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Bipolar Disorder and Heroin Addiction

The bipolar disorders are a group of mental health disorders that include shifts in mood, energy, and levels of activity.1 Perhaps the best known type, bipolar I, is defined by periods of mania.
Treatments that target both heroin addiction and the symptoms of bipolar disorder tend to have the highest rates of effectiveness.

What Is Bipolar Disorder?

Bipolar disorder, once called manic depression, is a psychiatric disorder that causes extreme shifts in mood, activity levels, energy, and ability to function on a daily basis.1

People with bipolar disorder have mood cycles or “mood episodes” that involve unusually intense emotions, changes in sleep, and unusual behavior. Some of the classic signs and symptoms of bipolar disorder include: 1
Bi-polar disorder with heroin use

  • Manic episodes. These may involve a very elevated or euphoric mood, increased activity, racing thoughts, increased sexual desire, inflated self-esteem, difficulty sleeping, and risky behaviors.
  • Depressive episodes. These involve feelings of sadness or hopelessness, lack of energy, trouble concentrating, low motivation, sleep disturbances, forgetfulness, changes in appetite, and thoughts of death or suicide.

Bipolar and Addiction

“Dual diagnosis” and “co-occurring disorders” are terms used to describe when a person has a psychiatric disorder and a substance abuse disorder at the same time.2

Multiple studies have found that people who have substance abuse issues are also likely to have co-occurring mental disorders. People diagnosed with mood and anxiety disorders are also twice as likely as the general population to have a substance use disorder.3

According to data from 2016, more than 8 million or 3.4% of adults age 18 and older had both a mental illness and substance abuse disorder in the past year.4  Studies indicate that lifetime co-occurrence of substance use disorders for people with bipolar disorder ranges from about 22% to 59%.5

Why Do People With Bipolar Use Heroin?

Bipolar disorder and heroin addiction share some of the same causes, including shared genetic vulnerability.3

Researchers are currently studying whether specific genes predispose people to both mental illness and substance abuse disorders. Approximately 40% to 60% of a person’s vulnerability to developing addiction has to do with genetics. But this vulnerability to addiction is not due to genes alone—it likely results from a combination of factors such as genes interacting with environmental influences as well as the interplay with other specific genes.3

Researchers have also discovered that some areas of the brain are affected by both mental illness and substance use. For example, the neurotransmitter dopamine has been implicated in both substance use and mental disorders, and several medications that treat mental illnesses target dopamine regulation in the brain.3

Stress and early exposure to trauma are 2 more factors that might play a role in the development of both heroin addiction and bipolar.3

Aside from genetic and biological factors, people with bipolar disorder might use heroin to self-medicate. In fact, over 24% of people with mood disorders used drugs or alcohol to relieve symptoms in one study. The highest rates of self-medication were seen in people diagnosed with bipolar I disorder. More than 41% of people with bipolar I used drugs such as heroin to alleviate symptoms, and men were more than twice as likely as women to self-medicate.6

While self-medication might relieve symptoms in the short term, using heroin or other drugs can worsen both manic and depressive symptoms in people with bipolar disorder.5

Treatment for Bipolar and Heroin Addiction

People with bipolar disorder and comorbid substance abuse disorders, such as a heroin use disorder, tend to struggle in treatment and may have worse outcomes than people who only have one disorder.7 For example, people with both bipolar disorder and alcohol use disorder are less likely to respond and adhere to treatment. They are also more likely to attempt suicide and to be hospitalized than people diagnosed with just bipolar disorder.5

Combined treatment for both the mental illness and comorbid drug use disorder has proven to be superior to separate treatment for each disorder. Integrated treatment involves a combination of therapies, such as cognitive behavioral therapy and coping skills training. These treatments provide support to the person and help with recovery.7

There are several medications useful for treating opioid use disorders such as heroin addiction as well as those useful in the management of bipolar disorder.7

