A dual diagnosis of bipolar disorders and addiction can lead to troubling health risks if left untreated. Individuals with these conditions require mental health treatment to heal and recover.

Bipolar disorder and addiction treatment are separate but work together to help individuals recover in the safest way possible. However, to understand how, you must know why one condition contributes to the other.

On this page, you’ll learn what a dual diagnosis is, how addiction and bipolar disorder accompany one another, how to identify them, and how they’re treated.

Does One Disorder Cause the Other?

Yes, bipolar disorders can lead to a substance use disorder, in turn creating a dual diagnosis.

Dual diagnosis—also called a comorbidity or co-occurring disorder—is the presence of a mental illness alongside an addiction or a substance use disorder (SUD). Some individuals develop mental health conditions as a result of abusing substances like opioids or alcohol, and others begin with a mental illness that raises the risk of developing an addiction. According to the Substance Abuse and Mental Health Services Association (SAMHSA), more than one in four adults live with dual diagnoses.

How Bipolar Disorders Lead to Dual Diagnosis

Bipolar disorder is a mental illness that causes sudden and dramatic shifts in a person’s mood. These shifts are called poles. People with bipolar disorder may appear happy and energetic in one moment and then depressed with no energy in another. What causes the disorder isn’t entirely clear, but research has uncovered a link to genetics, trauma, and brain dysfunctions.

Bipolar mood swings range in severity and may be severe enough to interfere with a person’s daily life. Individuals with bipolar disorder are also more likely to suffer from other mental health issues like anxiety, attention-deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD).

Without treatment, this condition and any other co-occurring mental illnesses worsen, leading a person to develop unhealthy coping mechanisms. This can include binge drinking or abusing drugs.

Each time alcohol or drugs enter the system, the brain is flooded with feel-good hormones that override the negative symptoms of bipolar disorder. With repeated use, the brain adapts to feeling good under the influence and quickly snaps into a negative state when the substance isn’t detected. This causes a person to feel uncomfortable withdrawal symptoms and cravings, motivating them to use more. This is the start of a substance use disorder, and unless it is treated, it can progress to an addiction.

Signs and Symptoms of a Dual Diagnosis

The signs of a dual diagnosis include the outward manifestations and behavioral changes related to bipolar disorder and an addiction. The symptoms include the physical and health effects.

They are separated into two categories below.

Signs of a Dual Diagnosis

The following are signs of a dual diagnosis:

• Isolating oneself from loved ones
• Unexplained behavioral changes
• Needing more money than usual
• Negative changes in physical appearance
• Taking part in risky activities like driving under the influence
• Having an angry outburst when someone mentions addiction
• Worsening hygiene habits
• Appearing confused or overwhelmed more often than not
• Avoiding social activities
• Preoccupation with using drugs or drinking
• Appearing under the influence more often than not
• Using substances despite the negative consequences
• Acting impulsively
• Changes in speech (speaking too fast or too slowly)
• Appearing jumpy or on high alert
• Inability to control substance use
• Appearing “zoned out”

Symptoms of a Dual Diagnosis

The following are symptoms of a dual diagnosis:

• Changes in energy (highs or lows)
• Difficulty concentrating
• Forgetting easily
• Changes in sleeping habits
• Negative intrusive thoughts
• Feeling indecisive, restless, or invincible
• Changes in appetite
• Hyperarousal
• Dilated pupils
• Bloodshot eyes
• Bad breath
• Weight loss or gain
• Slurred or fast speech

Individuals with addiction will experience withdrawal symptoms when attempting to abstain from substance use. These symptoms differ depending on the substance but often include:

• Anxiety
• Nervousness
• Insomnia
• Muscle pain
• Sweating
• Diarrhea
• Cold or flu symptoms
• Joint pain

How Are Co-Occurring Bipolar Disorders and Addiction Diagnosed?

