This also emphasizes why we will always need a therapeutic relationship that is safe to share in the experience. I know the highs are happening, yet, I am unable to regulate it. I know when the crashes are about to occur, and this is the time during which I am more likely to self-injure. Self-injury may not be directly related to the episode but to your experience of your relationships around you. Please explore this in therapy.
Substance abuse is the number one dual diagnosis with bipolar disorder.
This happens because people do not even realize they are bipolar, or they want to ease the depression that follows manic episodes. Or again, in the case of methamphetamines, they self-medicate in an attempt to recapture the power of the manic episode. So, chemical dependency can then become it's own problem and addiction, reformatting the brain to experience pleasure through neuropathways that are only artificially induced via chemicals. A third problem is, that medications for bipolar and chemical dependency cannot co-exist at the same time, so we can subconsciously maintain the addiction to use against any medication. Finally, the way that the mental health care system is constituted is, there is more powerful political influence involved in treating substance abuse, rather than identifying bipolar disorder, but both must be treated at the same time.