  • Methadone: This medication is a staple in the treatment of heroin addiction and helps relieve cravings and withdrawal symptoms in addition to helping people stay off heroin long term. Only providers associated with federally certified opioid treatment programs can prescribe methadone.8
  • Naltrexone: This medication treats heroin addiction by blocking opioid receptor activation, minimizing the rewarding effects of opioid use and reducing cravings.8 There have been reports of depression and suicide in patients taking naltrexone for opioid dependence, but research has not found a direct relationship. Because depression and suicidal thoughts are both symptoms of bipolar disorder, patients who take naltrexone and have a history of bipolar disorder require careful monitoring.9
  • Buprenorphine-naloxone (Suboxone): This prescription combo treats heroin withdrawal and, like methadone, can help people stay clean from heroin over an extended period.8
  • Buprenorphine: This medication alone also treats heroin addiction. It is preferable to buprenorphine-naloxone for some patients, such as those who are pregnant or have a sensitivity to naloxone.8
  • Lithium: This mood stabilizer treats mania in bipolar disorder and can help reduce suicidal thoughts and behavior.10
  • Valproic acid (divalproex, Depakote): This medication treats people with mixed symptoms of depression and mania or those with a rapid-cycling bipolar disorder.10

Other treatments for both bipolar disorder and heroin addiction include:7

    • Cognitive behavioral therapy (CBT): CBT can help people learn how to modify maladaptive thoughts and behaviors. It is useful for both substance abuse and mental health disorders.
    • Integrated group therapy: This therapy was specifically designed for people with co-occurring substance abuse disorders and bipolar disorder. It addresses both problems at the same time and helps people understand the symptoms of both disorders.

Using medications as to help with drug treatment

  • Contingency management therapy: This therapy is used in combination with other behavioral therapies. It is mainly for people with substance abuse disorders, but it can be beneficial for mental health disorders as well. It rewards patients who practice healthy behaviors such as complying with drug and psychiatric treatment.
  • Assertive community treatment (ACT): ACT is an integrative treatment designed for people with serious mental illness and co-occurring substance abuse disorders. Some of the features of ACT treatment include a small caseload size and personalized therapies.

Mutual support or self-help groups are an essential part of recovery for many people diagnosed with mental illness and substance abuse. Support groups exist for both the people diagnosed with co-occurring disorders and their families or significant others.11

  • Double Trouble in Recovery: This 12-step group was specifically designed for people diagnosed with co-occurring disorders.
  • Dual Recovery Anonymous: This is another 12-step program for people with co-occurring mental health disorders and substance abuse disorders.

Get Help for a Dual Diagnosis

Many programs all over the country offer treatment for co-occurring disorders such as heroin addiction and bipolar disorder. Search our directory of treatment centers to find a program that offers dual diagnosis treatment near you.

Sources

  1. National Institute of Mental Health. (2016). Bipolar Disorder.
  2. National Alliance on Mental Illness. (2017). Dual Diagnosis.
  3. National Institute on Drug Abuse. (2010). Comorbidity: Addiction And Other Illnesses. 
  4. Substance Abuse and Mental Health Services Administration. (2017). Key Substance Use And Mental Health Indicators In The United States: Results From The 2016 National Survey On Drug Use And Health.
  5. Substance Abuse and Mental Health Services Administration. (2016). An Introduction to Bipolar Disorder and Co-Occurring Substance Use Disorders.
  6. Bolton, J.M., Robinson, J. & Sareen, J. (2009). Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Affective Disorders, 115(3), 367-375.
  7. National Institute on Drug Abuse. (2018). Common Comorbidities with Substance Use Disorders: What are the treatments for comorbid substance use disorder and mental health conditions?
  8. National Institute on Drug Abuse. (2018). Pharmacotherapies Used to Treat Alcohol, Nicotine, and Opioid Use Disorders.
  9. Food and Drug Administration. (2018). Label: REVIA® (naltrexone hydrochloride tablets USP).
  10. National Institute on Mental Health. (2016). Mental Health Medications.
  11. Substance Abuse and Mental Health Services Administration. (2008). An Introduction to Mutual Support Groups for Alcohol and Drug Abuse.

 

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