The presence of physical withdrawal is one clue that a person has an addiction, but it isn’t the only determining factor. To be diagnosed with an addiction, a clinician will ask several questions related to substance use and then use one of the following assessment tools to complete the diagnosis:

• Addiction Severity Index (ASI)
• Psychiatric Research Interview for Substance and Mental Disorders (PRISM)
• Alcohol Use Disorder Identification Test
• Drug Use Disorder Identification Test
• Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA)
• Structured Clinical Interview for DSM-IV (SCID)
• Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS)
• Composite International Diagnostic Interview (CIDI)
• Screening to Brief Intervention (S2BI)
• Brief Screener for Alcohol, Tobacco, and Other Drugs (BSTAD)
• Tobacco, Alcohol, Prescription Medication and Other Substance Use (TAPS)
• Opioid Risk Tool – OUD (ORT-OUD Chart)

These diagnostic tools are backed by years of research and offer the most reliable diagnosis for addiction.

Diagnosing Bipolar Disorder

Only a psychiatrist can diagnose bipolar disorder. They may use a variety of tools to assess whether a person has bipolar disorder or another mental health issue.

These tools include:

• Structured Clinical Interview for DSM-IV (SCID)
• Schedule for Affective Disorders and Schizophrenia (SADS)
• Self-reported symptoms during an interview

Treatment for Co-Occurring Addiction and Bipolar Disorder

There isn’t a one-size-fits-all approach to treating dual diagnosis. Bipolar disorder and addiction require very different treatments and must be treated simultaneously for a successful outcome.

The treatment for bipolar disorder often includes the following:

• Prescription medications: These include mood stabilizers, antidepressants, or antipsychotics to control the symptoms of bipolar disorder. The most widely prescribed drugs from these classes include:
• Lithium
• Depakote
• Equetro
• Tegretol
• Lamictal
• Topamax
• Neurontin
• Trileptal
• Abilify
• Therapy: One-on-one therapy teaches the patient about bipolar disorder, its warning signs, and coping skills.

Addiction treatment involves a combination of the following:

• Detox: Addiction cannot be treated until a person abstains from using the addictive substance. This is called abstinence. As the substance leaves the system – detox – the person begins to experience symptoms of withdrawal like intense cravings, fluctuations in their vitals, and, at times, physical pain. For these reasons, anyone with an addiction is recommended to detox in an inpatient rehab under medical supervision. Detox could last from a few days to a few weeks.
• Medication-Assisted Treatment: To lighten the symptoms of withdrawal, control pain, and stabilize the vitals, individuals in detox might need prescription medicationsor supplemental support. These include:
• IV fluids
• Buprenorphine
• Naltrexone
• Acamprosate
• Disulfiram
• Methadone (only in licensed facilities)
• Behavioral Therapy: Behavioral therapies help individuals with dual diagnoses discover problematic thinking patterns, challenge them, and replace them with helpful thoughts. It also provides them with life skills, coping strategies, and a better sense of self-awareness. Common behavioral therapies include cognitive behavioral therapy, dialectical behavior therapy, and eye-movement desensitization and reprocessing(EMDR) therapy.
• Peer Support: Peer support comes from a group of individuals who have recovered from addiction or mental illness. They share lived experiences, act as role models, motivate each other to stay the course, and provide helpful paths to recovery. Examples of peer support groups include Alcoholics Anonymous and Narcotics Anonymous. Although peer support groups can be attended in an outpatient setting, some are offered as part of an inpatient program.

Other treatments can include:

• Mindfulness meditation
• Yoga
• Nature therapy
• Adventure therapy

Benefits of Dual Diagnosis Treatment

Anyone in a dual diagnosis program can expect to feel better during and after treatment.

Some of the benefits one can attribute to this include:

• Greater sense of awareness
• Renewed vigor
• Reduction in risk-taking
• Reduced substance usage
• Improved relationships with family and friends
• Reduced overdose risk
• Renewed sense of hope
• Improved quality of life
• Improved mental health
• Reduced substance-related hospital visits

Discover a Dual Diagnosis Treatment Program at Engage Wellness Acton

Receiving a dual diagnosis can be scary. You may feel alone, misunderstood, or even fearful about the future. But it’s important to know that with the right mental health treatment, you can recover and begin to feel better.

To start your path to recovery, seek assistance from a licensed mental health professional for bipolar disorder and addiction treatment. Together, you can set treatment goals and find the appropriate programs to help you achieve them.

Are you ready to break free from the grips of mental illness and addiction? We’re ready to help. Contact Engage Wellness Acton today.