Substance/Medication-Induced Bipolar or Related Disorder
Finding The Right Treatment
Treatment
Treatment for substance-induced bipolar disorder is extremely important. Without treatment, the symptoms can worsen, as substance abuse is a progressive disease. The most important part of treatment is to end the use of the triggering substance, whether it is alcohol, cannabis, methamphetamine, opiates, or another drug.
If the person with substance-induced bipolar disorder exhibits psychotic symptoms, then antipsychotics are often given. If the disorder was there from the beginning, then, although it was worsened by substance abuse, the individual likely was struggling with undiagnosed and untreated symptoms of bipolar disorder for years. A mood stabilizing medication is usually indicated when there are symptoms of bipolar disorder.
Finding a therapist
While medications may be a catalyst for change in individuals with substance-induced bipolar disorder, therapy has proven to yield major improvements in the lives of those struggling. Whether it be early recognition of symptoms that lead to a depressive or manic episode, an understanding of how one's past might have impacted them, or a simple awareness of one's thoughts and their triggers, therapy can help people become happier and better balanced versions of themselves. Another key goal of therapy is to learn about and come to accept the reality of having a chronic mental health condition. Understanding the need for long-term management and monitoring with the goal of avoiding future episodes, is another treatment target. Most therapists have experience working with adults with bipolar disorder.
There are different kinds of professionals who can provide effective therapy, including:
- Clinical psychologists (PhD)
- Licensed clinical social workers (LCSW or LMSW)
- Licensed professional counselors (LPC)
- Licensed clinical professional counselors (LCPC)
- Licensed Marriage and Family Therapists (LMFT)
- National certified counselors (NCC)
There are several styles of therapy that can be helpful for substance-induced bipolar disorder including Motivational Interviewing, psychodynamic, interpersonal, and supportive therapy. In recent years, more therapists employ cognitive behavioral therapy (CBT), which is a method that helps the individual identify unhelpful thought patterns, challenge self-destructive cognitions, and replace them with more constructive thinking.
Therapists will also help the individual identify behaviors which may help bring increased pleasure, self confidence, and hopefulness. Eye Movement Desensitization and Reprocessing (EMDR) is a therapy that was developed to treat trauma, which is frequently associated with alcohol and substance abuse.
Many individuals with substance-induced bipolar disorder find therapy to be one of the best ways to prevent future depressive episodes. It is critical to recognize the triggers and signs of an oncoming episode, and therapy can help a person take the needed next steps for prevention. The natural ups and downs of life can often be triggers for depressive episodes, and a good therapist will partner with their client to plan accordingly, even aiding in communicating with the prescribing clinician during these difficult periods.
The decision to start therapy
Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.
For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.
Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.
Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.
Where to start
Requesting one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.
To find a therapist who takes one's insurance, the National Institute of Mental Health offers a comprehensive list of resources.
Psychology Today also lists therapists by type, location and insurance.
Determining whether medications will play a role in treatment
Medications may play a central role in the lives of people with substance-induced bipolar disorder. Finding the right medication is not straightforward, as individuals metabolize and react to medications differently. Adjusting dosages to manage and prevent manic or depressive episodes can add an additional layer of complexity. There are different kinds of professionals who can prescribe treatment, including:
- Psychiatrists, MD’s.
- Medical doctors trained in psychopharmacology, a specialty of psychiatry
- Psychiatric Nurse Practitioners
- Physician Assistants trained in psychopharmacology
Antipsychotic medications
When psychotic or severe features are present, which may occur with substance-induced bipolar disorder, the individual will need a prescription for an antipsychotic medication. There are many antipsychotics and most physicians prefer the newer “second generation” or “atypical” antipsychotics available today, which are longer-acting and are also less likely to have side effects than medications that were popular twenty years ago. However, side effects do occur with many antipsychotics and the primary side effect is weight gain with some of these drugs.
Healthcare providers that can prescribe medications
Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.