Co-Occurring Bipolar Disorder & Substance Use Disorder

Many people that have bipolar disorder struggle with substance use and addiction. Fortunately, these conditions are both treatable.¹

This page will explore what bipolar disorder is, how it may co-occur with substance use disorders (SUDs), the risk factors for developing these conditions, and how these disorders can be treated in an integrated way that treats both conditions concurrently.

What Is Bipolar Disorder?

Bipolar disorder is a chronic mental disorder in which a person will have abrupt and stressful changes in mood that can affect their ability to concentrate, energy levels, and overall functioning. People with bipolar disorder typically experience manic or hypomanic episodes as well as depressive episodes. These moods significantly impact a person’s functioning and his or her ability to live a normal daily life.²

What Are The Different Types of Bipolar Disorder?

There are 2 main categories of bipolar disorder: bipolar I and bipolar II. When a person has bipolar I disorder, they suffer severe or long-lasting episodes of mania (7 days or longer), followed by depressive episodes lasting at least 2 weeks. It is also possible to have mixed episodes where mania and depression occur at the same time.²

Bipolar II disorder is marked by milder manic symptoms than bipolar I disorder. Rather than a full-blown manic episode, which can lead to hospitalization following psychosis, someone with bipolar II suffers less debilitating or shorter-lasting (4 days or shorter) episodes of hypomania. Sometimes a person with bipolar II may function well enough during a hypomanic episode to keep going to work or school.^2,3 However, this does not mean bipolar II is less severe than bipolar I; depressive episodes caused by bipolar II can be extreme and debilitating.¹

Symptoms of Bipolar Disorder

There are numerous symptoms that may indicate bipolar disorder. It is important to note that while you may recognize some of these symptoms in yourself or your loved one, only a mental health professional can diagnose someone with bipolar disorder.

When a person with bipolar disorder goes through mood cycles, the moods will present as either manic, hypomanic, or depressive. Some of the symptoms of the manic or hypomanic phase of bipolar disorder include:^2,3

• High levels of excitement, euphoria, and energy, as well as possibly showing signs of agitation and irritability.
• Excessively spending money, or engaging in promiscuous or risky sexual behaviors, when a person doesn’t normally do these things.
• Sleeping less than 3 hours at night.
• Having delusions, including having a special relationship with famous people, or having exceptional abilities or powers.

Moods can cycle from manic phases to depression, in which the person will oftentimes:²

• Feel sad, down, or hopeless.
• Have trouble sleeping or sleep too long or too often.
• Gain weight due to raised appetite.
• Speak very slowly or not speak much at all.
• Lose interest in most activities.

Co-Occurring Bipolar Disorder and Addiction

People with bipolar disorder are more likely to develop a co-occurring substance use disorder than people without bipolar disorder or people with other types of mental health diagnoses. As many as 30%–50% of people with bipolar disorder will suffer from a co-occurring SUD.¹

When one or more conditions occur in the same person—either simultaneously or at different periods in their lives—it is known as having a co-occurring disorder or a dual diagnosis.⁴

Signs of Co-Occurring Bipolar Disorder and Drug or Alcohol Addiction

The diagnostic criteria for bipolar I or bipolar II disorder provided in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) include separate criteria for manic, hypomanic, and depressive episodes. Criteria for diagnosing hypomanic or manic episodes include having at least 3 of the following 7 symptoms lasting most of the day for each day in the episode:³

• Excessive self-confidence.
• A markedly decreased need for sleep.
• Being very talkative.
• Racing thoughts.
• Being highly distractable.
• A marked increase in goal-related activity or restless behavior.
• Engaging in high-risk activities, such as sexual recklessness out or excessive spending.

The difference between a hypomanic episode (characteristic of bipolar II disorder) and a manic episode (characteristic of bipolar I disorder) is the duration or severity of the episode. If the episode has psychotic features (i.e., severe enough to result in hospitalization or significantly impairs the patient’s ability to function) or lasts 7 days or longer, this means it is a manic episode, indicating bipolar I disorder.³

Depressive episodes are characterized by a minimum of 5 of the following criteria experienced within a 2-week period:³

• Low mood most of the day, almost every day. This may be self-reported or observed by others.
• Decreased interest in activities or the pleasure derived from these activities most of the day almost all days.
• Significant weight gain or loss (not attributable to a diet).
• Trouble sleeping or oversleeping almost every day.
• Difficulty thinking or concentrating.
• Feeling fatigued almost every day.
• Repeated thoughts of death or suicide, either with or without a plan.
• Feeling useless or guilty most or all the time.
• Agitated or reduced movements, which are observable by others.

To result in a diagnosis of bipolar disorder, the symptoms of a depressive, manic, or hypomanic episodes must not be better explained by substance use or another condition like psychosis or schizophrenia.³

There are also 11 separate diagnostic criteria for substance use disorders, of which a person must meet at least 2 within a 12-month period, which are also outlined in the DSM-5. These include:³

• Using substances in unsafe situations (e.g., while driving).
• Spending considerable time and money using substances, seeking substances, or recovering from their effects.
• Skipping important work or familial obligations to use substances.
• Continuing to use substances despite the knowledge that substance use has caused or worsened psychological problems (such as bipolar disorder).
• Additional criteria that are listed in this addiction guide.

