Dual Diagnosis – Bipolar Disorder and Addiction

dual diagnosis

Dual Diagnosis

Although not fully symptomatic of each other, a large percentage of people with bipolar disorder also struggle with addiction. In fact, in a recent study, 60% of people with bipolar disorder also had some history of substance abuse. The symptoms of bipolar disorder are usually made worse by drugs and alcohol. Even people with no history of mental health issues can develop bipolar addictive personality as a result of drug abuse. Although it is not fully understood, research is finding that those having bipolar disorder are more likely to abuse alcohol or drugs as part of a dual diagnosis.

In the past, bipolar disorder and addiction were treated separately and as separate conditions. Most people with bipolar disorder were treated at mental health centers or psychiatric hospitals, while those with drug or alcohol addictions were sent to rehab. Today, however, addiction treatment programs and professionals are recognizing the importance of treating both conditions simultaneously through an integrated treatment process. Bipolar disorder and addiction are now seen as a dual diagnosis— a condition in which a mental disorder and a substance disorder coexist and where each exacerbates the symptoms of the other. In this article, we will look at the signs and symptoms of bipolar disorder and addiction, as well as various treatment options.

What is Bipolar Disorder?

Bipolar disorder, once more commonly known as manic depression, is a serious mental disorder characterized by intense and sudden changes in mood, behavior and/or energy levels. Just like substance abuse, bipolar disorder presents considerable risks for an individual’s emotional and physical wellness. Those afflicted with bipolar disorder typically have a higher rate of relationship problems, accidental injuries, financial instability and suicide than the general population. Research also finds they are significantly more likely to develop an addiction to drugs or alcohol.

There are various subtypes of bipolar disorder, each with its own set of symptoms and severities. Most experts agree there are a number of ways in which the disorder can manifest, with most symptoms appearing along a spectrum. Understanding these different types as well as their individual connections with addiction is an important step for those living with bipolar disorder or their loved ones. Gaining more insight and information regarding each subtype can enable individuals to get the specialized treatment they need to heal.

Bipolar I

Bipolar I is common to about one percent of the population, with symptoms swinging between the highest high and the lowest lows on a regular basis. During a manic episode, individuals might speak rapidly, express delusional beliefs, refuse to sleep, or try to spend extreme amounts of money. That same person might then have a subsequent episode of intense depression in which life hardly seems worth living. They may refuse to go to work, struggle to engage in conversation or even make decisions. Substance abuse plays a major role in the life of those with Bipolar I disorder. Many turn to drugs or alcohol in an attempt to self-medicate some of the more severe symptoms.

Bipolar II

This form of bipolar disorder also presents many difficulties, but most people don’t experience the intense mania associated with Bipolar I. Instead, individuals move from moderate moments of sadness to moments of intense despair. These people still cycle between moods, but do not typically experience the intense highs of creativity and joy that comes with other manic episodes.   Most often they cycle between severities of depression. People with Bipolar II have the highest risk of suicide among all those on the bipolar spectrum as their depressive episodes are nearly endless. Many people who fall into this category of bipolarity rely on euphoric drugs to feel some moments of happiness. Others may take stimulants to boost energy levels, which can assist them in getting through daily tasks even while depressed.


Cyclothymia is a milder form of bipolar disorder, sometimes referred to as cyclothymic disorder. Both cyclothymia and bipolar disorder I are characterized by extreme mood swings, from the highs of mania to the lows of depression, with short periods of neutral moods in between. The difference is the intensity: People with bipolar disorder will typically experience mania and also major depression, while people with cyclothymia have low-grade depression and mild symptoms of hypomania.

There are other forms of bipolar disorders, but these are the most common. However, everyone who struggled with bipolar disorder experiences mood shifts, with rapid cycles between various moods, whether depressive or elevating. Dealing with these shifts can often leave individuals feeling deeply disabled, completely unaware of which mood may strike them next. A huge percentage of these people turn to drugs and alcohol in an attempt to mitigate their symptoms. Unfortunately, substance abuse only serves to make bipolar symptoms worse.

