Bipolar disorder is a complex mental health disorder characterized by intense emotional highs and lows. These mood swings can make it hard for people to function in their daily lives, often leading them to seek relief with unhealthy coping mechanisms, including substance use. However, substance use can be both a potential contributor to bipolar disorder and a consequence of bipolar disorder. The intertwined relationship between bipolar disorder and substance use disorder (SUD) can overlap and complicate a medical diagnosis, in turn rendering proper medical treatment a challenge. It is therefore critical to understand how the two conditions interact and can be effectively treated.
Read on for more information on co-occurring bipolar disorder or contact our drug and alcohol rehab in Atlanta to learn more about treatment.
What is Bipolar Disorder?
Formerly known as manic depression, bipolar disorder is a mental health disorder (though some medical practitioners may also refer to it as a “mood disorder”) marked by extreme mood swings. These mood swings range from emotional “lows,” or depression, to manic “highs,” or mania. Depression involves persistent feelings of sadness and a lack of interest in daily activities, while mania is its polar opposite, involving euphoria and impulsive behavior.
The mood swings that characterize bipolar disorder can occur up to several times per year, lasting days at a time. Some people experience long stretches of emotional stability between episodes while others cycle through their moods more quickly. Some even experience symptoms of depression and mania at the same time. These mood swings can interfere with sleep, decision-making, and the ability to function on a day-to-day basis.
There is no known cause of bipolar disorder, but research suggests some combination of genetic, biological, and environmental factors is involved. While bipolar disorder is a lifelong condition, it can be effectively managed with a treatment plan that usually includes prescription medication and therapy.1
Symptoms of Bipolar Disorder
The symptoms of bipolar disorder can vary, with different people experiencing milder symptoms than others. Symptoms of bipolar can also change with the seasons. Specific symptoms of bipolar disorder include:1,2
Symptoms of a Manic or Hypomanic Episode (“High”)
- Hyperactivity or agitation
- A distorted sense of well-being or overconfidence
- Needing less sleep than usual
- Being unusually talkative or talking fast
- Having racing thoughts or jumping from one topic to another, trouble concentrating
- Being easy to distract
- Poor impulse control (buying sprees, risky sexual behavior, etc.)
Symptoms of a Major Depressive Episode (“Low”
- Sadness, emptiness, hopelessness
- Irritability or anger
- Loss of interest or feelings of pleasure in most activities
- Weight loss or weight gain
- Sleeping too little or too much
- Restlessness
- Fatigue
- Feelings of worthlessness or guilt
- Difficulty concentrating or making decisions
- Suicidal ideation
The Types of Bipolar Disorder
Most people are diagnosed with three basic types of bipolar disorder, all of which involve clear changes in mood, energy, and activity. The three main types of bipolar disorder are:3
- Bipolar I disorder is defined by manic episodes that last at least seven days or when the manic symptoms are so severe that hospitalization is recommended. Depressive episodes, which also occur, are known to last two weeks or more. The experiencing of four or more episodes of mania or depression within a year is termed “rapid cycling.”
- Bipolar II disorder is defined by a pattern of depressive and hypomanic episodes, but the hypomanic episodes are less severe than the mania of bipolar I. Many people with bipolar II disorder spend extended periods in a persistent, low-grade depressive state.
- Also called cyclothymia, cyclothymic disorder is characterized by recurrent hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as strictly hypomanic or depressive episodes.
Bipolar disorder can start at any age, but usually it’s diagnosed in one’s teenage years or early 20s. Symptoms can differ from person to person and can vary over time.1
Is There a Connection Between Bipolar Disorder & Addiction?
There appears to be a strong connection between bipolar disorder and addiction. People diagnosed with bipolar run a higher risk for developing an addiction, either an alcohol use disorder (AUD), a substance use disorder (SUD), or a behavioral addiction, such as gambling.4 Additionally, there is a strong association between bipolar disorder and alcohol dependence.5
People often tend to turn to alcohol or drugs as a means of coping with or numbing themselves to the more severe symptoms of their bipolar disorder. This behavior is known as self-medication. While it may offer temporary escape from one’s mental health issues, self-medication can lead to a vicious cycle of substance use leading to worsening bipolar symptoms, which can lead to increased substance use, which in turn leads to worsening bipolar symptoms, and so on. The existence of two disorders in one patient is called comorbidity.
Does Bipolar Disorder Affect Addiction Treatment/Diagnosis?
Treating SUD in bipolar disorder patients requires a comprehensive and multidisciplinary treatment approach.4 While AUD can be somewhat easily diagnosed in patients with bipolar disorder, other SUDs are much harder to diagnose. This is due to the overlap in symptoms between SUD and bipolar. By the same measure and for the same reason, bipolar disorder can be hard to diagnose in SUD patients. The overlapping symptoms of SUD and bipolar disorder include:
- Poor impulse control
- Agitation
- Trouble concentrating
- Sleeping too little or too much
- Loss of interest or feelings of pleasure in most activities
- Anxiety
- Sadness, hopelessness
- Fatigue
Because of these overlapping symptoms, it is crucial that medical professionals consider the timing of the patient’s withdrawal from substances. Monitoring the patient’s symptoms over an extended period is necessary in making an accurate diagnosis.
Can You Treat Bipolar Disorder & Addiction at the Same Time?
