Addiction and Bipolar Disorder: What’s The Connection and How Do I Get Help?

This article was updated on March 29, 2023.

Today marks World Bipolar Day, an event that provides an opportunity to examine the origins and sustaining factors of bipolar disorder, as well as ways to reduce stigma and help ourselves and our loved ones manage this condition. It’s also an opportunity to examine the relationship between bipolar disorder and alcohol or drug addiction.

Like other types of serious mental health issues, addiction, and bipolar disorder are closely linked. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that over nine million (nearly four percent) American adults currently struggle with a co-occurring mental illness and substance use disorder in 2021, and the onset and progression of bipolar disorder is one of the largest drivers of this alarming correlation. SAMHSA also reports that 30-50 percent of people who struggle with bipolar disorder (including bipolar 1 and bipolar 2) will develop a substance use disorder at some point in their lives, for which they’ll need comprehensive dual-diagnosis treatment.

Understanding the relationship between addiction and bipolar disorder, including how one condition affects the other, factors that exacerbate the association, and ways to get treatment, can help you or your loved one either prevent, independently manage, or get help for this complex co-occurring disease. You don’t have to struggle with addiction and bipolar disorder on your own, nor should you.

What Is Bipolar Disorder?

Bipolar disorder (formerly called manic-depressive illness or manic depression) is defined by the National Institute of Mental Health (NIMH) as a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. There are multiple types of bipolar disorder, including:

• Bipolar I —Manifested through manic episodes lasting for a week or more, or those that were so severe they required immediate hospitalization. These incidents also often include prolonged bouts of depression.
• Bipolar II — Identified and diagnosed through a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
• Cyclothymic Disorder (also called Cyclothymia)— Identified by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least two years that don’t meet the requirements of care for general hypomania and depression.

If you or your loved one are experiencing any of these symptoms, and are not already diagnosed or receiving treatment, work with your doctor or therapist to identify which, if any, type of bipolar disorder you may be facing.

Signs of Bipolar Disorder

It can be hard to recognize bipolar disorder in yourself or a loved one. Many are unable to distinguish early episodes and symptoms from everyday, ordinary shifts in mood caused by external stressors. It can also be hard for clinicians themselves to diagnose the disease. One 2018 review suggests that as many as 40 percent of people with bipolar disorder were misdiagnosed, usually with major depression. Some of the primary signs of bipolar disorder can include, but are not limited to:

• Sudden and Extreme Highs and Lows in Mood that Last for Hours or Days
• Decreased Need to Sleep
• Extreme Restlessness and Impulsivity
• Inability to Focus
• Extreme Overconfidence
• High-Risk Behavior (Impulsive Sex, Irresponsible Spending, Gambling, Etc.)

Substance use is another example of high-risk behavior exhibited during extreme bipolar episodes, a cycle of behavior which, over time, can lead to addiction. This is why it’s best to recognize bipolar disorder early and mitigate any dangerous behavior that can lead to long-term health issues, including those caused by excessive drinking and drug use.

The Chicken and the Egg: Causes and Effects of Substance Use and Bipolar Diagnosis

Patients who experience mania during bipolar episodes are 14 times more likely to have a drug abuse disorder and six times more likely to battle alcoholism. There are multiple factors that drive individuals with bipolar disorder to drink or use drugs, including physiological and experiential. More often than not, however, it’s bipolar disorder that causes addiction and not the other way around. While the neurological side effects of prolonged and untreated substance abuse can create changes in mood that can easily be confused with bipolar disorder, they are usually associated with withdrawal and can often be mitigated with comprehensive medical detox.

What Type of Addiction is Most Common in Bipolar Patients?

Although bipolar disorder is associated with all types of substance use disorder, alcohol is by, far, the most common addictive substance associated with this condition. A comprehensive 25-year meta-analysis published in the Journal of Affective Disorders indicates that 42 percent of individuals with co-co-occurring bipolar 1 and bipolar 2 had alcohol use disorder and 17 percent struggle with drug use disorder.

