Adolescent Alcohol/Drug Use and Comorbidity in Bipolar 1 Disorder

An APA style paper delving into Bipolar and drug/alcohol use in adolescents.

Adolescents who suffer from Bipolar I Disorder often have Alcohol Use Disorders (AUD) and Substance Abuse Disorders (SUD). Bipolar I Disorder is a complex mental illness that has reoccurring episodes of mania (an extreme heightened state of euphoria, and aggression) and/or depressive (an extreme state of inhibition) symptoms. Through Quilty, Sellbom, Tacket and Bagby’s research in “Personality Trait Predictors in Bipolar Disorder Symptoms”, mania is described as a heightened, and euphoric state, while depression is described as inhibited, and withdrawn behavior (pg. 160) Per Merline, Jaeger and Schulenberg (2008) in their article “Adolescent Risk Factors for Adult Alcohol Use and Abuse: Stability and Change of Predictive Value Across Early and Middle Adulthood”, Alcohol Use Disorder is classified by alcohol abuse (where alcohol has inhibited normal responsibilities and personal life), and alcohol dependency (pg. 85) Alcohol dependency is the case of when individual develops a tolerance (requiring more to feel the effects) to the substance and develops withdrawal symptoms (the body’s need of the substance) from lack of alcohol ( Merline, Jager and Schulender, 2008, pg. 85). In Linda Patia Spear’s article “Adolescent Alcohol Exposure: Are there separable vulnerable periods in adolescents?” (2014), fifty percent of these adolescents are in the tenth grade when they are introduced to alcohol, making them 16 to 17 years old (pg. 124). In Spear’s study (2014), she used a combination of animal and human studies to measure the effects of alcohol on the neurological system by use of MRI. She found that alcohol affects the number of excitatory synapses and the amount of gray matter in the cortex and the subcortical regions (pg. 127). This would inhibit response, and flow of information in and to the brain. (Spear, 2014)

Substance Use in Bipolar I Disorder includes alcohol, but the other illicit drug commonly found to be used are opioids, such as Vicodin, and Percocet (Cerullo & Strawkoski, 2007). In Cerullo and Strakowski’s literature review, they compared different SUDs, from cannabis use to cocaine, and what would ultimately be best to treat both Bipolar I Disorder and SUD; they found that with substantial evidence, both should be treated immediately and if possible, simultaneously (Cerullo and Strakowski, 2007). This conclusion has been supported by Weiss et al’s article “A “community-friendly” version of integrated group therapy for patients with bipolar disorder and substance dependence: A randomized controlled trial” (Weiss et al., 2009) Weiss et al’s article (2009) has shown that use of these substances lead to worse outcomes that range from slower mood recovery, poor medication adherence and a higher rate of suicidality in Bipolar Disorder I patients (pg. 212). Unlike the experiment done by Spear, Weiss et al’s research was solely done on human beings, with a pre-occurring diagnosis of both Bipolar I Disorder and SUD to see if integrated group therapy could help relieve the symptoms of both, and had discovered that this had worked better than group drug counseling (Weiss et al., 2009) Unfortunately, the comorbidity of these two mental disorders is poorly understood, and misdiagnosed (Nesvaͦg et al., 2014). In Nesvaͦg et al’s experiment (2014), they had used selected individuals who were registered in the NPR (Norwegian Patients Register) with SUD and Bipolar I Disorder to find a connection between the two disorders, but they balanced the experiment with other psychiatric disorders comorbid with AUD and SUD, like schizophrenia and depressive illness (pg. 1268). Although much of the research conducted revealed that opioids aren’t the only substances used, and that there are other psychological illnesses that are comorbid with SUD and AUD, for this literature review, only opioid and alcohol use will be mentioned. This, along with Bipolar I Disorder will be explained throughout this paper. Finally, this paper examines how Bipolar I adolescents can, and sometimes do turn to alcohol and illicit drugs, and what it can do to them neurologically and psychologically.