Dual Diagnosis – The Relationship Between Bipolar Disorder and Addiction

There isn’t an easy explanation for the high rate of chemical dependence and abuse among individuals with bipolar disorders. One possible reason for this relationship, however, is that many individuals are hoping to numb the painful effects of their disorder with drugs and alcohol. Symptoms of bipolar disorder like anxiety, depression, sleeplessness and pain can be so oppressive that drugs and alcohol may seem like an effective solution to offset them. They may also hope to stabilize their mood swings, without realizing that substance abuse only serves to make symptoms worse.

Current research shows that brain chemistry may influence both bipolar disorder and substance abuse. Individuals affected by bipolar disorder often have abnormal levels of dopamine, serotonin and norepinephrine—chemicals responsible for bodily functions such as appetite, sleep, metabolism and stress responses. They also are responsible for mood and emotions. Heavy drug or alcohol use will interfere with the way the brain processes these chemicals, further compounding issues of depression, emotional instability and turbulent energy levels.

Regular drug use creates physical changes in the brain, with the most significant change being to  the brain’s reward system, which makes drug use feel gratifying. These changes eventually lead a user to develop drug-seeking, compulsive behavioral issues. When those with bipolar disorder begin abusing drugs or alcohol, they enter a dangerous cycle in which each condition is contributing to the gravity of the other.

Research shows that individuals with bipolar disorder will have an exceptionally difficult time recovering from substance addictions due to already erratic chemical levels. Even those individuals who are mentally healthy before addiction can develop bipolar disorders from regular drug use due to drug abilities to retire the parts of the brain that control mood and behavior.

Symptoms of Addiction

The symptoms of drug addiction vary as much as those associated with bipolar disorder. There is not a drug or type of drugs common to all cases of bipolar disorder, but most users resort to stimulants to combat depression or sedatives to control manic episodes. Symptoms will vary based on whether the type of drug being abused is an “upper” versus a “downer”. The National Institute on Drug Abuse‘s list of the most common symptoms of drug abuse include:

  • Isolation from loved ones
  • Changes in appetite
  • Irritability
  • Fatigue
  • Loss of interest in past enjoyable activities
  • Unusual sleep patterns
  • Random high-energy levels

Additionally, the NIDA  reports that bipolar alcohol addiction is even more prevalent than drug addiction. The combination of alcohol with stimulants and/or sedatives can be especially dangerous, leading to combined drug intoxication.

There is not a particular point at which casual drug or alcohol use crosses into addiction. There is a fine line between drug/alcohol use and abuse for most individuals, and most do not realize when they have crossed over that line. For those affected by bipolar disorder, addiction may not be defined by the type of frequency of substance use, but more by the consequences associated with their use. Many users will begin to experience problems in life—at home, school, work or in their relationships— as their use turns into abuse and addiction.

Treatment for Bipolar Disorder

Effective treatments must treat both bipolar disorder and substance abuse simultaneously for treatment to be effective. Without treating both disorders as part of a dual diagnosis, the chances of relapse are high. There are various relapse prevention strategies for an individual with bipolar disorder, with most focusing on managing both the emotional and psychological components which trigger substance abuse.

Both Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) have proven to be effective modalities in treating patients with a dual diagnosis. These therapeutic methods help individuals to identify the source of their emotions and then learn how to regulate them so as not to be overwhelmed by dramatic mood changes. Additionally, group support meetings are an essential component to recovery for those suffering from bipolar disorder and substance abuse. Sharing experiences with others and developing coping strategies from peers has proven to be an effective method of treatment.

Treatment facilities that specialize in the treatment of dual diagnosis patients provide the best options for individuals to find recovery. Centers like these are dedicated to treating both the mental illness and the substance addiction to give patients the best chance to living a happy, normal life.

If you or someone you love suffers from bipolar disorder and addiction, contact Blu by the Sea today. We are a dual diagnosis rehabilitation facility, located in Destin, Florida. Our rehabilitation program is designed to meet the needs of each client via a personally tailored treatment plan. Our staff are specially trained and credentialed health professionals and specialists in addiction. Our care plans integrate the best strategies for treating bipolar disorder along with the most effective treatments for beating addiction.