Bipolar Disorder and Addiction Treatment

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 Bipolar Disorder Cause Addiction and Vice Versa?

Research shows a complex relationship between bipolar disorder and substance use disorders, with each condition potentially influencing the development and severity of the other.[1] People living with bipolar disorder may turn to substances as a form of self-medication, attempting to manage their mood episodes. This pattern often leads to increased instability and worsening symptoms over time.

The shared biological and environmental risk factors between these conditions can create a cyclical effect.[2] Genetic predisposition, trauma history, and neurological changes can make someone more vulnerable to both conditions. Substance use affects the same brain circuits involved in mood regulation, potentially triggering or intensifying manic and depressive episodes. Similarly, impulsivity and poor judgment during manic phases can lead to increased substance use.

How Bipolar Disorders Lead to Dual Diagnosis

Bipolar disorder is a mental illness that causes sudden and dramatic shifts in a person’s mood.[3] 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.[4]

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 Bipolar Disorder and Substance Abuse

The signs and symptoms of bipolar disorder and substance use disorders can overlap and intensify each other, making diagnosis challenging. Mental health specialists look for distinct patterns and combinations of symptoms to determine appropriate treatment approaches. Someone experiencing both conditions might show unique presentations of each disorder, while some symptoms may appear magnified due to the interaction between the two conditions.[5]

Bipolar Disorder Symptoms

• Manic episodes are marked by excessive energy that can last for extended periods, often accompanied by reduced need for sleep and racing thoughts.
• Risky behaviors and poor judgment that occur during manic phases, including excessive spending and dangerous activities.
• Deep depressive periods are characterized by hopelessness, isolation, and difficulty managing daily tasks.
• Rapid mood swings can shift dramatically within short time periods, creating instability in relationships and work life.

Substance Use Disorder Signs

• Changes in physical appearance including unexpected weight changes, bloodshot eyes, and poor hygiene maintenance.
• Financial difficulties stemming from spending increasing amounts of money on substances.
• Withdrawal from previously enjoyed activities and isolation from family members and friends.
• Increased tolerance requires larger amounts of substances to achieve the same effects.

Symptoms of Both Conditions

• Intensified mood episodes that become more severe or frequent with substance use.
• Increased suicidal thoughts may become more prevalent when both conditions are present.
• Memory problems and confusion worsen during active substance use periods.
• Sleep disturbances that extend beyond typical patterns are seen in either condition alone.

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:[6]

• 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.[7]

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 medications or supplemental support.[8] 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.[9, 10, 11]]
• 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

Additional Treatment Modalities For Bipolar Disorder and Addiction

Several treatment modalities work together to create a comprehensive approach for managing co-occurring bipolar disorder and substance use disorders. Each method targets specific aspects of recovery, helping people develop coping skills, process trauma, and build support networks for active, long-lasting healing.

• Holistic treatment: Mind-body wellness practices including meditation, yoga, nutrition counseling, and stress management techniques that support overall recovery and emotional balance.
• Relapse prevention: Structured planning and skill development focusing on identifying triggers, creating coping strategies, and building a strong support network to maintain long-term sobriety.
• Family program: Comprehensive support and education helping loved ones understand both conditions while improving communication patterns and establishing healthy boundaries.
• Eye Movement Desensitization and Reprocessing (EMDR) therapy: EMDR therapy for bipolar focuses on specialized trauma treatment addressing underlying experiences that may contribute to both bipolar disorder and substance use through guided processing techniques.
• Cognitive-Behavioral Therapy (CBT): Evidence-based therapeutic approach helping identify and modify problematic thought patterns and behaviors associated with both conditions.
• Dialectical Behavior Therapy (DBT): DBT for bipolar provides skills-based intervention teaching mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness for managing symptoms.
• Group therapy: Group therapy for bipolar offers structured peer support sessions providing shared learning experiences, accountability, and understanding from others facing similar challenges.
• 12-Step program: Community-based recovery framework offering spiritual principles, peer support, and structured steps toward maintaining sobriety and emotional stability.
• Motivational Interviewing: Collaborative counseling method enhancing internal motivation for change while exploring and resolving ambivalence about recovery.

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.

Frequently Asked Questions About Bipolar Disorders and Addiction