Clinicians need greater understanding of bipolar disorder

The relative likelihood of a co-occurrence of bipolar disorder with a substance use disorder needs to be on addiction professionals' radar, says a Colorado marriage and family therapist who is a national speaker on bipolar disorder.

The only behavioral health disorder that outpaces bipolar disorder on co-existence with substance use disorders is antisocial personality disorder, says Michael Pipich, LMFT. Unfortunately, bipolar disorder largely remains a misdiagnosed and mistreated issue, Pipich tells Addiction Professional.

“The average time between a first-time bipolar mood event and treatment for bipolar disorder is about 10 years,” says Pipich, whose new book Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder (Citadel Press) will be out in September.

Pipich urges addiction professionals and facilities to look deeper into bipolar disorder, improving assessment and considering the illness as a lifelong issue—similar to how they see addiction.

Progression varies

For patients with bipolar disorder and a substance use disorder, there is no single pattern for how the illnesses unfold in patients' history. Pipich does say, however, that “typically, the bipolar disorder tends to drive the substance use pattern across a lifetime.”

Misdiagnosis can lead to years of suffering for patients. Pipich says that up to two-thirds of individuals with bipolar disorder are misdiagnosed, with depression alone being the most common diagnosis in these cases. Research has shown that as many as one-quarter of suicides may be attributable to bipolar disorder.

Pipich advises that once a substance use treatment patient achieves a stable level of sobriety, programs should look for the emergence of symptoms that could indicate bipolar disorder (these are often mistaken for manifestations of withdrawal). He adds that an in-depth family history is important as part of assessment, given that the illness tends to run in families.

Pipich's new book is geared toward patients and family members, but also includes information relevant to treating professionals, he says.