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Heroin Addiction and Related Clinical Problems: 2013, 15, 4 (pages: 25 - 32)

Do bipolar patients use street opioids to stabilize mood?

Maremmani A.G.I., Bacciardi S., Rovai L., Rugani F., Akiskal H.S., Maremmani I.

Summary: Introduction: The link between heroin addiction and bipolar disorder is generally accepted, both at the level of full-blown pathology and at the affective, temperamental level. Nevertheless, the nature of this relationship is still far from being elucidated. Aim: to verify whether the use of heroin in bipolar patients could lead to a faster progression of the illness or whether bipolar 1 drug addicts who use heroin are actually looking for the mood-stabilizing properties of the opiates. Method: we compared the clinical characteristics and the natural history of heroin addiction between bipolar 1 and non-dually diagnosed heroin-dependent patients at their first agonist opioid treatment; in fact, our starting point was that bipolar 1 heroin-dependent patients would show a more severe psychopathological condition and a shorter, less severe drug addiction history at treatment entry. This hypothesis would, if borne out, support a ‘self-medication' approach to heroin use in bipolar 1 heroin-dependent patients. Result: bipolar 1 heroin addicts showed faster progression of their illness, and a worse clinical presentation, both on the psychopathological and on the addictive plane. Conclusions: Even if the unprovable initial beneficial effect exerted by the substance on the emotional instability of bipolar patients were present to some degree, it would soon be followed by a mood-destabilizing action, which would then accelerate the course of the illness.