Navigating Drug and Alcohol Misuse in Bipolar Disorder Treatment

Join Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, clinical professor at the University of Illinois at Chicago, and Arwen Podesta, MD, ABPN, FASAM, ABIHM, psychiatrist at Podesta Psychiatry LLC, as they delve into the complex relationship between substance use and mental health in this insightful video discussion. Dr Carbray highlights her experiences with teens and young adults facing psychotic breaks possibly triggered by substance use, while Dr Podesta shares her insights from working with adults in addiction treatment, emphasizing the challenges of discerning between substance-induced symptoms and underlying psychiatric disorders. Together, they navigate the intricate interplay between addiction, mood dysregulation, and mental illness, advocating for open dialogue, honest screening, and education to address these overlapping issues without stigma. 

Read the Transcript: 

Psych Congress Network: Can drug or alcohol misuse trigger the development of bipolar disorder and/or a psychotic episode? 

Julie Carbray, PhD: So Arwen, in my practice, I work with mostly teens and young adults, children. And so I see, more often than I'd like to, a first psychotic break or a first incidence of illness after use, typically after cannabis, typically after other substances. And then it's hard to tease out whether that is evoking an illness in an individual or really just a ongoing substance use challenge. And so I was wondering what you thought about that first versus the chicken and the egg and what you think about that first use episode. 

Arwen Podesta, MD:  So frequently when I'm working with the adults that are seeking addiction treatment, and maybe that I can tell you at one place that was very high volume, long-term residential program that I worked for many, many years, more than not the patient would identify as having bipolar schizophrenia, right? But then you look at all the meds they're on and then we make abstinence key, and they didn't really have the disease. But we had to do that chronology to really understand. And this was very much crack cocaine, methamphetamines. Meth is terrible for triggering psychosis in those maybe without the genetic predilection of the disease of bipolar or schizophrenia. So we have these really deep complicated tasks ahead of us, you in the child and teen realm, and then me in the adult addiction treatment realm. And so we have to kind of marry those, that collaboration. 

Dr Carbray: I too have had this situation where it's a young individual abusing something, and I'm thinking of a case where it was even caffeine tablets. And it appeared as if he was having hypomanic episodes. But instead, as we discovered after a lot of digging and some work on behalf of the family, this wasn't really a hypomanic episode. This was really substance misuse. And so that's a milder case in being caffeine, but certainly amphetamine, methylphenidate, we see cocaine as being those types of drugs that really might be sought for depressive episodes or for managing illness too, as is other drugs to sort of calm down mania. There might be an intention around managing illness with substances, or there might be a presentation that looks like mania or looks like depression, but might be substance induced. I see that with alcohol quite a bit. 

Dr Podesta:  Absolutely. And also alcohol withdrawal. That can look like mania, that can look like anxiety. So there's so much overlap. And so clinicians everywhere being able to screen, to talk about it openly and honestly without stigma, I think, is key. 

Dr Carbray: And educating too. I think we probably do a lot of that educating around what using that substance might do across time with their mood dysregulation. Because I think when you're feeling good, you have that immediate effect, but then there's a prolonged effect with many substances of choice. 

Dr Podesta: Correct. 

Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, is a clinical professor of psychiatry and nursing at the University of Illinois at Chicago. Dr Carbray holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago, and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana. 

Arwen Podesta, MD, ABPN, FASAM, ABIHM, is a board-certified adult psychiatrist with sub-specializations in addiction medicine, forensic psychiatry, and integrative medicine. A graduate of the University of Southern California Keck School of Medicine, Dr Podesta completed her psychiatry residency in at Louisiana State University before pursuing a fellowship in forensic psychiatry at Tulane University.