Q:  Cocaine & Bipolar

i am a union representative and am handling a case for a union member who was fired for testing postive for cocaine.  after going for treatment for the cocaine, the member was diagnosed as having bipolar disorder.  it has been suggested to me by the member, who was told by his doctor, that the cocaine usage may have been a form of self medication for the at that time undiagnosed bipolar disorder.  this would make the cocaine usage, while perhaps not excusable, still disease related.  does the literature support this?  is this usage of cocaine because of the disease something that is common?  why would a person use cocaine to "self medicate"?  how does the use of cocaine relate to the disease?  thank you.
 

Dear Mr. H' -- 
Fair question.  There might be a legal precedent some attorney could dig up.  To try to answer your question from a medical point of view, as opposed to legal (obviously I'm not the guy for that part):  about 50% of people with bipolar disorder use some sort of psychoactive substance like alcohol or cocaine or marijuana, etc -- so, yes, it's common.  Why cocaine to self-medicate?  Usually people think that folks with bipolar disorder would use "uppers" like cocaine to treat their depressive phases, but it's actually slightly more common to use cocaine in the manic phase, I'm told; the explanation I've heard is that the manic phase includes poor judgment and feels pretty good to start with, so people want to push it "even higher".  I'm not so sure about that as an explanation, myself.  And as to how it relates to the disease:  most substance use, certainly cocaine and alcohol, can really make the mood cycling worse.  We routinely counsel folks to get substance-free as part of the treatment for bipolar disorder.  

Dr. Phelps