Co-Occurring Bipolar Disorder and Substance Use Disorder
Bipolar disorder is a chronic mental health condition characterized by unusual changes in activity levels, energy, and mood.1 When a person is diagnosed with a mental health condition like bipolar disorder and a substance use disorder, it is referred to as having co-occurring disorders.2 Research suggests that up to 56% of people with bipolar disorder will experience a substance use disorder during their lifetime.3
While co-occurring disorders are complex, treatment for co-occurring bipolar disorder and substance use disorder is available and can help people better manage both disorders and live healthy, productive lives.1
This page will help you learn about co-occurring bipolar disorder and substance use disorder, including the relationship between the two, available treatment, and the steps to take to find treatment.
What Is Bipolar Disorder?
Bipolar disorder is characterized by dramatic shifts in activity levels, energy, or mood that may affect a person’s ability to complete daily tasks. People with bipolar disorder typically experience 2 emotional states: mania (or hypomania) and depression.1 They may also experience periods where their mood is balanced, or a “mixed state,” where manic and depressive symptoms occur simultaneously.1 Bipolar disorder affects approximately 4.4% of adults in the United States during their lifetime.4
What Is the Difference Between Bipolar I and Bipolar II Disorder?
There are different types of bipolar disorder, all of which involve noticeable changes in activity levels, energy, and mood:5
- Bipolar I disorder: Characterized by manic episodes that last for at least 7 days or by severe manic symptoms that require medical attention. Depressive episodes that last for at least 2 weeks often occur. A person may also experience manic and depressive symptoms simultaneously.
- Bipolar II disorder: Characterized by a pattern of depressive episodes and hypomanic episodes. (Hypomanic episodes are typically less severe than manic episodes, but still cause disruptions in a person’s normal functioning).
Cyclothymic disorder (cyclothymia) is another type of bipolar disorder. It is characterized by recurring depressive and hypomanic symptoms that are shorter or less severe than full depressive or hypomanic episodes.5 An important distinction between bipolar I and II disorders and cyclothymic disorder is the level of dysfunction. In bipolar I and II disorders, mania, hypomania, and depressive episodes cause significant dysfunction in at least one important domain of functioning.6
What Are the Signs and Symptoms of Bipolar Disorder?
A person with bipolar disorder may experience distinct episodes of mania and depression. These episodes can occur independently, in rapid succession, or simultaneously.7 The signs and symptoms of bipolar disorder can vary in duration and severity. In severe cases, manic or depressive episodes may involve psychotic symptoms (e.g., delusions or hallucinations), which can sometimes be misdiagnosed as schizophrenia.7
To receive a bipolar disorder diagnosis, a person must experience at least 1 episode of mania or hypomania that lasts at least 1 week (mania) or at least 4 consecutive days (hypomania) in addition to 3 or more of the following symptoms as outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):6
- Grandiose delusions or inflated self-esteem.
- Decreased need for sleep.
- Racing thoughts.
- Increased distractibility.
- Increased talking.
- Increased psychomotor agitation or goal-oriented academic, occupational, social, or sexual activities.
- Excessive involvement in risky activities (e.g., excessive spending).
A person experiencing mania may exhibit rapidly irritable moods, unpredictable behavior, and impaired judgment. They may also make impulsive decisions and take risks they normally wouldn’t. In some cases, the severity of these symptoms may warrant hospitalization. While a person experiencing hypomania may have less severe symptoms, the symptoms can still cause significant occupational or social impairment.6
Major depressive episodes are common in bipolar I disorder but are not required for a diagnosis. For bipolar II disorder, a current or past major depressive episode is required for a diagnosis. To qualify as a major depressive episode, the symptoms must cause clinically significant distress or occupational or social impairment.6 The DSM-5 explains that a person must experience one of two of the below symptoms in a 2-week period and that these symptoms must represent a change from previous functioning:6
- Depressed mood for most of the day, nearly every day.
- Diminished interest or pleasure in almost all activities.
The episode must also include three (if both symptoms above were experienced) or four (if only one) additional symptoms:6
- Weight loss.
- Insomnia or hypersomnia.
- Psychomotor agitation or retardation.
- Feelings of excessive guilt or worthlessness.
- Impaired concentration.
- Recurrent thoughts of suicidal ideation or suicide attempts.
The Relationship Between Mental Health Disorders and Addiction
A substance use disorder is a chronic but treatable mental health condition that occurs when a person cannot stop or control the recurrent use of drugs or alcohol despite it causing significant occupational, physical, or social problems.8
Substance use disorders commonly co-occur with other mental health disorders, including bipolar disorder.8 According to the 2021 National Survey on Drug and Health (NSDUH), 7.6% (or 19.4 million) of people in the U.S. had both a mental health disorder and a substance use disorder in the past year.9
The relationship between mental health disorders and substance use disorders is complex, and evidence shows a bidirectional relationship between the two.9 However, it is unclear how each disorder influences the other; although a person might have both disorders, one does not necessarily cause the other.10, 11
Mental health disorders and substance use disorders share several risk factors, including:2, 11
- Environmental factors, such as exposure to adverse childhood experiences, stress, and trauma.