Adolescent Alcohol and Drug Use and Comorbidity in Bipolar Disorder I

Adolescents with Bipolar I Disorder often turn to drugs and alcohol to control their symptoms. When this becomes excessive, the diagnosis of Substance Use Disorder (SUD), and Alcohol Use Disorder (AUD) can swiftly follow. 59.4% of patients with Bipolar I Disorder have reported having a lifetime SUD (Weiss et al., 2009). Also, Bahorik, Newhill, and Eack’s research in their article “Characterizing the Longitudinal Patterns of Substance Use Among Individuals Diagnosed with Serious Mental Illness after Psychiatric Hospitalization” (2013) shows that Substance Abuse Disorder is comorbid with bipolar and depressive disorders, and can lead to poorer remission rates with illicit drugs and alcohol (pg. 1260). These combined diagnoses prove to pose a challenge to treat the patient with the psychological illnesses in question (Nasvaͦg et al., 2014). Finally, there have been little studies done in regards to Bipolar I Disorder and the comorbidity of SUD and AUD (Cerullo and Strakowski, 2007). Furthermore, what little that has been done has given little to no understanding of the comorbidity between Bipolar I and SUD and AUD (Nesva°g et al., 2014). The question remains: how does the comorbidity of SUD, AUD and Bipolar I Disorder affect a young adult? Bipolar I Disorder in an adolescent is comorbid of SUD and AUD through temperament, gender and treatment levels.

Bipolar I Disorder is a disabling illness (Dell’Osso et al., 2016). Furthermore, this illness became more commonly diagnosed than it has in the present. For example, in an older statistic, 1-3% to 3-5% of the US population were diagnosed with the seemingly common, but serious illness (Cerullo and Strakowski, 2007). A current evaluation revealed only 1% of the population has Bipolar I Disorder (Dell’Osso et al., 2016). This is suggestive of a former overuse and maybe even misunderstanding of Bipolar I Disorder. To continue, this psychological disorder is progressive, multi- systemic, and has recurrent symptoms of manic (highs) and depressive (lows) mood swings, along with rapid cycling of both mania and depression (Dell’Osso et al., 2016). In Quilty et al’s (2008) research by use of psychiatric patients in a clinical setting, the FFM’s association with mania and depression are limited, and the results in every Bipolar I patient was not consistently the same (pg, 160). This lack of consistency makes diagnosis extremely difficult. In addition, Dell’Osso et al’s research (2016) which consisted with a large sample literature review, had revealed that this illness is disabling due to its cognitive impairment and suicide risk (pg. 57). Furthermore, in accordance to Cerullo and Strakowski’s literature review (2007), suicidal behavior is much more common with Bipolar I Disorder patients with comorbid SUD than it is without (pg. 4).

Psychologists had discovered there are two types of SUD diagnosed alongside Bipolar I Disorder. Per Cerullo and Strakowski (2007), there is Primary SUD and Secondary SUD: primary being existent before a diagnosis of Bipolar I, and secondary being diagnosed after the diagnosis of Bipolar I. Alcohol and drug use is very high in Bipolar I Disorder patients. In Khazaal, Gex-Fabrey, Nallet, Weber, Favre, Voide, Zullino, and Aubry’s research in their article “Affective Temperaments of Alcohol and Opiate Addictions” (2013), the prevalence of dual SUDs (in this case, alcohol and opioids) was 61.1% of the test subjects with a median lifetime use of 7.5 years (pg. 432). Khazaal et al conducted a screening amongst SUD out patients in two psychiatric facilities that specialized in treatment of SUD and AUD patients. This was accomplished by use of a self-answered questionnaire called the TEMPS-A, and through that screening they discovered that the distribution of comorbid psychological illnesses differed in each facility (Khazaal et al., 2013).

Next, men have a higher chance of developing Bipolar I Disorder than women do. In the article “Life stress in adolescence predicts early adult reward-related brain function and alcohol dependence” by Casement, Shaw, Sitnick, Musselman and Forbes, men are more than twice as likely to develop dependency than women (Casement et al., 2014) Through Bahorik et al’s findings (2013) bipolar men who used alcohol also exhibited poor functionality in comparison to bipolar women (pg. 1266). Their experiment also had revealed these men were young, unmarried and unemployed (Bahorik et al., 2013). In Bahorik et al’s research, it had revealed that 30 % of the men in their experiment used alcohol within thirty days of treatment. Likewise, Nesva°g et al’s (2016) conclusions state that after a five-year study, bipolar men were higher in the prevalence for SUD than women (pg. 1269). In Khazaal et al’s study (2013), these men were also young, single, and unemployed (pg. 432). However, there are some who are employed and use their mental illness as motivation to do better. For example, in Luciano and Carpenter-Song’s article “A Qualitative Study of Career Exploration Among Young Adult Men With Psychosis and Co-occurring Substance Use Disorder”, finishing school, and finding a better job are resources of self-efficacy and optimism to better themselves and reach a goal (Luciano and Carpenter-Song, 2014). Luciano and Carpenter-Song in their experiment interviewed SUD patients (who were actual clients), and they found that success motivated the subjects to keep pursuing their goal.

