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Bipolar Disorder & Addiction: Is There a Connection?

Bipolar disorder is complicated by its close connection to addiction. Many people with bipolar disorder also struggle with substance use disorder (SUD). Researchers are not sure why there is such a strong connection between the two disorders, but there appears to be genetic and neurobiological factors at play.[2]

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The Connection Between Bipolar Disorder & Addiction

Bipolar disorder is a mental health condition in which people experience significant shifts in their mood, behavior, energy, and concentration. The shifts in mood can be described as episodes that last for at least seven days to two weeks. 

Manic episodes are when a person’s mood is particularly high, while depressive episodes can be marked by severe depression. Both types of episodes can be dangerous and require medical and mental health care.[1]

Having bipolar disorder increases the risk of developing a substance use disorder. Recent data has shown that up to 50% of people with bipolar I disorder have an alcohol or substance use disorder. Likewise, people with substance use disorders are more likely to experience manic episodes (up to 13.4% higher) as compared to people without SUDs.[1]

Biological & Psychological Underpinnings

Researchers are still exploring the causes of bipolar and substance use disorder. While an exact cause has not yet been identified, there is a strong consensus that certain neurological and biological factors impact the likelihood of developing these conditions. Scientists, for example, have identified certain ways in which the brain of someone with bipolar disorder functions differently than people without bipolar or other mental health disorders.[2]

Studies suggest that people with specific genes are more likely to develop bipolar disorder. If you have a parent, brother, or sister with bipolar disorder, you are more likely to develop the condition than people without a family history of the condition.[2] 

No single biological or psychological factor causes bipolar disorder or a substance use disorder, but certain risk factors like this are associated with an increased risk of each disease.

Bipolar Symptoms Exacerbated by Substance Use

Bipolar symptoms can be exacerbated by substance use, particularly manic symptoms. Studies have found that 25% of people with bipolar disorder experiencing a manic episode increase their use of substances.[3] However, most people do not increase their substance use during a depressive episode. Researchers hypothesize that people with bipolar symptoms may abuse substances to experience an increased sense of euphoria or to mitigate symptoms of anxiety or other mood issues.[3]

Substances can also cause or increase the severity of certain mood disorders. Substance-induced disorders occur due to abusing substances and medications. Symptoms related to bipolar disorder that can be exacerbate by drug use include the following:[4]

  • Anxiety
  • Depression 
  • Psychotic episodes
  • Manic symptoms, including an elevated and expansive mood
  • Irritable mood

Substance-induced bipolar disorder can occur during active substance use, after using, and while withdrawing from substances. Manic symptoms of bipolar disorder are mostly liked to be exacerbated by substance use, though depression (including a notably decreased interest in all aspects of life) can also occur.[4] 

Impact on Life & Relationships 

Mental health and substance use disorders can greatly interfere with one’s personal life and ability to maintain healthy relationships. When someone is struggling with substance abuse and mental health issues, they aren’t the only ones impacted by it—their family and friends are as well. Such conditions cause serious negative effects on work, issues maintaining a stable lifestyle, and problems in the family unit. 

Families affected by dual diagnoses are encouraged to identify strategies that support the individual without supporting their drug use, such as buying the person food rather than giving them money to buy food on their own. Families can educate themselves as much as possible about the conditions their loved one is struggling with to gain empathy and understanding of the person’s experience.[6]

Interventions can be used to positively pressure someone to seek treatment. For willing family members, engaging in family therapy can also be highly beneficial. In this type of therapy, the impact of substance abuse and the mental health condition on the entire family unit is addressed, open communication in a safe space is encouraged, and strategies to support the individual in recovery can be discussed and established together.[7]

Integrated Treatment Options for Dual Diagnosis

People with dual diagnoses, such as the co-occurrence of bipolar disorder and substance use disorder, require comprehensive treatment of both disorders simultaneously. Treating one condition without treating the other is likely to result in poor treatment outcomes. Treatment for co-occurring bipolar disorder and substance use disorder usually includes both medication and psychotherapy.[5]

For bipolar disorder, medications are used to help stabilize the person’s mood. Studies have found that some medications designed to treat bipolar disorder also help to manage cravings for substances like alcohol. Regardless of the presence of bipolar disorder, medication-assisted treatment is encouraged for the treatment of substance use disorders, when appropriate.[5]

Integrated care for the treatment of co-occurring disorders is recommended when possible. Integrated treatment addresses the needs of the whole person, including their medical and mental health needs. 

For bipolar disorder and substance abuse, this kind of care aims to educate the client about how the two conditions impact one another. Individuals learn how substance use can increase their symptoms of bipolar disorder and how neglecting to take their medication for bipolar disorder can increase their risk of substance abuse. [5]

Overview of the Treatment Journey 

Both bipolar disorder and addiction are lifelong illnesses that cannot be fully cured but can be well-managed. Treatment may begin in an inpatient or outpatient treatment program, where participants safely withdraw from all substances of abuse and learn about maintaining sobriety through a variety of programs.  

However, treatment for bipolar disorder and addiction requires ongoing care and support and does not end when formal rehab is over. Care for both conditions must be regularly evaluated and updated to address the person’s changing needs. 

Symptoms of bipolar disorder can change over time, just as addiction recovery needs change.[1] The goal of treatment is for participants to learn effective coping strategies to maintain sobriety on their own after formal treatment programs end. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) encourages providers and individuals in recovery from bipolar disorder and addiction to adopt a focus on wellness and recovery rather than remaining focused on illness and disease. Such a shift in mindset takes a strengths-based approach to managing the co-occurring disorders.[5]

Diet, exercise, and other lifestyle changes are essential for overall health and well-being, especially for people with dual diagnoses like bipolar disorder and addiction. Adopting healthy living habits supports a healthy body and mind, and this equips you to best handle any adverse symptoms and situations you are faced with. 

Updated February 16, 2024
Resources
  1. Bipolar disorder. National Institute of Mental Health. Published February 2023. Accessed January 25, 2024.
  2. Bipolar disorder and comorbid use of illicit substances. Preuss, U., Schaefer, M., Born, C., and Grunze, H. Medicina. 2021;57(11).
  3. Bipolar disorder and addictions: The elephant in the room. Stokes, P., Kalk, N., and Young, A. The British Journal of Psychiatry. 2017;211(3):132-134.
  4. Substance-induced mood disorders. Revadigar, N. and Gupta, V. U.S. National Library of Medicine. Published November 14, 2022. Accessed January 26, 2024.
  5. An introduction to bipolar disorder and co-occurring substance use disorder. Substance Abuse and Mental Health Services Administration. Published 2016. Accessed January 26, 2024.
  6. Understanding dual diagnosis: Mental illness and substance use. Mental Illness Fellowship Victoria. Published 2013. Accessed January 26, 2024.
  7. Family and social aspects of substance use disorders and treatment. Daley, D. Journal of Food and Drug Analysis. 201321(4):73-76.
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