 When two disorders or illnesses occur in the same person, simultaneously or sequentially, they are described as comorbid. Comorbidity also implies interactions between the illnesses that affect the course and prognosis of both.  Bipolar disorder and alcohol abuse commonly co–occur. Multiple explanations for the relationship between these conditions have been proposed, but this relationship remains poorly understood. Some evidence suggests a genetic link. This comorbidity also has implications for diagnosis and treatment. Alcohol use may worsen the clinical course of bipolar disorder, making it harder to treat.  Studies showing a connection between bipolar disorder and likelihood to self-medicate through substance abuse are prompting doctors and patients to learn more about this complicated relationship. From prescription drugs not given by their doctor, to cocaine, marijuana and alcohol, some bipolar patients report using substances to combat pain, insomnia and anxiety; they also report getting trapped in a cycle that only makes the situation worse

 Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic and typically vary greatly over the course of a person’s life as well as among individuals. Over 10 million people in America have bipolar disorder, and the illness affects men and women equally. Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from days to months that often begin in adolescence or early adulthood, and occasionally even in children. Most people generally require some sort of lifelong treatment. While medication is one key element in successful treatment of bipolar disorder, psychotherapy, support, and education about the illness are also essential components of the treatment process.  Studies have suggested that up to 60% of people with bipolar affective disorder misuse drugs or alcohol.

 Bipolar II Disorder. This is characterized by episodes of severe depression and episodes of hypomania. The episodes of depression must last for at least two weeks and the hypomania for four days. Again, we are not talking about “mood swings” where people experience sudden sadness, anger, irritability, energy, or euphoria which “come out of the blue” and go away in a few hours. The two weeks of depression consists of sadness (or lack of interest), with interrupted sleep, decreased energy, inability to concentrate, lethargy (or agitation), disrupted appetite, and sometimes thoughts of death. An episode of depression in someone with Bipolar II Disorder may require hospital care to prevent self harm. On the other hand, people with Bipolar II Disorder may enjoy their episodes of hypomania. They can be fun to be around as long as they are not irritable. Their mood is elevated or expansive, they sleep less, experience a surge of energy, and may get a good deal accomplished. Hypomanic people are not disorganized and do not become psychotic.  There are some things which make bipolar illnesses worse. Taking medicine inconsistently always makes it worse. Bipolar disorders are chronic, relapsing illnesses. Most people with bipolar illness need to take medicine all the time, not just when they feel depressed or manic or irritable. Drugs and alcohol always make bipolar illnesses worse. Stress from poverty, unemployment, loss of relationships, and physical illness also contributes to relapse.

 Millions of people throughout the world engage in irresponsible and excessive drinking and exhibit drinking problems. Such drinking behavior is known as alcohol abuse.  Alcohol abuse is a drinking pattern that frequently results in recurring alcohol-related legal difficulties (such as multiple DUIs); ongoing alcohol-related relationship issues; failure to attend to important responsibilities at school, work, or home; alcohol-related physical injuries.

 Another one of the key facts on alcohol abuse and some basic alcohol abuse information is that irresponsible and long term alcohol abuse usually results in various alcohol long term effects that are highly correlated with different diseases, medical issues, and illnesses.

Research indicates that both men and women with bipolar have a greater likelihood of alcohol misuse than the general population, that bipolar men are more likely than bipolar women to abuse alcohol and that there is more chance of a lifetime history of alcohol misuse with the combined alcohol abuse and bipolar. At the 1996 U.S. Psychiatric & Mental Health Congress, Kathleen Brady, M.D., Ph.D., an associate professor of psychiatry at the Medical University of South Carolina, reported that substance abuse occurs in 30% to 60% of patients with bipolar disorder and is more likely to coexist with bipolar illness than with any other Axis I psychiatric disorder. Reality is that the relief of symptoms via self-medication is short lived. An individual struggling with dual diagnosis 2 offers this perspective: "Self-medicating treats the symptoms, not the underlying illness. The more we use a substance other than doctor supervised medication the worse our symptoms become and we often find ourselves in a hole which is very difficult to climb out of" (SoberDykes, 2000).

Alcohol intoxication and mania and hypermania display similar symptoms as do alcohol withdrawal and depression. Concurrent alcohol abuse complicates the diagnosis, prognosis and treatment of bipolar individuals and often leads to heightened severity of bipolar symptoms, and poor treatment outcomes. Alcohol or drug use or the withdrawal from alcohol or other drugs can mimic or give the appearance of some psychiatric illness.

 Dual diagnosis is the term used when a person has a mood disorder such as depression or bipolar disorder (also known as manic depression) and a problem with alcohol or drugs. A person who has a dual diagnosis has two separate illnesses, and each illness needs its own treatment plan.  Dual diagnoses are difficult to treat - One of the things that make dual diagnoses so difficult to treat is that it is hard to know where certain symptoms are coming from. For example, if a dual diagnosis patient is suffering from depression, there's no way to initially know whether the drug addiction or the individual's mental illness is causing the problem. Depression is a symptom of many things, so the challenge is on the medical professional to find the root cause and treat it.

