Treating Bipolar Disorder and Drug or Alcohol Addiction

Co-occurring disorders impact the lives of millions of Americans every year. When an individual has at least one mental health disorder in addition to at least one substance use disorder simultaneously it is known as a co-occurring disorder. Co-occurring disorder is also referred to as dual diagnosis. According to the Substance Abuse and Mental Health Services Administration (SAMHSA)’s 2020 National Survey on Drug Use and Health, 17 million adults in the U.S. were diagnosed with co-occurring disorders; among those, many struggle with bipolar disorder.¹

While co-occurring disorders pose challenges, effective treatment is available that can help you manage the symptoms of bipolar disorder and addiction. Our guide will help you understand co-occurring bipolar and substance use disorders, risk factors, and effective treatment options for those with co-occurring disorders and addiction.

What is Bipolar Disorder?

Bipolar disorder is a mental health condition marked by periods of unusual energy, mood, and activity changes.² The average age of onset of this disorder is 25 years old; however, it can present as early as adolescence or childhood.³ It is estimated that 2.8% of adults in the United States had a diagnosis of bipolar disorder in the past year, and 4.4% of adults will experience symptoms at some point in their lives.²

Bipolar disorder can have a detrimental impact on a person’s day-to-day life.² The changes in mood and energy levels can be drastic and are not “typical” mood changes experienced by someone who doesn’t have this disorder. While the level of impairment is different for everyone, bipolar disorder can impact a person’s day-to-day life in the following ways:⁴

• Difficulty carrying out responsibilities at work, home, or school.
• Changes in behavior.
• Impaired thinking, judgment, and cognitive functioning.
• Changes in sleep patterns (sleeping too much or too little).
• Difficulty maintaining healthy relationships with others.

What Are the Symptoms of Bipolar Disorder?

Bipolar disorder symptoms are generally divided into three types of episodes: depressive, manic, and hypomanic. These symptoms cycle and can vary in severity, occurrence, frequency, and can overlap.⁴

The “lows” of bipolar disorder are referred to as depressive episodes. Symptoms include:⁴

• Forgetfulness.
• Problems with decision-making.
• Feelings of unusual fatigue or low energy.
• Sleep disruptions, including sleeping too much or too little.
• Suicidal ideation.
• Anhedonia, or loss of interest in activities that were once enjoyable.
• Feelings of sadness, worry, worthlessness, guilt, or hopelessness.
• Difficulty focusing or concentrating.
• Changes in appetite, such as eating too much or not eating enough.

The “highs” of bipolar disorder are referred to as manic episodes. Symptoms include:⁴

• Experiencing excessive bursts of energy.
• Feeling a decreased need for sleep; difficulty falling or staying asleep.
• Speaking too fast or too much.
• Engaging in impulsive and risky behavior, such as unsafe sex or excessive spending.
• Feelings of increased agitation, irritation, or aggression.
• Experiencing intense feelings of euphoria and excitement.
• Feeling an exaggerated sense of self-importance or delusions of grandeur.

Episodes of hypomania can resemble manic symptoms but are generally less intense. It is not always apparent to the person when they are experiencing hypomanic symptoms — especially after a depressive episode — but people around them may notice unusual behavior changes.⁴

Co-Occurring Bipolar Disorder and Substance Use Disorder

There is a strong link between mental health and substance use disorders. People with mental health disorders are more likely to develop substance use disorders than those without a mental health concern.⁵ Additionally, research suggests that individuals with bipolar disorder tend to have higher substance use disorder rates than other types of mental health disorders.⁶

It’s important to note that co-occurring disorders are not specific to just bipolar disorder and addiction. Other co-occurring conditions include:

• Depression and substance use.
• Anxiety and addiction.
• Borderline personality disorder and substance use disorder.
• PTSD and substance misuse.
• Attention-deficit hyperactivity disorder (ADHD) and addiction.
• Schizophrenia and addiction.

