Bipolar Disorder is a condition involving emotional highs and lows. The highs, called manic episodes, involve periods lasting a few days or more of unusually cheerful, happy, or irritable mood. The lows, called depressive episodes, involve periods lasting several days or more involving depressed mood or loss of interest, and symptoms such as changes in sleep, appetite, energy level, attention and concentration, self-esteem, and suicidal thoughts or actions.

Bipolar Disorder is considered to be spectrum of disorders ranging in severity. The most severe condition, Bipolar I Disorder, involves having manic symptoms that interfere with work, school, or social functioning. Bipolar I symptoms last at least 1 week, may include psychotic experiences, and may require hospitalization. Bipolar II Disorder is less severe, with manic symptoms lasting 4 days or more and not so severe as to significantly affect work, school, or social functioning. Cyclothymic Disorder occurs when the patient experiences two years of continuous low grade manic and depressive symptoms that are not so severe as to fit Bipolar I or Bipolar II diagnoses.

As many as 60 per cent of patients with Bipolar Disorder also suffer from a Substance Use disorder.  A Substance Use Disorder may also be referred to as substance abuse, substance addiction, drug abuse, drug addiction, or chemical dependency.  Many Bipolar patients turn to drugs in order to “self-medicate” their symptoms of anxiety, depression, mania, or psychosis.  While they may get temporary relief of these symptoms, illegal drugs invariably will may the bipolar symptoms worse and a new set of problems will develop from the addictive drugs themselves.  Bipolar patients may develop addictions to any class of drugs including alcohol, cocaine, amphetamine or methamphetamine, opioids or opiates, hallucinogens, marijuana, inhalants or “huffing,” bath salts, K2 or spice, ecstasy or molly, anabolic steroids, club drugs, and tobacco or nicotine.

At The Arroyos, bipolar disorder is diagnosed by psychologists and psychiatrists through interviews and psychological testing.  When a patient is using drugs and also has manic or depressive symptoms, determining whether their mood symptoms are caused by bipolar disorder, the drug or drugs of abuse, or both, can be very complicated.  A comprehensive evaluation by an expert licensed doctor who is a specialist in bipolar disorder and substance abuse is essential in order to obtain an accurate comprehensive diagnosis and treatment plan.

An individual with bipolar disorder and co-occurring chemical dependency may also have other psychiatric diagnoses such as an anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), trauma-based disorders, or medical conditions such as cardiac illness, thyroid disease, or diabetes. If present, these co-occurring disorders also need to be diagnosed and a comprehensive treatment plan must be created to treat all of the patient’s conditions. Treatment typically consists of non-addictive medications and psychotherapy in an appropriate setting to manage the patient’s symptoms and behavior.

Psychotherapy for Bipolar Disorder and Substance Abuse

Psychotherapy for a patient with bipolar disorder and drug abuse at The Arroyos involves treatments that include psychoeducation addressing the bipolar condition to help the patient and his or her family learn more about bipolar disorder and drug dependence and develop coping skills to manage bipolar symptoms and substance abuse and the effect these have on the family.  At the same time, the patient also needs treatment to understand his or her addiction to substances and help in developing an active sober recovery plan. Our office staff can accommodate the patient’s schedule if he or she is working or managing a household.

The Arroyos offers three types of bipolar-specific psychotherapy that also address substance abuse issues. Interpersonal and Social Rhythm Therapy identifies current interpersonal problems and develops effective coping skills as well as stabilizes and 24 hour circadian rhythms. Cognitive Behavioral Therapy (CBT) for Bipolar Disorder and Substance Abuse identifies dysfunctional patterns of thinking and behavior and helps the patient develop healthy alternatives in order to live a more effective life. Family Focused Therapy, in which the patient and his or her family come in for family therapy, addresses problem-solving skills and improved communication among family members while patients are recovering from a bipolar episode and in early stages of recovery.

Medications for Bipolar Disorder and Substance Abuse

Medications for bipolar disorder are managed at The Arroyos by a board certified staff psychiatrist. Our psychiatrists collaborate closely with the patient’s therapist to provide integrated care. The patient may be given a mood stabilizer, an antidepressant, and sometimes medications for agitation, anxiety, insomnia, or psychosis. Special care must be given to avoid addictive medications for patients who have a drug or alcohol addiction problem.  Some patients also have other co-occurring conditions such as ADHD or ongoing depression, medications for these disorders may conflict with the primary treatment of the bipolar disorder. In such instances the psychiatrist often will stabilize the primary bipolar disorder first, and treat the additional conditions when the bipolar disorder is stable.

Some patients who have a chemical dependency problem may benefit from treatment with medications to ease withdrawal, reduce cravings, or help deter use.  Patients who are withdrawing from opioids such as heroin, OxyContin, and Vicodin may undergo a naltrexone (Suboxone) taper at our offices to help the patient get off of this class of drugs.  Naltrexone (Vivitrol or Revia) is also sometimes used at The Arroyos to reduce cravings for opioids and alcohol in patients who have attained sobriety.  Acamprosate (Campral) is sometimes prescribed to reduce symptoms of withdrawal from alcohol.  Disulfiram (Antabuse) can be used with highly motivated patients to help deter the use of alcohol.

Day Treatment

The Arroyos operates a Day Treatment Program from 9:30 a.m. to 5 p.m. Monday through Friday.  Meals are provided weekdays between 12:45 p.m. to 1:30 p.m.  We offer a less intense Intensive Outpatient Program (IOP) three hours a day, three to five days a week, with flexibility as to which days the patient attends. The Day Treatment Program has patients who are coping with a variety of psychological disorders including depression, bipolar disorder, severe anxiety disorders, and psychotic disorders, sometimes with co-occurring chemical dependency diagnoses.  The program consists of a wide variety of group therapy experiences which can be viewed by clicking here. The Program is coed and patients with a variety of different conditions attend it.

Our Day Treatment Program patients also have individual psychotherapy sessions three times a week with a licensed clinical psychologist who is an expert in treating depression.  Each patient also see a board certified psychiatrist for medication management once a week.

Those patients who are also suffering from co-occurring chemical dependency problems such as alcohol and drug abuse problems find that in many respects the Day Treatment Program operates like a depression rehab center.  The program includes Chemical dependency relapse prevention groups three times a week. Patients with depression who do not need PHP or IOP may attend a single group or choose a few groups to attend at their convenience. If you would like to speak with us about the Day Treatment Program, The Arroyos PHP, or The Arroyos IOP, please contact us by calling (877) 884-8272 for further information.

Transitional Living for Bipolar Disorder and Substance Abuse

Clients may choose to live in Transitional Living facility, a safe and secure private home in a beautiful residential community in Pasadena.  Residents enjoy a private chef, a fully stocked pantry of food items, 24 hour house staff, transportation to 12 step meetings and to The Arroyos office, and staff observation while the patient self-manages his or her medications. Residents are able to bring laptops and telephones, and there are many amenities such as a swimming pool, basketball court, tennis court, two entertainment areas, secluded outdoor smoking area, and a outdoor barbeque grill.  Resident enjoy opportunities to visit the greater Pasadena area with shopping plazas, movie theaters, the Rose Bowl, mountain hiking trails, and more.  Extended stay residents can sign up for classes, volunteer activities, and part-time employment.