 There are many physical complications to the treatment of a person with a dual diagnosis. Douglas Polcin outlines some major challenges in his article entitled "Issues in the Treatment of Dual Diagnosis Clients Who Have Chronic Mental Illness." He cites poor treatment response, high rates of rehospitalization, aggravated psychotic thoughts, and changes in neurophysiology. He also notes that those dually diagnosed are often less responsive to medications than those who do not abuse substances, specifically stating that cocaine users have problems with lithium (Polcin, 1992).  Another issue with treatment of dual diagnosis is that "systems have not been well designed with this population in mind. Typically a community has treatment services for people with mental illness in one agency and treatment for substance abuse in another. Clients are referred back and forth between them in what some have called 'ping- pong' therapy" (NAMI).

Sometimes behavior problems go along with mood episodes. A person may drink too much or take drugs. Some people take a lot of risks, like spending too much money or having out of control sex. These problems can damage lives and hurt relationships. Some people with bipolar disorder have trouble keeping a job or doing well in school. Psychiatric symptoms may be covered up or masked by alcohol or drug use. Isolation and social withdrawal. Legal problems, possible incarceration, and homelessness.

Alcohol or illegal drug abuse may interfere with the treatment of depression or bipolar disorder. For example, alcohol reduces the effectiveness of some antidepressants. The combination of alcohol or drugs with your medication(s) may lead to serious or dangerous side effects even death. When a person with bipolar disorder drinks alcohol, it can cause him/her symptoms to become more severe. The NIAAA reports the findings of a research study conducted by Susan Sonne and colleagues in 1994 that compared the severity of symptoms between people with bipolar disorder who drank alcohol and those who did not; they found that those who drank were more likely to be hospitalized, experience an earlier onset of bipolar disorder, experience more rapid cycling and have more mixed forms of mania.

Just why individuals who are mentally ill are so prone to abuse alcohol and other drugs is a matter of controversy. Some researchers believe that substance abuse may precipitate mental illness in vulnerable individuals, while others believe that people with psychiatric disorders use alcohol and other drugs in a misguided attempt to alleviate symptoms of their illnesses or side effects from their medications. The evidence is most consistent with a more complex explanation in which well-known risk factors - such as poor cognitive function, anxiety, deficient interpersonal skills, social isolation, poverty, and lack of structured activities - combine to render people with mental illnesses particularly vulnerable to alcohol and drug abuse.

A problem with treating somebody with a dual diagnosis has been that this type of individual often finds it hard to accept the need for dual diagnosis drug rehabilitation. All addicts suffer from denial as this is a symptom of the condition, but a breakthrough can often occur when the addict can get past their denial and see the need for help. This moment of insight is often not as easy for the person with dual diagnosis to reach. Their other mental health issue can seriously detract from their ability for any type of insight into their own behavior; for instance those with bipolar and schizophrenia usually have poor judgment. If the individual is able to recognize the need for dual diagnosis drug treatment then there is far less hope of it being successful. When you can’t see a problem you are unlikely to put much effort into fixing this problem. In fact for many people with a dual diagnosis it is hard to let go of the belief that their addiction is helping them cope with their other problems; this may have in fact been the case in the beginning, but the only place that addiction leads is misery.

 Over 50% of those individuals who abuse drugs or are addicted to drugs are believed to all have at least one significant mental illness as well.  Almost a third of all individuals with a mental illness also have a substance abuse problem, and also suffer from alcohol or drug addiction.  Dual diagnosis patients are at a high risk for suicide. Studies have found that those with co-occurring disorders commit suicide at a rate much higher than those with just an addiction or mental illness alone.  The eight most common mental disorders found in dual diagnosis patients are: Bipolar Disorder, Borderline Personality Disorder, Depression, Obsessive Compulsive Disorder, Panic Anxiety Disorder, Post Traumatic Stress Syndrome, Eating Disorders and Schizophrenia  Integrated Care is the most effective way to treat dual diagnosis patients. Integrated care refers to treatment from both psychiatric professionals and addiction counselors under the same roof. This treatment "team" is able to communicate with one another about the best ways to help the individual and make sure each component of the plan is complimenting one another.

 As with other addictions, groups are very helpful, not only in maintaining sobriety, but also as a safe place to get support and discuss challenges. Sometimes treatment programs for co-occurring disorders provide groups that continue to meet on an aftercare basis. Your doctor or treatment provider may also be able to refer you to a group for people with co- occurring disorders.  Dual Recovery Anonymous™ is an independent, nonprofessional, Twelve Step, self-help membership organization for people with a dual diagnosis. Their goal is to help men and women who experience a dual illness. That are chemically dependent and are also affected by an emotional or psychiatric illness. Both illnesses affect a person in all areas of their lives; physically, psychologically, socially, and spiritually.

 Helping a loved one with both a substance abuse and a mental health problem can be a roller coaster. Resistance to treatment is common and the road to recovery can be long. It’s common to feel isolated, overwhelmed, scared, and confused.  The best way to help someone is to accept what you can and cannot do. You cannot force someone to remain sober, nor can you make someone take their medication or keep appointments. What you can do is make positive choices for yourself, encourage your loved one to get help, and offer your support while making sure you don’t lose yourself in the process.