1. Running head: BIPOLAR 1 AND SUBSTANCE ABUSE DISORDERS
Bipolar1 and Substance Abuse Disorders
Jody Marvin, Cathy Lint, Heidi Oconnor, Mickel Malone, and Nicole Hesprich
PSY410
August 12, 2013
Dr. Kristi Husk
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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 forSubstance 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

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use disorders include abuse and dependence. Substance-induced disorders include intoxication,
withdrawal, and various mental states (dementiapsychosis, 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, andnor 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%”

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(as cited in Bipolar Disorder, 2009, p. 128). Additionally, “When both parents have 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 calledthe Dexamethasone Suppression Test
that tests cortisol levels. Medications that help relieve most if not all symptoms of depression are
Tricyclics, MAO inhibitors, andSSRIS. 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, andthe 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, andthe world. Consecutively, the psychodynamic componentrootsin loss,
anger,disappointment, andisunconscious in thought.This self-criticism is similar to hurting an
individual's ego. Interventions for the psychodynamic approach aretherapy 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 withfriends
andwith 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, andclasses. 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.

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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,
andcontingency management to treat substance abuse (Hansell, 2008).
Cognitiveapproach 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, andintervention 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.

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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

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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, IFIhelps to identify stressors that

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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

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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 familyoriented 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

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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

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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.

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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