Bipolar Disorder and Substance Abuse Are Often Connected

According to the National Institute of Mental Health, an estimated 2.8% of U.S. adults suffered from bipolar disorder in the past year. An estimated 82.9% of these individuals were considered to be seriously impaired, which is the highest impairment percentage of all mood disorder types.

For some individuals with bipolar disorder, mood swings can lead to another challenging battle: substance use disorders (SUDs). The Substance Abuse and Mental Health Services Administration estimates that between 30% and 50% of adults with bipolar disorder will develop an SUD at some time during their lives.

While these statistics may seem bleak, there is hope. With evidence-based care that addresses these co-occurring conditions, it’s possible to live a happy, productive, and fulfilling life.

Understanding Bipolar Disorder

Bipolar disorder comes in several subtypes, with the hallmark feature being alternating episodes of mania and depression.

Symptoms of a manic episode can include:

Elevated mood. A person with bipolar disorder may experience an abnormally high or euphoric mood regardless of their surroundings.
Increased energy. In a manic episode, a person may engage in hyperactive behavior, speak rapidly, and show a decreased need for sleep.
Grandiosity. An inflated sense of self-importance, confidence, or belief in their abilities is common when a person is experiencing a manic episode.
Risky behavior. Bipolar disorder can lead to impulsive and potentially harmful activities, such as reckless driving or spending sprees, when a person is in the middle of a manic episode.

Symptoms of a depressive episode can include:

Persistent sadness and low mood. A depressive episode can lead to prolonged periods of feeling extremely down or sad, accompanied by a lack of interest or pleasure in previously enjoyed activities.
Changes in appetite and weight. Significant changes in appetite and weight, either an increase or decrease, are common when a person with bipolar disorder is experiencing a depressive episode.
Fatigue and sleep problems. Persistent feelings of tiredness and low energy are common during depressive episodes, as is insomnia or hypersomnia (excessive sleep).
Difficulty concentrating. People with bipolar disorder often have trouble with focus and decision-making during depressive episodes.
Thoughts of self-harm or suicide. In severe cases, thoughts of self-harm or suicide may be present.

The duration of mood cycles in bipolar disorder can vary widely from person to person and even from one episode to another within the same individual—with episodes lasting days, weeks, or even months. Some people with bipolar disorder experience rapid cycling, where they have four or more mood episodes within 12 months with short periods of stability in between. It is also possible to have mixed episodes, where a person experiences manic and depressive symptoms simultaneously.

The Intersection of Bipolar Disorder and Substance Use

Not everyone with bipolar disorder will develop a substance use disorder, and not everyone with a substance use disorder has bipolar disorder. However, the relationship between the two conditions is significant for several interconnected reasons:

Self-medication. People with bipolar disorder may use alcohol or drugs to manage their mental health. During manic episodes, they might seek substances to enhance their already elevated mood. During depressive episodes, they may use substances to numb emotional pain.
Impulsivity. Manic episodes in bipolar disorder are often characterized by a lack of impulse control that can lead to excessive drinking or drug use without considering the consequences.
Altered judgment. During manic episodes, individuals may take risks they wouldn’t otherwise take, including experimenting with substances. In depressive episodes, they may use substances to cope with feelings of hopelessness or despair.
Psychosocial stressors. Living with bipolar disorder can be challenging, with psychosocial stressors such as relationship problems, unemployment, or social isolation. These stressors can increase the risk of turning to substances as a coping mechanism.
Genetic risk factors. There is evidence to suggest a genetic predisposition for both bipolar disorder and SUDs.

How St. Joseph Institute Can Help

Treatment for co-occurring bipolar disorder and substance use disorder requires an integrated approach. Here’s a brief overview of how we help clients at our Pennsylvania residential addiction treatment program:

Comprehensive intake assessment. Our services begin with an intake assessment that helps determine the extent of both conditions, identify any underlying factors contributing to the dual diagnosis, and guide treatment planning.
Individual therapy. Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and contingency management have shown effectiveness in treating people with bipolar disorder and SUD.
Group therapy. Group therapy sessions that focus on both bipolar disorder and addiction can provide a supportive environment for sharing experiences and learning from peers.
Psychoeducation. Education about bipolar disorder, addiction, and the relationship between the two is essential for individuals and their families to better manage these conditions.
Medication management. Mood stabilizers, antipsychotics, and antidepressants can effectively manage bipolar disorder. Medications like methadone or buprenorphine may be used for opioid addiction, while medications like acamprosate or naltrexone can be used for alcohol use disorder.
Lifestyle management. Regular exercise, proper nutrition, and adequate sleep can significantly impact mood stabilization and addiction recovery.
Relapse prevention. We work with each of our clients to develop personalized strategies for preventing relapse in both bipolar symptoms and substance use. This includes identifying triggers, practicing coping skills, and building a strong support system.