Substance Abuse and Bipolar Treatment

What Is Bipolar Disorder?

Bipolar disorder is a mental illness that involves swings in a person’s mood, energy, activity levels, and concentration. It’s constituted by alternating episodes of depression and mania/hypomania.[1]

Mania is the more severe version of hypomania, but they both involve extreme energy episodes. Depression involves extreme episodes of lethargy and irritability. The swings back and forth from energy to lethargy constitute “bipolar disorder.”

Types of Bipolar Disorder

Bipolar disorder can look different from person to person, and diagnosis depends on the type, length, and severity of the mood episodes a person experiences. Some people have clear manic episodes, while others have hypomanic episodes, depressive episodes, or ongoing mood instability that does not fit neatly into one category. A mental health professional will also consider medical history, substance use, anxiety disorders, other mental disorders, and whether symptoms may be caused or worsened by drugs, alcohol, medications, or another health condition.

• Bipolar I disorder: Bipolar I involves at least one manic episode. Mania is more severe than hypomania and may cause major impairment, risky behavior, hospitalization, psychotic symptoms, or safety concerns. Bipolar patients with bipolar I may also experience depressive episodes, but a depressive episode is not required for the diagnosis.
• Bipolar II disorder: Bipolar II involves at least one hypomanic episode and at least one major depressive episode. Hypomania is less severe than mania, but it can still affect sleep, energy, judgment, mood, and behavior. Many people with bipolar II seek help during depression rather than hypomania, which can make bipolar symptoms harder to recognize at first.
• Cyclothymic disorder: Cyclothymic disorder, sometimes called cyclothymia, involves ongoing shifts between hypomanic symptoms and depressive symptoms that do not fully meet the criteria for bipolar I or bipolar II. These mood changes may be less intense than full manic or depressive episodes, but they can still interfere with relationships, work, school, and daily stability.
• Other specified or unspecified bipolar and related disorders: These diagnoses may apply when someone has bipolar symptoms that cause distress or impairment but do not fully match bipolar I, bipolar II, or cyclothymic disorder. This may happen when symptoms are significant but shorter in duration, unclear in pattern, or complicated by co-occurring mental disorders, substance use, or medical conditions.

You may also hear the term bipolar affective disorder. This is not usually a separate type of bipolar disorder. It is another name sometimes used for bipolar disorder in medical or clinical settings.[2] Because several factors can increase the risk of developing bipolar disorder or complicate diagnosis, a professional evaluation is important before starting treatment.

Common Symptoms of Bipolar Disorder

A professional must diagnose bipolar disorder. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for manic episodes within Bipolar I and Bipolar II disorder constitute the following seven criteria:[3]

Manic Symptoms

Mania and hypomania both involve elevated or unusually energized mood, but mania is more severe and may cause major impairment, psychotic symptoms, hospitalization, or safety concerns. Common manic or hypomanic symptoms may include:

• Increased energy or activity
• Needing much less sleep than usual
• Rushed or excessive talking
• Racing thoughts
• Difficulty focusing or staying on task
• Restlessness or purposeless movement
• Inflated confidence or grandiosity
• Irritability or agitation
• Impulsive or risky behavior, such as reckless spending, substance use, unsafe sex, or dangerous driving

Substance use can trigger or worsen mood episodes, especially when manic symptoms are already emerging; in acute mania, clinicians may also need to watch for substance use disorder symptoms that can overlap with or intensify risky behavior.

Depressive Symptoms

The depressed phase of bipolar disorder involves depressive episodes with a significant drop in mood, energy, motivation, and daily functioning. Common depressive symptoms may include:

• Persistent sadness, emptiness, or hopelessness
• Loss of interest or pleasure in activities
• Fatigue or low energy
• Sleeping too much or having trouble sleeping
• Changes in appetite or weight
• Slowed movement, speech, or thinking
• Trouble concentrating or making decisions
• Feelings of guilt, worthlessness, or shame
• Irritability
• Thoughts of death, self-harm, or suicide

Because bipolar disorder can overlap with substance use, anxiety disorders, and other mental disorders, a professional evaluation is important before diagnosis or treatment.

Bipolar Psychotic Breaks

Bipolar psychotic breaks are a severe form of bipolar disorder. People who experience psychotic breaks are disconnected from reality.

They may experience delusions, hallucinations, paranoia, poor insight, anxiety, agitation, and hostility.[4] People experiencing a psychotic break can be a danger to themselves and others, and co-occurring substance use can further raise suicide risk during psychosis. Those experiencing a psychotic break have an increased risk of suicidal thoughts and ideation. In severe presentations such as psychotic breaks, co-occurring substance use is also linked to poorer clinical outcomes.

Bipolar Disorder Statistics

Bipolar Disorder is a chronic mental illness characterized by significant mood swings, including manic/hypomanic and depressive episodes, not merely a side effect of medication. It can affect individuals over a lifetime, with symptom severity and frequency variations. 4.4% of adult Americans have reported experiencing bipolar disorder at some point in their lives.[5] That’s nearly 15 million people in 2023. In a population based prevalence study and national epidemiologic survey of the general population, prevalence data also show that 40–60% of people with bipolar disorder have substance use disorders, with lifetime prevalence reaching as high as 56%. Bipolar disorder is also associated with about an eightfold increase in substance dependence risk, and Bipolar I disorder carries a 5.8-times increased risk of SUD.