Symptoms of Substance Use Disorder

Substance use disorders can have a range of symptoms, and some may resemble symptoms of bipolar disorder.¹ The Diagnostic and Statistical Manual of Mental Disorders (5th ed.) outlines specific criteria that healthcare professionals use to diagnose substance use disorders. These include:⁷

• Using substances more often and in larger amounts than intended.
• Using drugs or alcohol in hazardous situations, such as driving or operating heavy machinery.
• Needing increasing amounts of a substance to feel the same effects (tolerance).
• Feeling unpleasant side effects when the use of drugs or alcohol is cut back or stopped (withdrawal).
• Spending a great deal of time getting or using substances.
• Craving drugs or alcohol.
• Continuing to use substances despite harmful consequences to mental and physical health.
• Using drugs or alcohol has caused problems with relationships, work, and other interpersonal areas.
• Giving up hobbies or other activities that were once enjoyed to use substances.
• Neglecting important family, work, or social responsibilities because of substance use.
• Attempting to or expressing a desire to stop using drugs or alcohol but being unable to do so.

Bipolar Disorder & Alcoholism

There is a strong connection between — or alcohol use disorder — and bipolar disorder, but how the two disorders influence one another is unclear.⁸ Research has shown that up to 54% of individuals with bipolar disorder will struggle with alcohol use disorder during their lifetime.⁸

Bipolar Disorder & Drug Use

Like alcohol use disorders, there is a link between bipolar disorder and drug use. Studies have shown a high rate of drug use — particularly cannabis⁸ — among those with bipolar disorder. Up to 32% will have co-occurring drug use disorder and bipolar disorder.⁸

Can Bipolar Disorder Cause Addiction?

Bipolar disorder does not cause addiction, but the two disorders can exacerbate symptoms of each other,⁹ and having bipolar disorder can increase the likelihood of someone developing a substance use disorder (SUD).⁸ Research indicates that the prevalence of co-occurring bipolar disorder and SUD is between 21.7% and 59%.¹

While there isn’t an exact “cause” for co-occurring disorders, there are certain risk factors for each condition. People with bipolar disorder may turn to substances like drugs or alcohol to manage or alleviate the disorder’s symptoms. Additionally, both substance use and bipolar disorders impact how the brain functions, which can influence motivation, impulsivity, behavior, and the feeling of reward.⁴

Risk Factors for Co-Occurring Bipolar Disorder and Addiction

Certain risk factors can contribute to developing a mental health disorder or addiction. Risk factors for substance use disorders can occur at the individual, family, and environmental levels and include:¹⁰

• A family history of addiction, especially among first-degree relatives.
• Prenatal exposure to substances.
• Parental substance use.
• Mental health disorders.
• A history of childhood maltreatment, abuse, or neglect.
• Neighborhood violence and poverty.
• Racism.
• Lack of economic and occupational opportunity.

Risk factors that can increase your risk of developing bipolar disorder include:³

• A family history of bipolar disorder.
• Substance use disorder.
• Stress in the environment, including the death of a loved one, divorce, or a problematic relationship.
• Brain function and structure.

Fortunately, effective treatment is available. Because of the complex nature of co-occurring disorders, treatment approaches that use an integrated approach that addresses substance use and bipolar disorder simultaneously can be particularly effective for managing both.¹¹

How to Treat Co-Occurring Bipolar Disorder and Addiction

If you are struggling with co-occurring bipolar disorder and addiction, help is available to you. At our inpatient addiction treatment near Tampa, FL our experienced and compassionate treatment specialists use effective evidence-based therapies to help people address co-occurring disorders and get on the road to recovery.

We offer many different levels of care to help address all of your unique challenges to support you in meeting your recovery goals. You can or call our trained and compassionate admissions navigators at to receive more information about inpatient rehab and other treatment services available to you. They can also discuss ways to pay for rehab, rehab insurance coverage, and help you start the rehab admissions process.

Addiction doesn’t wait, and neither should you. Contact us today.