Risk Factors for Co-Occurring Bipolar Disorder and Addiction

There is no single cause or risk factor for addiction or other mental health disorders like bipolar disorder. However, these conditions share common risk factors, affect similar areas of the brain, and research shows that the development, course, and treatment of one condition can influence the development, course, and treatment of the other. Common risk factors for both bipolar disorder and addiction include:⁵

• Using substances at a young age. Drug or alcohol use during adolescence can increase the risk of both substance use disorders and other mental health problems such as bipolar disorder.
• Family history and Genetic vulnerabilities can play a strong role in the development of both these disorders.
• High-stress environments, trauma, and other adverse experiences may increase the risk of both types of disorders.

Over time, chronic use of drugs or alcohol may change the brain, making someone more vulnerable to developing mental health disorders. Conversely, someone may develop a substance use disorder after using drugs or alcohol in an attempt to relieve the symptoms of their bipolar disorder.⁵

How to Help Someone with Bipolar Disorder and Addiction

Helping a loved one with addiction is never easy. Nor is it easy to persuade people to get help for a mental health disorder. However, there are some methods you can try, such as:⁶

• Finding incentives to get them to speak to a doctor or other professional, as oftentimes people will listen to a professional rather than a family member.
• Helping them find a treatment center if they ask for help.
• Researching treatment centers even if they aren’t yet interested in treatment.

While looking for treatment, there are several questions you may want to ask to assess whether an addiction treatment center is equipped to provide the best possible care for your loved one. Consider asking:⁷

• Does the program use evidence-based treatment practices? These include behavioral therapies, medication, psychoeducation, and more. Holistic treatment practices may be helpful as well, but there is limited research on their efficacy and they should be utilized in conjunction with approaches more firmly grounded on scientific research.
• Is the treatment tailored to the individual and not just a “one size fits all” approach? For example, some treatment centers may not be equipped to help someone with a co-occurring condition such as bipolar disorder.
• Does the treatment approach change as the person’s needs change? Effective treatment centers continuously assess patients throughout the treatment process, making adjustments to the plan as needed.
• Does the program incorporate the principles of mutual or peer support and 12-step programs? These group-based models can be an effective component of ongoing recovery.

Co-Occurring Disorder Treatment for Bipolar Disorder & Substance Abuse

An integrated treatment approach where both disorders are treated at the same time is the standard of care when a person has co-occurring bipolar disorder and a substance use disorder. Generally, studies show that a comprehensive, integrated approach to treatment is superior to treating each disorder separately.⁸

Treating co-occurring bipolar and substance use disorders usually involves a combination of various types of behavioral therapy and medication, such as lithium or another mood-stabilizing medication. Some of the behavioral therapy for treating addiction and bipolar disorder include the following:^1,5

• Cognitive-behavioral therapy (CBT). CBT is a behavioral therapy approach that helps people learn to change their thought and behavioral patterns, reducing their emotional responses to situations that may cause them distress.
• Integrated group therapy (IGT). Developed specifically to address bipolar disorder and substance use disorder simultaneously, IGT is largely based on CBT principles and is usually an adjunct to medication. IGT is designed to help patients understand the relationship between the two disorders, as well as the link between thoughts and behaviors, and how they contribute to recovery and relapse.
• Family therapy. This approach involves the patient’s loved ones, improving family communication and the ability of family members to recognize and effectively respond when a depressive, manic, or hypomanic episode is beginning.

Medication is sometimes administered during detoxification and addiction treatment to reduce cravings, mitigate withdrawal symptoms, or discourage misuse. Other medications, such as antidepressants, antipsychotics, or other mood stabilizers may be prescribed to help someone suffering from mood disorders like bipolar disorder.⁹

Treatment for co-occurring substance use disorder and bipolar can be administered in multiple settings that vary in intensity; however, patients with severe mental health problems may benefit from treatment settings that can provide 24/7 support.¹⁰

At Desert Hope Treatment Center, types of addiction treatment include the following:

• Medical detox for drugs or alcohol provides short-term interventions to help a person safely withdraw from substances and get them stable and ready to continue treatment.
• Inpatient drug or alcohol treatment, where a person benefits from 24/7 support from staff while living at the treatment facility.
• Partial hospitalization programs for addiction, which allows patients to live at home and visit the facility a minimum of 5 days a week for 6 hours at a time.
• Intensive outpatient care for addiction, where patients receive treatment at least 3 times per week in 3-hour sessions.
• Standard outpatient addiction treatment programs, in which a patient may undergo treatment only once or twice a week.
• Sober living programs, where people live in a drug-free environment while working or attending school.

The duration of treatment (i.e., short-term rehab, month-long treatment, or long-term rehab) depends on the patient’s needs as well as their progress during treatment. Many people go through multiple levels of care during treatment at Desert Hope.

How to Pay for Treatment of Addiction and Bipolar Disorder

Paying for rehab is likely to be one concern you have before you or a loved one begins addiction treatment. Fortunately, insurance plans are required to cover substance use treatment, due to numerous federal laws and regulations.¹¹ However, the extent of coverage will vary based on your insurance plan and coverage.

Fill out the confidential to verify your insurance at Desert Hope Treatment Center.

Additionally, there are numerous other ways to pay for treatment other than insurance (such as financing, credit cards, or personal loans) that can make the costs of rehab more manageable.

Desert Hope can help you or your loved one recover from co-occurring bipolar disorders and addiction. Call today to speak with one of our admission navigators about addiction treatment in Las Vegas, Nevada.