It is absolutely possible to receive treatment for bipolar disorder and addiction at the same time. Many bipolar treatment programs specialize in what’s called dual diagnosis treatment, which addresses both SUDs and co-occurring mental health conditions like bipolar disorder together. Dual diagnosis treatment recognizes how these two disorders can influence each other to provide comprehensive, coordinated care.
Dual diagnosis treatment is in fact recommended for individuals with the co-occurring disorders of bipolar and SUD. This is because treating only one condition while neglecting the other can increase the risk of relapse or lead to a decline in the patients’ overall mental health.6
How is Bipolar Disorder & Addiction Treated?
Dual-diagnosis treatment of an SUD and bipolar disorder can take place in a variety of settings, though the treatment traditionally begins with a period of detox. Detox is the process of ridding toxic substances from the body while safely managing withdrawal symptoms.
Dual diagnosis treatment can include the use of prescription medications to manage the patient’s most intense withdrawal symptoms. This is known as medication-assisted treatment (MAT).
After detox, the patient moves through one or more treatments designed to help them maintain their sobriety and treat their bipolar symptoms. These treatments include residential treatment, partial hospitalization (PHP) treatment, intensive outpatient (IOP), outpatient (OP), and aftercare. As for which specific treatment plan is right for the patient depends on the specific patient and their needs, as well as their health history and physical makeup.
Whatever the treatment, patients typically receive therapy, counseling, and group support to help them develop coping mechanisms and avoid returning to substance use by working through their individual triggers. As they relate to addiction and recovery, triggers can be defined as a stimulus or occurrence that elicits the patient to want to use substances.7
Along with treating patients in various settings, Empowered Recovery Center in Atlanta also employs holistic techniques like mindfulness and breathwork that can further assist patients.
Medication Used to Treat Bipolar Disorder
Effective bipolar disorder treatment usually involves psychotherapy, individual and group support, and the use of prescription medications. Medications play a significant role in providing mood stabilization and managing the more severe episodes of bipolar. Medications used to treat bipolar disorder include:8
- Lithium is considered the “gold standard” for long-term maintenance therapy due to its effectiveness in preventing both the manic and depressive episodes that characterize bipolar disorder. Still, lithium requires regular medical monitoring due to its potential toxicity.
- Valproic Acid, or Valproate, is commonly used for acute mania and as a maintenance therapy, especially if lithium is ineffective or not well tolerated.
- Carbamazepine, an anticonvulsant, can be used as a mood stabilizer when lithium and valproate are deemed unsuitable. Carbamazepine requires regular blood and liver function monitoring due to its potential for dangerous side effects.
- Antipsychotics such as olanzapine and risperidone have been found effective in treating bipolar disorder’s manic episodes and, at times, bipolar depression.
- Benzodiazepines like diazepam are sometimes used temporarily to help stabilize the agitation and insomnia that can occur during acute manic episodes.
- Used with caution, antidepressants can be combined with a mood stabilizer to help manage the depressive episodes of bipolar disorder. However, if not balanced with an antimanic drug, antidepressants can trigger mania.
Treating Co-Occurring Bipolar Disorders in Atlanta
If you’re ready to break out of the vicious cycles of bipolar disorder and SUD, Empowered Recovery Center in Atlanta can help. We know that recovery is about more than saying “no.” It’s about having the strength to ask for help and being willing to work toward a future you can believe in.
Our treatment programs can be built around you and your needs. Whether you’re looking for partial hospitalization (PHP), intensive outpatient (IOP), or outpatient (OP) care, we can tailor an individualized treatment plan to meet you where you are. And after you’ve finished treatment, we will stay with you with one full year of free recovery coaching.
Wondering about insurance or what is involved in paying for rehab? Wonder no more, because our admissions team can answer any question you might have. We can even verify your benefits and assist you with out-of-network coverage plans. Reach out today!
References
- Mayo Clinic (2024). Bipolar Disorder. Mayo Foundation for Medical Education and Research. Retrieved May 21, 2025, from https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955
- National Health Service (2024). Bipolar Disorder. NHS England. Retrieved May 21, 2025, from https://www.nhs.uk/mental-health/conditions/bipolar-disorder/
- National Institute of Mental Health (2025). Bipolar Disorder. U.S. Department of Health and Human Services. Retrieved May 21, 2025, from https://www.nimh.nih.gov/health/publications/bipolar-disorder
- U.S. National Library of Medicine (2021). Bipolar Disorder and Comorbid Use of Illicit Substances. National Institutes of Health. Retrieved May 22, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC8623998/
- U.S. National Library of Medicine (2001). Drug abuse and bipolar disorder: comorbidity or misdiagnosis? National Institutes of Health. Retrieved May 22, 2025, from https://pubmed.ncbi.nlm.nih.gov/11356233/
- Cleveland Clinic (2022). Dual Diagnosis. Cleveland Clinic’s Health Library. Retrieved May 22, 2025, from https://my.clevelandclinic.org/health/diseases/24426-dual-diagnosis
- U.S. National Library of Medicine (2020). What Is the “Trigger” of Addiction? National Institutes of Health. Retrieved May 22, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC7186308/
- U.S. National Library of Medicine (2009). Medicines used in bipolar disorders (Pharmacological Treatment of Mental Disorders in Primary Health Care). National Institutes of Health. Retrieved May 22, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK143204/
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