Bipolar Disorder and Addiction: Signs, Symptoms and Treatment

Approximately 4.4% of people in the United States will be diagnosed with bipolar disorder at some point in their lives.¹ Many people who have bipolar disorder also struggle with the use of alcohol or drugs. When a person is diagnosed with a substance use disorder and another mental health condition like bipolar disorder, it is referred to as having co-occurring disorders.²

This article will help you understand the signs and symptoms of bipolar disorder, some of the reasons bipolar disorder and addiction often occur together, and what treatment options are available for someone with these co-occurring disorders.

What Is Bipolar Disorder?

Bipolar disorder is a mental health disorder generally characterized by episodes of elevated mood, with abnormally high levels of energy, and episodes of major depression. These unusual periods of heightened and lowered mood and energy levels interfere with the person’s ability to function in their daily life.³ There are three types of bipolar disorder.³

What Are the Different Kinds of Bipolar Disorder?

The 3 types of bipolar disorder are:^3,4,5

• Bipolar I disorder—Includes manic episodes that last at least 7 days and most, but not all, people with bipolar I also experience periods of major depression that usually last around 2 weeks. Symptoms of manic episodes must not be attributed to substance use or other medical conditions, they result in impaired social or occupational functioning, and may even require hospitalization.
• Bipolar II disorder—Involves recurring depressive episodes that include either depressed mood or loss of interest or pleasure and lasts at least 2 weeks and at least one hypomanic episode that lasts at least 4 days. Hypomania is milder than the full-blown mania that occurs in people with bipolar I disorder. Typically, hypomanic episodes are not severe enough to require being hospitalized, however, depressive episodes represent a noticeable change from a person’s usual functioning.
• Cyclothymic disorder—Is a pattern of symptoms of hypomania and symptoms of depressive episodes (that don’t meet the full criteria for hypomanic or depressive episodes) occurring in cycles at least half the time during a 2-year period. The individual must not have been without symptoms for more than 2 months at a time.

What Are the Signs and Symptoms of Bipolar Disorder?

Bipolar disorders are marked by periods of extremely elevated (up) and depressive (down) moods, or periods of mania (or hypermania) that may or may not include: ³

• Periods of major depression (bipolar I).
• Periods of major depressive episodes and at least one period of hypomania (bipolar II).
• Cyclical periods of hypomanic and depressive symptoms that don’t meet the full criteria for mania, hypomania or depressive episodes.

Mania and hypomania are characterized by high levels of energy, euphoria, and excitement or agitation and irritability lasting at least a week (mania) or at least four consecutive days (hypomania), as well as three or more of the following symptoms:^3,4

• Have grandiose delusions or inflated self-esteem.
• Have little need for sleep, often only 3 hours or less per night.
• Experience racing thoughts.
• Be easily distracted by unimportant/irrelevant things.
• Appear more talkative or feel the need to continue talking.
• Have psychomotor agitation or an increase in goal-directed social, occupational, sexual, or academic activity.
• Engage in risky behaviors, such as spending money excessively, or in sexually promiscuous behaviors that are out of character for the person.

Manic episodes differ from hypomanic episodes in their severity. A manic episode will cause significant impairment in social or occupational functioning or even require hospitalization. Hypomanic episodes do not; however, the person may function in ways that are uncharacteristic for them.^3,4

The other mood state is depression, in which the person feels either a depressed mood or a loss of interest or pleasure, as well as four or more of the following symptoms in a 2-week period:^3,4

• Having a depressed mood nearly every day, for most of the day.
• Showing a lack of interest in all, or almost all, activities nearly every day, for most of the day.
• Difficulty sleeping or sleeping too much nearly every day.
• Unintended, significant weight loss or weight gain.
• Restless feelings or feelings of being slowed down nearly every day.
• Loss of energy or fatigue nearly every day.
• Excessive guilt or feelings of worthlessness nearly every day.
• Indecisiveness or difficulty concentrating or thinking nearly every day.
• Recurrent thoughts of suicidal ideation, suicide attempt, or death.

It is important to remember that you cannot diagnose yourself or anyone else by applying these criteria to them. A diagnosis must be made by a physician or other licensed mental health professional to determine if you or your loved one has bipolar disorder. Diagnosis is based on an intensive assessment that evaluates a person’s history, current symptoms, and overall functioning.³

How Common Is Bipolar Disorder and Substance Abuse?

It is important to know that while many people use the term “substance abuse” when referring to the misuse of drugs or alcohol, the word “abuse” is stigmatizing, placing blame on the person for having a disease in such a way that it actually makes it less likely a person will seek treatment and more difficult to recover from their illness.

The preferred term is “misuse”, and people afflicted by addiction are not addicts, but have a “substance use disorder.”⁸ A substance use disorder is a treatable medical illness characterized by the uncontrollable use of drugs or alcohol despite significant negative consequences.⁴

Overall, over 14.5% of the population in the United States, or about 40.3 million people aged 12 and over, had a substance use disorder in 2020.⁹

Lifetime prevalence rates of bipolar disorder in adults in the U.S. is between 1% and 3% for bipolar I and another 1% for bipolar II disorder.¹ Research indicates that 30% to more than 50% of people with either a bipolar I or bipolar II disorder will develop a substance use disorder in their lifetime.¹⁰

Studies also show that bipolar I disorder has a higher prevalence of co-occurrence with substance use disorder, and that as many as 65% of individuals with bipolar I disorder experience a substance use disorder in their lifetime.⁵

Overall, alcohol is the most common substance involved with a co-occurring bipolar disorder in clinical settings (30% of the time).⁵ This is followed by cannabis (with 20% having a marijuana use disorder) and then by any drug use disorder (17%).⁵

What’s the Connection Between Bipolar Disorder and Substance Use Disorder?

