Dual Diagnosis: Bipolar Disorder and Substance Use Disorder

Bipolar disorders can co-occur with substance abuse disorders. Dual diagnosis provides unique interventions for each disorder in a separate, but integrated way. Many people suffer from bipolar disorder, but there are a range of treatments available to help you get on the road to recovery.

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.” 

Common Symptoms of Bipolar Disorder

Bipolar disorder must be diagnosed by a professional. 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:[2]

• Extravagant behavior
• Staying up through the night in a “feverish” energetic state
• Rushed or endless talking
• Racing thoughts
• Lack of attention or focus
• Movement that has no purpose
• Indulging in risky behavior

Three (3) out of seven (7) criteria must be met to qualify as a manic episode:

• If the manic episode lasts for 4 consecutive days, it is considered Bipolar II Disorder.[3]
• If the manic episode lasts for more than 7 consecutive days and requires hospitalization, it is considered Bipolar I Disorder.[4]

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.[5] People experiencing a psychotic break can be a danger to themselves and others. Those experiencing a psychotic break have an increased risk of suicidal thoughts and ideation.

Bipolar Disorder Statistics

Bipolar Disorder is not a side effect of medication. It’s a mental illness that affects people for an indeterminate length of time. 4.4% of adult Americans have reported experiencing bipolar disorder at some point in their lives.[6] That’s nearly 15 million people in 2023.

In the last year, 2.9% of men and 2.8% of women have reported experiencing bipolar disorder.[7] Regarding bipolar-induced impairment, the numbers are heavily skewed towards “serious” impairment.[8] 82.9% of bipolar disorder sufferers report a “serious” degree of impairment, versus just 17.1% who reported a “moderate” degree of impairment.

Bipolar Dual Diagnosis

Bipolar dual diagnosis involves the diagnosis of a secondary co-occurring disorder alongside bipolar disorder. Many people with bipolar disorder also suffer from a co-occurring substance abuse disorder. 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.

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 a popular antiseizure medication with mood-stabilizing properties for adults.[9] Other similar drugs for bipolar disorder could include:

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

Lithium therapy via Priadel or Camcolit has been shown to help stabilize moods.

CBT for Bipolar Disorder

Medication alone is not enough to facilitate true, lasting healing. Therapy is also beneficial to enhance 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 a Bipolar Dual Diagnosis 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:

• Psychoeducation
• Experiential
• Family Therapy

Cost of Dual Diagnosis Treatment for Bipolar Disorder

The cost of bipolar dual diagnosis treatment can depend on a number of factors. Your needs, history, and desired lifestyle during treatment play a big part in what the cost will be.

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.