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Section 13
Substance Dependence

CEU Question 13 | CE Test | Table of Contents | Bipolar
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track, we discussed how stress affects those with bipolar disorder and how clients can monitor their stress:  kindling; short-term and chronic stress; and stress symptoms.

Several researchers have found that more than one half of clients with bipolar disorder have substance abuse problems as well. 

On this track, we will examine the several types of substance abuse most common in bipolar disorder clients:  alcohol, illegal drug abuse, and nicotine.

3 Types of Common Substance Abuse

1. Alcohol
The first and most common type of substance in bipolar disorder clients is alcohol abuse.  Alcohol is a favorite among many because while it can enliven a manic client, it also numbs the pain of a depressive client. However, this numbing does not last for long as alcohol is, in fact, a type of depressant and only worsens a client’s condition. 

Clarisse, age 42, told me about her alcohol binges during her college days, "I started off one party by splitting a fifth of rum with a friend. When that was gone, I downed another partygoer’s vodka. Then I switched to wine for a while. All the time, I was singing, dancing, entertaining. Other partygoers were placing bets on when I’d finally pass out.  I concluded the evening by polishing off the host’s scotch." 

At this point in her life, Clarisse was undergoing a manic episode. Often, manic clients drink socially because they feel so euphoric and want to be the center of attention. Usually, when a manic client suffers from alcohol poisoning, he or she is more likely to be taken to the hospital for treatment because of the fact that he or she is around other people. However, those clients suffering from a depressive episode pose more danger to themselves because they prefer to drink alone. This becomes extremely perilous when there is no one around to help them if they should overdose on alcohol.

Exercise:  Goal Setting
Obviously, the major course of action when a client is suffering from alcohol abuse is to recommend them to a support group such as Alcoholics Anonymous. The client by him or her self cannot fully break from the hold that alcoholism has on them. However, in addition to group therapy, I have suggested to Clarisse and several other of my other clients suffering from alcohol abuse to try the "Goal Setting" exercise. 

5 Guidelines for Setting Goals
This exercise can also be helpful for those clients trying to break from any other destructive habit. I ask each of them to follow these guidelines to set their own goals toward a more healthy life.
1. Around the same time on the same day each week, list the goals most on your mind.
2. Do this for three consecutive weeks.
3. Put the list away each week without looking at it until the fourth week.
4. On the fourth week, compare all of your lists.  Most likely, you’ll find some differences.
5. Make a master list and prioritize your goals.
Clarisse found that her first goal each week was "drink less" and "smoke less".  Now that she could see her own goals on paper, Clarisse felt more determined to keep to them.

2. Illegal Drug Abuse
A second type of substance abuse is illicit drug abuse. Obviously, this includes such drugs as cocaine, speed, ecstasy, and heroine. I have found that those clients who experience mania tend to abuse stimulants during their manic states. One client of mine, Greg, reported having a friend in college who was a pill pusher. Greg stated, "He’d dole out a couple of dozen little white cross pills like a parent paying allowance. I liked speed—a lot. I helped me feel productive. Suddenly, I had the power to create or extend my highs on my own. It was one of the few times I felt in control. At least until the speed led to the shakes." 

Cocaine has been reported to give the same kind of energized feeling that manics thrive on. Depressive clients tend to become addicted to opioids such as heroin, morphine, and sleeping pills.  These narcotics again help to numb the depressive client and induce sleep, which, as you know, is a symptom of depression. 

Lorraine, a unipolar client of mine, reported the character of her substance abuse during her depressive states.  She stated, "When I first felt depressed, I started taking heroin.  It helped me sleep longer, which is exactly what I wanted to do. After that, sleeping pills helped me to sleep even longer.  I might have been sleeping for about 14 hours a day."  As you can see, there is a significant difference between the choice of drugs for a manic and a depressive client.

3. Nicotine

In addition to alcohol and drug abuse, as you know a third type of addiction that is legal here in the US is nicotine. Nicotine as you are aware is in fact a stimulant that causes the user to feel euphoric and in control. Aside from its cancer-inducing nature, nicotine is as addictive a substance as cocaine.

Daniel, a bipolar client of mine, reported his bout with a nicotine addiction. He stated, "I usually only smoked when I was manic. That manic urge to breathe in life’s essence—to get it while you can—is a lot like the drive to inhale a hard rag from a cigarette. Though, when I’m down, I hardly feel like a cigarette at all." 

For Daniel, it was relatively easy to give up smoking, partly due to the fact that when he was depressed, he felt no craving for tobacco.  However, for those clients who can’t seem to shake the habit, I strongly recommend that they seek aid in the form of nicotine patches or gum.  Otherwise, the stimulant nicotine could push them into a manic state.

What addictive behavior does your client exhibit? Would the Goal Setting Exercise be beneficial?

On this track, we discussed the several types of substance abuse most common in bipolar disorder clients:  alcohol, illegal drug abuse, and nicotine.

On the next track, we will examine ways that bipolar clients can adjust their living habits to help them better cope with their disorder:  regular mealtimes; eating natural foods; and regular exercise.

Peer-Reviewed Journal Article Reference:
Hogarth, L., Hardy, L., Mathew, A. R., & Hitsman, B. (2018). Negative mood-induced alcohol-seeking is greater in young adults who report depression symptoms, drinking to cope, and subjective reactivity. Experimental and Clinical Psychopharmacology, 26(2), 138–146.

Johnson, S. L., Tharp, J. A., Peckham, A. D., & McMaster, K. J. (2016). Emotion in bipolar I disorder: Implications for functional and symptom outcomes. Journal of Abnormal Psychology, 125(1), 40–52.

Leventhal, A. M., & Zimmerman, M. (2010). The relative roles of bipolar disorder and psychomotor agitation in substance dependence. Psychology of Addictive Behaviors, 24(2), 360–365.

Mneimne, M., Fleeson, W., Arnold, E. M., & Furr, R. M. (2018). Differentiating the everyday emotion dynamics of borderline personality disorder from major depressive disorder and bipolar disorder. Personality Disorders: Theory, Research, and Treatment, 9(2), 192–196.

Sullivan, A. E., & Miklowitz, D. J. (2010). Family functioning among adolescents with bipolar disorder. Journal of Family Psychology, 24(1), 60–67.

Zegel, M., Rogers, A. H., Vujanovic, A. A., & Zvolensky, M. J. (2021). Alcohol use problems and opioid misuse and dependence among adults with chronic pain: The role of distress tolerance. Psychology of Addictive Behaviors, 35(1), 42–51.

Online Continuing Education QUESTION 13
What are the three most common types of substance abuse in bipolar clients? To select and enter your answer go to CE Test.


CE Test for this course | Bipolar
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