychological addiction is often connected with physical addiction, which may cause

confusion whether the addiction is mental or physical. It is important to note that a psychological


addiction to substances usually leads to a physical addiction. When a mental addiction occurs the

craving takes priority to other needs, such as love and staying healthy.

Socio/cultural Perspective for Substance Abuse Disorder

“The sociocultural perspective emphasizes that substance misuse problems are strongly

correlated with social variables” (Hansell & Damour, 2008, pg. 350). There are higher rates of

alcoholism in populations that consist of underemployed, young, urban men. Alcoholism is also

high in populations of those possessing high stress jobs such as medical and dental fields.

Apparently, the family dynamics characteristic of substance abusers are family-wide including

denial, codependency, and enabling behaviors. Codependency is described as “A relationship in

which family member(s) unconsciously collude with the substance misuse of another member

even though they may consciously oppose it” (Hansell & Damour, 2008, pg. 351).

Characteristics such as these work together in keeping substance abuse a highly protected

secret within the family. Therefore, family therapy focuses on confronting family defenses like

those mentioned above. Family therapy is not the only course of action for substance misuse.

Network therapy is identified as “a treatment for substance misuse that emphasizes engagement

of the client’s social network of friends and family in treatment” (Hansell & Damour, 2008, p.

351).

Socio/cultural Perspective for Bipolar 1

A model developed for families of people who suffer schizophrenia called inpatient

family intervention (IFI) has found success with family and relatives of people who suffer from

bipolar illness requiring hospitalization. IFI provides education to family members of those who

suffer from bipolar illness. Assisting in answering questions, IFI helps to identify stressors that


may trigger relapses. Conclusively, IFI assists in making a game plan when there are

unavoidable family conflicts.

According to Parker (2007), to diagnose bipolar disorder an individual should have a

diagnosis of clinical depression. Because patients do not tend to complain of their “highs” they

should be screened for them. “Patients with bipolar disorder have the highest suicide rate of all

the psychiatric conditions. Undiagnosed, individuals are at risk of a suicide attempt when they

feel themselves sinking into a ‘black hole’ of depression” (Parker, pg. 241, 2007). During the

manic or hypomanic episode the individual may note that anxiety, which is usually experienced,

disappears. In most cases the higher the mood swings, the greater the chance of a more severe

depression (Parker, 2007). During these cases the highs are often observable and the biological

depression that follows is observable as well (Parker, 2007).

Treatment for Bipolar 1 Disorder

Treating bipolar I requires mood stabilizers and in some cases sedative-hypnotics. “Lithium

is used to bind inositol in order to make it unusable, thus calming neuron communication.

Anticonvulsant drugs are also prescribed for the manic phase” (Howard, 2006. P. 446).

Sometimes antidepressants are used to help a depressive cycle. Subsequently, these medications

are used with extreme caution as they can trigger a manic episode.

Although Lithium has been found as highly effective when treating a patient, researchers

have discovered some drawbacks such as negative thinking, disruption in normal routine, sleep

disturbance, and personal disaster. These side effects can trigger a manic phase, which is why it


is important to have a doctor continually monitoring the dosage as well as behavior (Hansell &

Damour, 2008).

Different treatment methods are required for treating bipolar I disorder because there are

two segments within the illness. In some cases patients are prescribed Depakote or Zyprexia

along with the lithium to treat the disorder. Depakote is a form of anticonvulsant medication.

Zyprexia helps with any psychosis that may occur. The drug Lamictal works to prevent both

mania and depression (Hansell & Damour, 2008),

Therapy, in addition to the medication for treating bipolar I disorder, is highly effective.

Some of the therapies helpful with this disorder are interpersonal, social, cognitive, and family-

oriented therapy. Interpersonal therapy focuses on one’s relationships and employment

strategies. In addition, interpersonal therapy also gives the patient the tools needed to solve

problems and eliminate situations that trigger stress.

