For many people who struggle with mental health conditions like mood disorders, substance use is a common co-occurring problem. Studies have found that 47.3% of people with any bipolar disorder will have a substance use disorder at some point in their lifetime (that number goes up to 60.3% if we limit it to just Bipolar I disorder). For people struggling with major depression, 40.3% will develop alcohol use disorder at some point and 17.2% will develop a drug use disorder. Even with this significant overlap, many people are not aware of how to treat co-occurring mood and substance use disorders. Here are some tips on how you can cope if you are one of the many people struggling with both.
Why Does This Happen?
Many people end up using drugs and alcohol to manage some of the symptoms associated with these illnesses. For example, even though alcohol is a central nervous system depressant, which might make it seem an odd choice for a depressed person to use, the effect initially is euphoric. So, while your depression may pull you to isolate and hide under your covers, making it difficult to go and spend time with your friends, a drink may feel like it will pick up your spirits or give you enough energy to go that football game. Similarly, alcohol and benzodiazepines (like Xanax) are frequently used by people who are trying to calm symptoms of mania (this time using the depressive qualities to calm down their brain).
Put in context, it makes perfect sense why people who have a mood disorder might want to turn to substances. They are incredibly powerful and good at what they do, they are reliable (I get the effect I am looking for each time), and even if they aren’t actually helping, they appear to be helping. And when you’re “desperate” for something to change, which is what many people with a mood disorders feel, the appearance of helping is a very powerful motivator. At the same time, using a substance to manage a mood disorder can make the problem worse and last longer than it might if treated with therapy and appropriate medications.
While it can be challenging to live with a mood disorder there are several things that are in your control and can improve your odds of managing your mood without using substances. While part of coping with a mood disorder is accepting that there are things you cannot control, like your brain chemistry, there are things you can target and have an influence over that can help. Consider the the chain of events that leads you to behave in particular ways. We know that specific environmental circumstances (including certain people, situations, and times) can act as “triggers” both to mood symptoms and substance use. We also know that there are some emotions that are related to not using. Understanding and keeping track of what triggers you to want to use and what helps you avoid using can help you make choices to engage with or avoid situations and people that will lead you towards use. In this way, you’ve impacted your behaviors without the use of substances!
A lack of awareness about your symptoms and what to do about them can contribute to mood episodes staying in place for longer periods of time and becoming more severe and disruptive to your life. Stigma and shame often prevent people from openly trying to understand what is happening to them. Instead of explaining to a doctor how horrible they feel, many people will self-medicate and hope they can solve the problem themselves. For example, someone with severe depression who often contemplates suicide can look like the life of the party when using alcohol and cocaine.
Stressful life events, both positive and negative can have a profound impact on a person’s mood. A change in school or job, getting married, the death of a loved one, a new baby, divorce or a move can all create a shift in mood. It is also not uncommon for people to have certain mood patterns around certain holidays or anniversaries (i.e., getting depressed after the holiday season or the yearly anniversary of a loss of a loved one). Many people with mood disorders also have a biological rhythm that seems to come in quite predictable patterns. These patterns can be seasonal, such as a shift to hypomania in the spring and depression in the fall. Many women also have symptoms that get worse depending on hormonal fluctuations.
Increasing your awareness of what triggers both your mood symptoms and your desire to use substances can help you figure out what kinds of skills and supports you need in order to maintain your goals. And, the more you know about what sets you off, the more you can be mindful of when those thoughts/feelings/behaviors are showing up! Increasing your mindful awareness of what is happening to you internally can help you make better choices.
If you are trying not to use substances to manage underlying mood symptoms, it is very important to identify and enlist the help of treatment professionals, family and friends who can help. People who care about you can give you feedback regarding your thinking, mood, and behavior. It is often difficult to see mood symptoms because they can feel normal and just like part of life. An outside observer can give perspective and may act as a helpful early warning system before an episode gets really problematic. Your support systems can arrange appointments and help with treatment planning or help you address you environment at home and work to to reduce stimulation (in the case of mania) and increase stimulation (in the case of depression).
And, don’t forget about medications. Research suggests that the best outcomes are the result of a combination of medication and behavioral modification strategies. If you are struggling with both a mood disorder and a substance use disorder, working with an addiction psychiatrist (who knows about how to treat both sets of issues) can help you attain your goals.