If a person has bipolar I disorder, they are 2 to nearly 6 times more likely to also have a substance use disorder.⁵ This suggests there are common risk factors for bipolar disorder and addiction.

They are both more likely to occur in an individual and can occur simultaneously because of shared risk factors combined with the complex interactions where each disorder can influence the other. This does not mean that one disorder directly causes the other, although each disorder may worsen or exacerbate the other.¹¹

Substance use disorders and bipolar disorders occur in the same area of the brain involved with reward, making decisions, and impulse control.¹⁰ Having one is a risk factor for having the other. They also share a number of risk factors, including:^11,12

• Genetic vulnerabilities and family history.
• Traumatic and/or stressful life experiences, including childhood adversity and trauma
• Traumatic brain injury.
• Anxiety disorders and PTSD.

The interplay between bipolar disorder and substance use is complex, and stress can increase the risk that those with bipolar disorder will use substances and those with a substance use disorder might experience more frequently occurring or worsened mania/hypermania or depressive episodes.¹³ 

This bidirectional relationship is also referred to as cross-sensitization, and can partially explain why having both of these disorders occur simultaneously is associated with increased symptom severity including protracted mood episodes, poorer treatment outcomes, and greater suicide risk.^5,13

The Dangers of Self-Medication

Some people with bipolar disorder may use substances to relieve symptoms of bipolar disorder or otherwise cope with the illness. This is often referred to as “self-medicating,” however, it is important to note that drugs of misuse (which typically worsens health) are not the same thing as true medications (which are designed to improve health). Although there are cases where a person turns to drugs or alcohol as a way to cope with a co-occurring disorder, it should not be assumed this is always the case.⁵

How To Treat Co-Occurring Disorders: Treating Bipolar Disorder and Addiction Successfully

When a person has a dual diagnosis of bipolar disorder and a substance use disorder, it is increasingly becoming the standard of care to integrate care and treat both disorders at the same time. Studies show that integrating treatment of both disorders concurrently is superior to treating each type of disorder separately.¹⁴

Treatment for co-occurring bipolar and substance use disorders usually involves a combination of psychotherapy and medication.¹⁴

What Kind of Medications Are Used to Treat Bipolar Disorder and Substance Use?

If a person has bipolar disorder, numerous medications can help stabilize their moods. These medications, such a lithium or divalproex sodium, reduce abnormal brain activity that causes mania and shifting mood states.^5,10

Antiseizure and antipsychotic medications may also be used, either separately or in combination with one another.¹⁰

Medications may also be used to treat certain forms of substance use disorders, such as opioids and alcohol, and these can be used while treating co-occurring bipolar disorder.¹⁰

What Kinds of Therapies Work for Bipolar and Addiction Treatment?

Several therapies used in addiction treatment have also been shown to be effective in treating bipolar and substance use disorders. These therapies include:^2,14

• Cognitive-Behavioral Therapy (CBT): CBT is a type of behavioral therapy where people learn to challenge ineffective thoughts, replace them with more helpful ones, and change their behaviors.
• Dialectical Behavior Therapy (DBT): DBT is an approach that incorporates mindfulness and increases the management of difficult emotions. DBT can also teach people skills to manage destructive, self-harming behaviors and suicidal urges.
• Integrated Group Therapy (IGT): This type of therapy was specifically developed for patients with co-occurring bipolar disorder and substance use disorder. It treats both disorders at the same time by helping patients understand how the two disorders relate to each other and how recovery and relapse are linked to thoughts and behaviors.

How To Find Treatment for Bipolar Disorder and Addiction

When you seek a rehab program with integrated treatment for bipolar and substance use disorders, there are numerous factors to consider. These include:

• The levels of care the program can provide.
• Whether the facility has a state license to operate, as well as accreditation.
• The location (e.g., whether you want to get away and get a fresh start, or if you need to be close to home).
• The type of amenities and other services offered (e.g., lodging and food).
• The cost and what insurances are accepted.

Recovery First specializes in providing integrated treatment for co-occurring disorders. Our drug rehab in Miami offers several levels of care for addiction treatment, including inpatient addiction treatment and outpatient drug rehab.

How to Pay for Bipolar and Addiction Treatment

There are numerous options for paying for treatment at Recovery First. If you have insurance, you may be able to use your insurance coverage for rehab.

Depending on your provider and coverage, this could cover all or a portion of your treatment costs. Fill out our secure to quickly verify your insurance benefits.

If your insurance doesn’t cover all the costs of rehab or you don’t have health insurance, there are other ways to pay for rehab. Call one of our compassionate admissions navigators at to discuss payment options.

You don’t have to go through this alone. Recovery is possible, and we’re here to help you. Start the admissions process today.