- Genetic vulnerabilities.
- Certain mental health disorders, such as anxiety, depression, and post-traumatic stress disorder (PTSD).
Individuals with mental health disorders often turn to substances to alleviate or “self-medication” symptoms.2, 11 While substances may provide temporary relief, they can exacerbate mental health disorder symptoms in the short- and long-term. The brain changes associated with mental health disorders can heighten the rewarding effects of substances, reinforcing the cycle of substance use. Conversely, substance use can also contribute to the development of other mental health disorders.2, 11
Treatment for Bipolar Disorder and Substance Use Disorder
Treatment for co-occurring bipolar disorder and substance use disorder typically involves a combination of pharmacological and psychosocial therapies.1
Treatment may take place in a range of settings depending on your needs. While not always necessary, some patients may begin treatment with a period of medical detox to withdraw from certain substances (e.g., alcohol, benzodiazepines) while under the care and supervision of medical professionals.12 This can help ensure their comfort and safety and support the transition to ongoing treatment. Ongoing treatment can help patients work toward sustained recovery. Common treatment settings include:12
- Inpatient rehab, where patients live at a treatment facility and receive around-the-clock support.
- Outpatient rehab, where patients receive many of the benefits of inpatient rehab but live at home or in a type of recovery housing and attend treatment during the week.
Medications Used in Treatment for Bipolar Disorder and Substance Use Disorder
Bipolar disorder can be treated with various medications, including mood stabilizers like lithium divalproex sodium, antipsychotics, and antidepressants.1
Whether or not medication is used in the treatment of a substance use disorder depends on the substances taken, currently there are only available medication for alcohol use disorder or medication for opioid use disorder.1
Therapies Used in Treatment for Bipolar Disorder and Substance Use Disorder
There is limited research on effective treatment regimens for nonpharmacological treatment for co-occurring disorder bipolar disorder and addiction.10 In general, treatment for co-occurring disorders, including bipolar disorder and substance use disorder, may involve several therapeutic approaches:1, 2, 10
- Cognitive behavioral therapy (CBT): CBT helps individuals learn to cope with situations by challenging irrational thoughts and changing negative behaviors.
- Integrated group therapy (IGT): IGT focuses on the relationship between the two disorders and helps patients understand how recovery and relapse are linked to behaviors and thoughts.
- Family–focused therapy (FFT): FFT helps family members better understand bipolar disorder and learn to identify when a new manic or depressive episode may be starting.
- Dialectical behavior therapy (DBT): DBT uses the principles of acceptance and mindfulness to help change negative behavior.
- Assertive community treatment (ACT): ACT is a community-based mental health therapy that uses outreach in the community and an individualized treatment approach.
- Therapeutic communities (TC): This is a long-term residential treatment setting that helps individuals develop new and healthier values, attitudes, and behaviors.
- Contingency management (CM): CM encourages healthy behaviors in individuals with rewards or vouchers for the desired behaviors.
How to Find Treatment for Bipolar Disorder and Addiction
If you or a loved one is struggling with co-occurring bipolar disorder and substance use disorder, treatment is available. Every program is different, and it’s important to research the options that are best suited to your needs. Some factors you might consider include the program location, levels of care provided, specialty programs offered, and whether your insurance is in-network.
You can start the process of finding treatment for bipolar disorder and substance use disorder by talking to your doctor or a qualified mental health practitioner. You can also use online tools like the treatment locator from the Substance Abuse and Mental Health Services Administration (SAMHSA) or our rehab directory to search for a treatment center based on specific criteria. If you’d like to learn more about treating bipolar disorder and substance abuse, please contact one of our admissions navigators today at . Calling is confidential and free, and there is no obligation to enter treatment.
Does Insurance Cover Rehab for Bipolar Disorder and Addiction?
The Affordable Care Act (ACA) states that mental health and behavioral health services are considered essential health benefits.13 This means that all health plans under the ACA must cover behavioral health treatment, inpatient services, and substance use disorder treatment.13 Check with your insurance provider to see what your plan covers and your coverage options.
Even if you do not have insurance, treatment is still an option. You can ask the rehab facility you are considering if they offer financial assistance or payment options, such as financing, payment plans, or sliding scales. You can also work with research state-funded treatment plans or options (e.g., grants) for which you may qualify to help get the treatment you need.
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