In the last year, 2.9% of men and 2.8% of women have reported experiencing bipolar disorder.[6] Regarding bipolar-induced impairment, the numbers are heavily skewed towards “serious” impairment.  82.9% of people with bipolar disorder report a “serious” degree of impairment, versus just 17.1% who reported a “moderate” degree of impairment.[7]

Co-Occurring Bipolar Disorder and Substance Use Disorder

Bipolar dual diagnosis involves the diagnosis of a secondary co-occurring disorder alongside bipolar disorder. Such as substance abuse and bipolar disorder co-occurring. The symptoms of each disorder can intensify the effects of the other.

For instance, the deep periods of acute bipolar depression could trigger the need to experience euphoria via substance abuse. After the euphoric highs are achieved during substance abuse, the withdrawal period could launch the sufferer right back into acute bipolar depression. This depression could trigger the desire for substance-related relief, and so on.

Why Bipolar Disorder and Addiction Often Occur Together

Bipolar disorder and addiction often occur together for more than one reason. Self-medication is a common response to the distress of bipolar disorder, including distress linked to sleep problems or anxiety symptoms. Some people may use alcohol or drugs to cope with depressive episodes, sleep problems, agitation, anxiety, or emotional distress. Others may be more likely to use substances during manic or hypomanic episodes, when impulsivity, risk-taking, reduced sleep, and increased energy can make consequences feel less immediate, and this pattern can become a risk factor for a more severe course.

Substance use can also make bipolar symptoms harder to stabilize. Alcohol or drugs may disrupt sleep, worsen mood swings, and mimic or intensify bipolar symptoms, making it more difficult to tell whether symptoms are related to bipolar disorder, substance use, withdrawal, or all three. This overlap can complicate diagnosis and treatment, especially when mood symptoms and substance-related effects look similar, and substance misuse can further worsen bipolar disorder symptoms. Substance use disorders can also make it harder to follow treatment plans consistently and can worsen treatment outcomes.

Research suggests that bipolar disorder and substance use disorders may share several contributing factors, including genetic vulnerability, early stress, impulsivity, reward sensitivity, and mood instability, as well as shared neurobiological pathways linked to addiction.[8] This does not mean one condition always causes the other. It means treatment often needs to address both conditions together so that mood symptoms, cravings, relapse risk, medication needs, and coping skills are part of the same care plan, especially since co-occurring disorders are linked to greater mood instability, rapid cycling bipolar disorder, and hospitalization.

Bipolar Residential Treatment

There are many options for treatment centers for bipolar disorder, and one is residential or inpatient treatment. Residential programs for bipolar disorder are where patients live as “residents” in a structured environment and receive intensive, 24-hour support and therapy from medical professionals.

In these environments, residents are generally restricted to the campus day and night with some approved outings. Residential treatment centers may be a good option for those with severe or extreme disorders who need constant supervision or who have failed to complete outpatient treatment in the past.

Medication for Bipolar Disorder in Adults

Valproate (Epilim) is one of several treatment medications used in pharmacological treatment for adults with bipolar disorder, and it has mood-stabilizing properties.[9] Other similar drugs for bipolar disorder could include:

• Divalproex sodium (Depakote)
• Lamotrigine (Lamictal)
• Lithium (Lithobid)
• Carbamazepine (Tegretol, Equetro)

Mood stabilizers are often central to treatment, and atypical antipsychotics may also be used in some cases. Lamotrigine can also play a role in lamotrigine therapy for bipolar depression maintenance.

Lithium therapy via Priadel or Camcolit has been shown to help stabilize moods, and lithium treatment may support mood stabilization; lithium and valproate may reduce substance use in some bipolar patients. Pharmacological treatment should also be coordinated carefully when alcohol dependence, cocaine dependence, or other substances are involved.

CBT for Bipolar Disorder

While medication plays a crucial role in managing bipolar disorder, integrating psychotherapeutic approaches like Cognitive Behavioral Therapy (CBT) is essential for comprehensive treatment and long-term recovery. Cognitive Behavioral Therapy (CBT) is a type of talk therapy where you identify unhealthy thought patterns contributing to your bipolar disorder.

It involves structured therapy sessions with a trained therapist who can help identify and replace your negative, subjective thoughts with more realistic, objective ones. Incorporating CBT into bipolar treatment could be an effective way to manage a co-occurring substance abuse disorder.

Other common dual-diagnosis treatments for bipolar disorder and substance use disorder may include:

• Psycho-education
• Experiential
• Family Therapy

If you require further information, have inquiries, or seek assistance regarding potential treatments for bipolar disorder, don’t hesitate to contact our Nashville mental health treatment center.

Cost of Treatment for Bipolar Disorder and Substance Abuse

The cost of bipolar dual-diagnosis treatment can depend on several factors. Your needs, history, and desired lifestyle during treatment greatly affect the cost.

The higher level of care you need, the more expensive it will be to treat you. The length of stay, intensity of care, and different kinds of therapies chosen will all play a part in determining the cost.