This doesn’t mean women can’t develop AUD, and in some cases women can even outrank the men. For example, in Rose, Ti Lee, Selya and Dierker’s (2011) findings, the female spectrum had more AUD tendency than their male counterparts in the experiment (pg. 90). This was due to the hormonal differences between the two sexes (Rose et al., 2011). However, no matter the gender, these two forms of SUD are highly dangerous to the Bipolar I adolescents. In Kia-Keating, Brown, Shulte, and Monreal’s findings in their article “Adolescent Satisfaction with Brief Motivational Enhancement for Alcohol Abuse” alcohol use at a young age leads to further problems in life, including not seeking help activities, such as rehabilitation services and therapy (Kia-Keating et al., 2008). Kia-Keating et al’s experiment consisted of four hundred twenty-three high school students who completed a satisfaction questionnaire in regards to alcohol. There, they discovered youth development into adolescence is often overlooked by traditional programs and therefore seem inapplicable to teen drinkers (Kia-Keating et al., 2008). Also, the adolescent risk factor range from the individual’s characteristics to the social context (Merline et al., 2008). Furthermore, Bipolar patients with opioid use were less likely to continue and follow up treatment (Cerullo and Strakowski, 2007). And adolescents with a greater possible risk of narcotic use were classified as white, female, and older (Edlund et al., 2015). In Edlund et al’s research in their article “Opioid abuse and depression in adolescents: Results from the National Survey on Drug Use and Health”, they discovered that 15.1% of their subjects, both male and female reported to be addicted to narcotics (Edlund et al., 2015) In the end, gender has no effect on addiction, nor psychological illness.

Finally, adolescents who often do seek help for this psychological problem were often met with some difficulty receiving treatment due to the methods of treating SUD and AUD. Often, the comorbidity between Bipolar I, SUD and AUD was often poorly misunderstood due to SUD and AUD being treated as a secondary, and less severe illness (Nesva°g et al., 2015). This led to miscommunication and sometimes even misdiagnosis. However, in recent studies, multi-session therapies paired with cognitive behavioral therapy often helps address the dual mental illnesses (Weiss et al., 2009). Moreover, therapists and psychiatrists are attempting to personalize addiction treatment by gender and by diagnosis (Bahorik et al., 2013). What was once a difficult diagnosis to handle is now easier to see for what it is. In Weiss et al’s (2009) findings, the therapies reduced the use of drugs and alcohol and nearly brought about a year of abstinence from both (pg. 215).

Bipolar I Disorder, SUD and AUD are comorbid in adolescents. Substance Abuse Disorder, and Alcohol Use Disorder occurred in Bipolar I Disorder patients who self-medicated their symptoms. The patients’ prior and post diagnosis of Bipolar I Disorder was a key factor of how prevalent the use was, and it also dictated the time length of use. Men have a higher chance of developing this crippling set of diagnoses, yet women who are affected by Bipolar I Disorder had more of a chance of developing an AUD than their male counterparts. Finally, adolescents who sought help were met with difficulty due to AUD and SUD being treated as a lesser psychological condition in comparison to Bipolar Disorder. However, there have been recent attempts to make this archaic therapy more up-to-date by treating the patient based upon gender and diagnosis. To gain further understanding of Bipolar I Disorder and the comorbidity of Alcohol Use Disorder and Substance Use Disorder in the adolescent brain, more tests need to be run. Furthermore, the need to understand why the adolescent psyche turns to alcohol and/or illicit drugs is a mandatory discovery. The reasons may differ from each case, but if something isn’t done, and soon, more adolescents may attempt, or succeed in committing suicide. That is why every case should be evaluated by the doctor who is knowledgeable about Bipolar I Disorder and if need be, the treatment be tailored to the individual’s needs, both physical and psychological to help them recover. If this isn’t accomplished, they may not find relief or the help they need.

References

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