When someone with bipolar disorder also has a problem with alcohol or drugs, it is usually referred to as "dual diagnosis."   It isn't known yet whether people abuse alcohol or drugs as a result of their bipolar disorder, or have symptoms of bipolar disorder as a result of their substance abuse.  What is known, however, is that someone with a dual diagnosis needs help for both problems.


Because bipolar disorder is commonly diagnosed in the late teens and early twenties, it is not surprising that experimentation of alcohol and drugs might also begin at the same time.  It might also be argued that if symptoms of bipolar disorder have already appeared, the use of alcohol and drugs might be used to mask those symptoms in someone who has yet to be diagnosed.


Substance abuse can greatly complicate the treatment of bipolar disorder, since the most success for control or management of bipolar symptoms is with the use of medication.  Both drugs and alcohol, mixed with bipolar medication, can be very dangerous for someone with the disorder.  It can even be fatal.


On the other hand, most psychiatrists and therapists believe that unless you treat the bipolar disorder, treatment for the substance abuse problem will not be successful, either, and therein lies the dilemma.


Conventionally, the person with dual diagnosis had to be clean and sober before any treatment could be started for their bipolar disorder.  However, by using this approach, the cause for their abuse problem is never addressed, and the relapse rate is high.


Using a therapeutic approach, though, can treat both the bipolar disorder and the substance abuse problem, as long as the person stays clean and sober.


Any way you look at it, treating someone with dual diagnosis is a very difficult problem.


Through careful monitoring of medication and the right combination of psychiatric and therapeutic treatment approaches, there is a greater chance of recovery for the dually diagnosed person.