Social rhythm therapy is especially for individuals with bipolar disorder. Many

researchers believe people with bipolar disorder have sensitivities toward time and daily routine

patterns. Individuals in social rhythm therapy focus on stabilizing biological habits, such as

sleeping and eating (Hansell & Damour, 2008).

Cognitive therapy helps the patient scrutinize his or her own thoughts and feelings.

During therapy sessions the patient will work on turning negative thoughts into positive ones.

The center of the treatment for people with bipolar will be learning to manage symptoms and

avoid triggering situations. In conclusion, family-oriented therapy helps not only the person with

bipolar disorder, but also the family as well. Family members living with someone with bipolar

can become extremely overwhelmed and may not know how to deal with the situation


effectively, which is why in many cases it is important for family members to seek help (Hansell

& Damour, 2008).

Treatments for Substance Abuse Disorder

The craving for a substance cannot be fully eliminated. However, the craving can be

replaced with other methods, such as autotherapy, pharmacotherapy, or psychotherapy. These

other methods are often combined to help with the anxiety of abstinence. Autotherapy is like a

12-step program. In these sessions people commit to abstinence as well as some sort of a higher

power. Psychotherapy involves free association in which the patient guides the discussion.

Methadone treatment is an example of pharmacotherapy. This treatment is for addiction to

opiates. This treatment is highly controversial because many people believe this treatment is

trading one addiction for another.

Auto or talking therapies can also assist the individual with avoiding future relapses.

Autotherapy and psychotherapy are extremely effective in helping the patient identify when a

negative cycle is occurring. When the patient can recognize what triggers his or her tendency to

use, he or she can learn how to handle these situations in a healthier way.

Rehabilitation centers also help to treat addictions. When an addict commits or is

committed to a rehabilitation center the first few weeks are usually the most difficult because of

severe withdrawals. In a rehab one usually will start out with nothing but the clothes supplied by

the rehabilitation center as well as a few essential items, such as a toothbrush, toothpaste, soap,

shampoo, and a bed. After improvement the patient may be allowed some personal items and

eventually released. Many people who go through rehabilitation centers to overcome addiction


may relapse even with the knowledge gained through the experience. These relapses occur

because he or she may not have the same support when released from the program.

Conclusion

A combination of factors is working together supporting the theory that a variety of

predisposing factors produce vulnerability to certain illnesses, including Bipolar1 Disorder and

Substance Abuse Disorder. Bipolar 1 Disorder equals biology (primary influence), plus

psychology, plus social or environmental, plus stress. Add alcohol and other drugs and you have

the recipe for Substance Abuse Disorder. An individual is not responsible for predisposition

(medical disorders in the brain) for Bipolar 1 Disorder or Substance Abuse Disorder. An

individual is responsible for participating in appropriate treatment and complying with a

recovery plan. In conclusion, the release of the Diagnostic and Statistical Manual of Mental

Disorders V took place May, 2013 at the Annual meeting of the American Psychological

Association. The criteria are concise and explicit, intended to facilitate an objective assessment

of symptom presentations in a variety of clinical settings. We only hope for the continued

evolution of objective ideas and scientific knowledge.


References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.

Fourth edition, text revised. Washington DC: American Psychiatric Association, 2000.

The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 10.

Ey, J., & Abell, S. (2009, July). Bipolar Disorder. Clinical Pediatrics, 48(6), 693-694. doi:

10.1177/0009922808316663

Galvez, J. F., Thommi, S., & Ghaemi, S. N. (2011, February). Positive Aspects of Mental Illness:

A Review in Bipolar Disorder. Journal of Affective Disorders, 128(3), 185-190.

Hansell, J., & Damour, L. (2008). Abnormal Psychology (2nd Ed.). Hoboken, NJ: Wiley

Howard, P. J. (2006). The Owner's Manual for the Brain (3rd Ed.). Austin, Texas: Brad Press.

Parker, G. (2007). Bipolar disorder-assessment and management. Australian Family Physician,

36(4), p. 240-243

bipolar 1 and substance abuse disorders

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