• Alcohol and Bipolar Disorder – Alcohol and bipolar disorder co-occur more often than practically any other SUD or mental health issue. Results from the National Epidemiologic Survey on Alcohol and Related Conditions showed that SUD co-occurrence was higher among people with bipolar disorder than among people with any of the other mental disorders included in the survey. Alcohol use and bipolar disorder can occur alongside one another through various circumstances. Patients may engage in alcohol abuse during periods of mania, drink to cope with depression symptoms, or simply try to use alcohol to drown out their symptoms and impulses. Since alcohol is generally the most accessible addictive substance, it’s easy for people with bipolar disorder to use it to cope with symptoms and hide their behavior from others.
• Prescription Drugs and Bipolar Disorder – Abuse of prescription drugs like sleeping pills and benzodiazepines is also common among bipolar disorder patients. While benzos, like Valium®, Xanax®, and others, are not long-term solutions for treating bipolar disorder, they are common remedies for extreme symptoms. It’s not uncommon for benzo use to continue past doctor’s orders, which can easily lead to dependency and addiction. Data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS) examined nonmedical prescription opioids (NMPO) and found that nearly two-thirds of study participants also used benzos for non-medical use on a regular basis, and nearly a third of this group was diagnosed with bipolar disorder. Withdrawal from benzo abuse can be particularly difficult for people with bipolar disorder.
• Illicit Drugs and Bipolar Disorder – Generally speaking, the relationship between bipolar and illicit drug use is unique to the individual. A person might use cocaine as a means to sustain their high; or they might use heroin as a response to impulse or a means to cope with withdrawal from prescription opioids, which they often abuse with benzos or sedatives. The relationship between illicit drug use and bipolar episodes is situational and, different for each individual patient.

Dual-Diagnosis Treatment for Co-Occurring Bipolar Disorder and Addiction

Treatment for addiction and bipolar disorder must include comprehensive medical detoxification to address complex medical and neurobiological issues associated with substance abuse and the originating disorder, as well as behavioral counseling and rehab to address the root causes and sustaining factors of both the substance abuse and the bipolar diagnosis. Just using medications isn’t enough and can be very dangerous to long-term cognitive health. At the same time, standard counseling and therapy might not be enough to rebalance the changes in brain chemistry that you or your loved one have experienced during your journey.

Treatment facilities that provide dual-diagnosis care for alcohol or drug addiction and bipolar disorder are your or your loved one’s best bet for getting the help you need. Doctors and therapists at these facilities understand the complex and delicate relationship between these two conditions and how they can co-exist to become one intermingled health problem. Dual-diagnosis programs offer access to medically supervised withdrawal management to ensure your body and brain are stabilized, and your neurochemistry is rebalanced after prolonged, untreated substance use.

After detox and withdrawal management, rehab can offer a variety of helpful clinical interventions, such as group therapy, individualized counseling, and supplemental therapies like cognitive behavioral therapy (CBT), motivational interviewing, dialectical behavioral therapy (DBT), and much more. Recovery Unplugged offers these evidence-based interventions while using music to help clients more readily embrace the treatment process. Music has been shown to help effectively treat many symptoms of bipolar disorder, including depression and anxiety. We use these benefits to help you or your loved one feel better about getting addiction help.

You’re Not Alone…Get Help Now

It’s easy to feel like you’re alone when you’re struggling with alcohol or drug addiction and bipolar disorder. It can feel like you don’t know what’s going on in your own head, how to make sense of it, or how to keep it from killing you. The first step toward reclaiming your health, dignity, and quality of life from this complex, interconnected illness is by acknowledging the existence of a problem in the first place. Talk to a friend, loved one, or mental health professional about what you’re experiencing and devise a plan to start a course of care.

While World Bipolar Day is a reminder that there is no shame in asking for help for drug addiction, and that there is strength in it, this reality shouldn’t be forgotten when the day is over. If you or your loved one need help with co-occurring addiction and bipolar disorder, contact Recovery Unplugged now to start your treatment today. We accept most major insurances and have multiple facilities across the country. Our admissions representatives are standing by 24-7 to help you with your alcohol or drug addiction and bipolar disorder.