Bipolar Disorder and Addiction

Mental health disorders like bipolar disorder commonly occur alongside substance use disorders (SUDs), the diagnostic term for addiction, because they tend to have the same risk factors, and each disorder can worsen the other.¹ When a person has both a mental illness and a substance use disorder, it is known as co-occurring disorders, or comorbidity.¹ While co-occurring addiction and bipolar disorder can be challenging, evidence-based treatment can lead to positive health outcomes.

What Is Bipolar Disorder?

Bipolar disorder is a mood disorder in which a person’s mood can greatly fluctuate between depressive and manic episodes.²Depressive episodes are often characterized by excessive sadness and loss of interest in favored activities.² Manic episodes are often characterized by intense euphoria, energy, and activity.² Bipolar disorder can present as episodic, occurring at varying intervals, or chronic, reoccurring constantly.³

Bipolar disorder is classified by the Diagnostic and statistical manual of mental disorders, 5th Edition (DSM-5), in a category known as “Bipolar and Related Disorders.”^{4, 5} The two commonly known disorders in this category are bipolar I and bipolar II.^{5, 6}

Bipolar I is defined as having at least one diagnosable manic episode with or without depressive episodes.^{5, 6} Bipolar II is defined as having at least one hypomanic and one depressive episode.^{5, 6} Hypomanic episodes include many of the same symptoms as manic episodes but are not severe enough to impair a person socially or at work.²

It’s estimated that around 20% of people with bipolar disorder attempt suicide at some time in their lives.² Some mental health professionals believe it to be the mental disorder with the highest suicide risk.²

Causes of Bipolar Disorder

There is no single cause for bipolar disorder.³ Like other mental health disorders, bipolar disorder is thought to be caused by a combination of genetics, brain structure, and environment.³ Evidence suggests that bipolar disorder occurs equally in men and women.⁵

Several factors may contribute to the risk of developing bipolar disorder, yet a person can have known risk factors and never develop bipolar disorder. Risk factors for bipolar disorder can include:^{3, 5, 6}

• Genes you are born with or inherit (family history).
• Genes that may alter based on your experiences (epigenetics).
• Influences or illnesses in the womb or as an infant.
• Changes in brain structure.
• Substance misuse.

Stressful life events, including grief, can also trigger or worsen mood episodes in people already at risk.

Like bipolar disorder, conditions such as ADHD and borderline personality disorder share similar genetic and environmental risk factors that can increase addiction risk.

Signs of Bipolar Disorder

If you think you or a loved one has bipolar disorder, a mental healthcare professional can provide a thorough assessment and give a diagnosis, if applicable. Since bipolar and related disorders have different diagnostic criteria, it’s important to see a professional to receive a diagnosis.

The diagnostic criteria for bipolar I are broken down into manic, hypomanic episodes, and major depressive episodes in the DSM-5.⁶

A depressive episode is recognized by symptoms of:²

• Depressed mood.
• Loss of interest in your usual activities.
• Significant weight changes.
• Difficulty sleeping or oversleeping.
• Fatigue.
• Feelings of worthlessness or unjustified guilt.
• Slowed thinking or diminished concentration.
• Recurrent thoughts of death or suicide.

A manic episode is characterized by symptoms such as:²

• Extremely inflated self-esteem or feelings of grandiosity.
• Decrease in need for sleep.
• Increased talkativeness.
• The feeling that your thoughts are racing.
• Being easily distracted.
• Motivation toward goal-directed activities or an increase in purposeless, restless activities.
• Excessive engagement in pleasurable, yet risky, activities (ex: buying sprees, gambling, thoughtless business ventures, or sexual sprees).

The criteria for diagnosing bipolar and related disorders must be carefully evaluated to make sure symptoms aren’t being caused by another mental health disorder.^{2, 3, 6} The causes can be difficult to diagnose because many other mental health and personality disorders share the same traits.³

What’s the Relationship Between Bipolar Disorder and Addiction?

Approximately 65% of people with bipolar will develop a substance use disorder at some time in their life.² About 30% of people with bipolar disorder in clinical settings also misuse alcohol.²

Individuals with co-occurring disorders tend to have lower treatment adherence for SUDs, longer mood episodes, worse recovery of functional skills, and more hospitalizations.² Sometimes only one of the two or more disorders are treated, or the behaviors motivated by each disorder tend to worsen the other behavior.¹ If they are not treated together, it can be extremely difficult to overcome the disorders one at a time.¹

The combination of bipolar disorder and addiction can occasionally worsen a person’s symptoms during manic or depressive episodes.⁴ It is not known exactly why bipolar disorder and SUDs commonly co-occur; however, the explanation that alcohol or drugs may be a form of ‘self-medication’ in which people relieve their psychological suffering appears true for many.⁴

Additionally, it is thought that both bipolar disorder and addiction come from the same genetic anomalies, and thus people with one are at risk for the other.⁴

The self-medication pattern seen in bipolar disorder is also common in people with anxiety, depression, and PTSD. Shared genetic risk factors also link bipolar disorder to addictive personality traits and antisocial personality disorder.⁶

Co-Occurring Treatment for Bipolar Disorder and Addiction

The co-occurrence of bipolar and SUDs can complicate treatment; however, they should be treated together to achieve more positive health outcomes. ^{2, 4} It’s possible that cognitive behavioral therapy, integrated therapy, and relapse prevention techniques may be helpful in:²

• Promoting abstinence.
• Reducing hospitalizations.
• Improving consistent use of prescribed medications.
• Reducing the severity of addictions.
• Potentially improving mood symptoms.

Integrated treatment is equally important for related co-occurring conditions such as borderline personality disorder that can complicate both mood stability and recovery.

Research on medications that treat both bipolar and SUDs is limited. However, there are several medications that may help treat the symptoms of bipolar disorder, including:⁴

• Mood stabilizers
• Atypical antipsychotics, which are often used in combination with other medications.
• Antidepressants, which are typically used with a mood stabilizer to help prevent the onset of a manic episode.

Depending on a person’s needs, these and other methods can be used to create an individualized treatment plan with the support of your treatment team.

Find a Co-Occurring Disorder Treatment Center Near You

Bipolar disorder and addiction are deeply connected. Treating one without the other significantly increases your risk of relapse and worsening mood episodes.

Integrated dual diagnosis treatment addresses both conditions simultaneously, combining mood stabilization, behavioral therapy, and addiction treatment in a coordinated care plan designed specifically for people like you.

Search dual diagnosis treatment centers to find programs experienced in treating co-occurring bipolar disorder and addiction.