On the last track, we discussed how stress affects those with
bipolar disorder and how clients can monitor their stress: kindling;
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
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.
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,
downed another partygoer’s vodka. Then I switched to wine for a
the time, I was singing, dancing, entertaining. Other partygoers were
placing bets on when I’d finally pass out. I concluded the evening
polishing off the host’s scotch."
At this point in her life,
undergoing a manic episode. Often, manic clients drink socially because
they feel so euphoric and want to be the center of attention. Usually,
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
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
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
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
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
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
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
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
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
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
do. After that, sleeping pills helped me to sleep even longer. I
have been sleeping for about 14 hours a day." As you can see, there
significant difference between the choice of drugs for a manic and a
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
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
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
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:
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.
Online Continuing Education QUESTION
What are the three most common types of substance abuse in bipolar clients?
To select and enter your answer go to .