Co-Occurring Bipolar Disorder & Drug or Alcohol Addiction

For many people battling addiction, a substance use disorder might not be the only mental health issue they face each day.

Bipolar disorder is one such mental health issue that commonly co-occurs with addiction.

Read on to learn more about bipolar disorder, its link to addiction, and how to get help if you or someone you love has been diagnosed with co-occurring bipolar and substance use disorders.

What Is Bipolar Disorder?

Bipolar disorder is a serious mental health condition characterized by abnormal changes in moods, as well as fluctuating levels of concentration, activity, and energy.¹

While many people experience routine ups and downs in their moods, the shifts experienced by individuals with bipolar disorder are much more severe and debilitating, impacting their daily lives and relationships.¹

Bipolar disorder affects an estimated 40 million people worldwide.² Each year in the U.S., roughly 2.8% of adults age 18 and up and 2.9% of adolescents age 13–18 struggle with the condition.³

Among American adults, past year prevalence rates are highest (at 4.7% of the population) in people between the ages of 18 and 29.³

Signs and Symptoms of Bipolar Disorder

With certain types of bipolar disorder, a person’s mood can change wildly and unexpectedly from extreme highs (manic episodes) to extreme lows (depressive episodes).¹

The mood episodes associated with bipolar disorder may be accompanied by periods of intense emotion, unusual behaviors, and changes in patterns of sleep and activity levels that can affect a person’s ability to function.

Here are some common signs and symptoms of bipolar disorder and its associated episodes of mania and depression:¹

More rarely, in severe manic episodes, people may experience mood congruent psychotic features, such as delusions or unrealistic beliefs that they are powerful or famous.¹

Additionally, some people experience psychotic symptoms during a depressive episode, which may include negatively themed false beliefs such as that of being financially destitute or suffering from an undiagnosed illness.¹

When symptoms of mania are present but less severe, clinicians refer to this as “hypomania.”¹

In some cases, a person with bipolar disorder may also experience symptoms of mania and depression at the same time, which is referred to as an episode of mixed features.¹

Types of Bipolar Disorder

There are three types of bipolar disorder:¹

• Bipolar I disorder is characterized by episodes of mania lasting at least 7 days, or with symptoms so severe a person needs immediate hospital care. Depressive episodes may also develop in people with bipolar I, often lasting for at least 2 weeks. Mixed features of simultaneous depressive and manic symptoms may also occur.
• Bipolar II disorder is defined by a pattern of alternating episodes of depression and hypomania, in the absence of full-blown manic episodes characteristic of bipolar I.
• Cyclothymic disorder is characterized by periods of hypomania and periods of depression lasting for at least 2 years, with symptoms that don’t otherwise meet the diagnostic requirements for depressive or hypomanic episodes.

Bipolar Disorder and Co-Occurring Disorders

While bipolar disorder may include a range of characteristic symptoms, some of these symptoms share similarities with other mental health conditions, such as depressive disorders or schizophrenia. This can sometimes lead to a misdiagnosis.^1,4

Additionally, bipolar disorder often occurs with other mental illnesses. Past research estimates that as many as 65%–95% of people with bipolar disorder have at least one other co-existing mental health condition.⁵

When substance use disorders and mental illness are present in the same individual at the same time, they are referred to as “co-occurring disorders,” or sometimes called a “dual diagnosis.”^6,7

Co-Occurring Bipolar and Substance Use Disorder

Bipolar disorder frequently co-occurs with substance use disorders.

An estimated 65% of individuals with bipolar I disorder also experience substance use disorder at some point in their lives. More than half of those with bipolar I (54%) may develop an alcohol use disorder and close to a third (32%) develop some form of  drug use disorder in their lifetime.^4,8

Co-occurring bipolar and substance use disorders is associated with poorer treatment outcomes, more severe symptoms in both conditions, and higher risks of suicide.⁸

How Does Bipolar Disorder Impact Substance Abuse?

The connection between bipolar disorder and substance is complex, and researchers are still trying to better understand the ways these two conditions impact each other.⁸

While bipolar disorder may not necessarily “cause” addiction to drugs or alcohol, and likewise, addiction does not cause bipolar disorder, these two conditions have a bidirectional relationship. This means the presence of one disorder may influence or worsen of the other.

As one possible explanation for the high prevalence of SUD and mental health co-occurrences, studies point to shared risk factors between substance use and mental health issues such as bipolar disorder.

These risk factors include:⁹

• Genetic vulnerabilities and epigenetic influences
• Similarly involved brain regions and neurochemical systems
• Environmental factors
• Early exposure to trauma or other stressors
• Chronic stress

Another theoretical explanation for the connection between these conditions is that people with mental health issues like bipolar disorder may begin drinking or using drugs to relieve some of its associated symptoms.

This is sometimes called “self-medicating” or “self-medication.”⁹ In this manner, bipolar disorder could contribute to problematic substance use and, eventually, addiction.⁹

Alcohol and drugs often worsen a person’s health and should not be equated with medications, which improve a person’s health.

Although drugs and alcohol may temporarily mask certain symptoms of bipolar disorder, continued substance use can become a maladaptive coping mechanism and lead to a substance use disorder.⁹

Finding Treatment for Co-Occurring Addiction and Bipolar Disorder

The presence of co-occurring disorders, such as addiction and bipolar disorder, can make the diagnosis and treatment process even more complex. Medical professionals generally recommend that patients showing signs of one condition also be assessed for the other.¹⁰

Integrated treatment approaches where both substance use disorder and bipolar disorder are addressed simultaneously have proven to be more effective than standalone treatments that address the conditions separately.¹¹

In an integrated approach, a patient’s doctors, counselors, case managers, and community service providers work together as a team to create a consistent treatment plan and achieve the same goals^.11

Treatment plans may include a combination of evidence-based therapies such as:¹¹

• 12-Step facilitation.
• Treatment medications (as needed).

Behavioral therapy is the foundation of treatment for co-occurring disorders and a key component of sustained recovery.¹¹ A recent study found that the use of CBT and relapse prevention techniques may help reduce hospitalizations and improve certain treatment outcomes, including abstinence, medication adherence, and mood symptoms.^5,8

At Laguna Treatment Center, we specialize in the treatment of co-occurring disorders. Our Orange County rehab facility tailors treatment plans to meet the individual needs of each patient.

For more information on the different types of addiction treatment we offer, or to learn more about how to pay for rehab or using insurance to pay for rehab, contact us at today.

Our admissions navigators are available 24/7 to answer your questions and help start the admissions process.

Co-occurring conditions like bipolar and substance use disorders can be overwhelming—but they are treatable. If you or someone you love is suffering from addiction alongside another mental illness, we can help you begin the path to recovery.