Table of Contents

Table of Contents

Contributors & Editors

Julie Miller

Addiction & Mental Health Writer

Last Update on July 7, 2023

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Bipolar disorder and addiction often intersect, forming a complex condition known as dual diagnosis.

This intricate interplay can amplify challenges, deepening the highs and lows experienced by those dealing with these disorders.

In this article, we delve into the complexities of bipolar disorder intertwined with addiction, aiming to provide a clear understanding and effective strategies for those navigating this multifaceted landscape.

Understanding Bipolar Disorder


Bipolar disorder, formerly known as manic-depressive illness, is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

These mood episodes can last from several days to many weeks, and they can interfere significantly with daily life tasks and long-term plans.

Symptoms during a manic episode might include feelings of elation, unusually high energy, decreased need for sleep, and racing thoughts, which may lead to rapid speech and impulsive decisions.

In a depressive episode, symptoms might involve feelings of sadness, hopelessness, low energy, excessive sleep, and in severe cases, thoughts of death or suicide.

It’s important to note that not everyone’s experience with bipolar disorder is the same, as there are several types of this condition, each with its own pattern of mood swings and varying levels of intensity.

Phases of Bipolar Disorder Symptoms
Manic/Hypomanic Episode
  • Feelings of elation and euphoria
  • Unusually high energy
  • Decreased need for sleep
  • Racing thoughts
  • Rapid, pressured speech
  • Impulsive, often reckless decisions
Depressive Episode
  • Feelings of sadness and hopelessness
  • Low energy and lethargy
  • Excessive sleep or insomnia
  • Indifference to activities once enjoyed
  • Difficulty concentrating
  • In severe cases, thoughts of death or suicide



Type of Bipolar Disorder Definition
Bipolar I Disorder Defined by the presence of at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes. Manic episodes in Bipolar I can be severe enough to require immediate medical attention.
Bipolar II Disorder Involves at least one major depressive episode and at least one hypomanic episode, but never a full manic episode. High mood swings in Bipolar II don’t reach the extreme levels seen in Bipolar I.
Cyclothymic Disorder, or Cyclothymia A milder form of bipolar disorder characterized by many periods of hypomanic symptoms and periods of depressive symptoms lasting for at least two years (one year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for hypomanic and depressive episodes.



Bipolar disorder is a complex condition that’s thought to arise from an intricate interplay of genetic and environmental factors.

Genetically, bipolar disorder tends to run in families, suggesting a solid hereditary component1.

Research has indicated that specific genes, although not yet fully identified, might render individuals more susceptible to developing the disorder.

However, not everyone with a genetic predisposition will develop bipolar disorder, pointing to the influence of environmental factors.

Chronic stress, traumatic events, substance abuse, and major life changes can act as triggers in susceptible individuals, potentially initiating the onset of bipolar symptoms or episodes.

It’s also been suggested that changes in brain structure and function, potentially driven by a combination of genetic and environmental influences, may be involved.

Therefore, bipolar disorder is best understood as a multifactorial condition, influenced by a variety of genetic and environmental components.



Bipolar disorder can significantly impact an individual’s daily life, disrupting their ability to function at work, school, or socially due to extreme mood swings.

During manic or hypomanic episodes, individuals may have bursts of high energy, leading to impulsivity and risk-taking behaviors, such as reckless driving or overspending.

These behaviors can lead to legal and financial problems, strained relationships, or job loss. In contrast, during depressive episodes, individuals may experience intense feelings of sadness, hopelessness, and a lack of energy.

This can lead to an inability to complete daily tasks, withdrawal from social activities, and difficulties in maintaining personal and professional relationships.

Furthermore, individuals with bipolar disorder may also have difficulty sleeping, which can exacerbate mood swings, impact cognitive function, and further disrupt daily life.

The potential for self-harm or suicide during depressive episodes also poses a significant risk.

Therefore, the impact of bipolar disorder on daily life can be substantial and far-reaching.


The Intersection of Bipolar Disorder and Addiction


Dual diagnosis, also known as co-occurring disorders, refers to the presence of both a mental health disorder and a substance use disorder in an individual.

This can be any combination of mental health disorders (like anxiety, depression, or bipolar disorder) and addiction (such as alcoholism, drug addiction, or gambling addiction).

It’s a particularly complex issue because the two conditions can interact in a way that exacerbates both.

For instance, a person might use substances as a form of self-medication for their mental health disorder, leading to the worsening of their mental health symptoms, which in turn can increase reliance on the substance – creating a destructive cycle.

Similarly, substance abuse can contribute to the development or worsening of mental health conditions.

Treating dual diagnosis can be challenging because both conditions need to be addressed simultaneously for effective recovery, requiring integrated and comprehensive treatment approaches.



The relationship between bipolar disorder and addiction is complex and multifaceted.

Research has shown a high rate of co-occurrence, with studies suggesting that up to 60% of people with bipolar disorder will experience a substance use disorder in their lifetime2.

This link may be influenced by several factors.

First, the self-medication hypothesis posits that individuals may use substances to manage or escape the extreme mood swings associated with bipolar disorder.

For instance, alcohol or sedatives might be used to alleviate manic symptoms, while stimulants could be used to counteract depressive symptoms.

Second, individuals in a manic state may have decreased impulse control, leading to risky behaviors, including substance use.

The intense highs of mania may also lead individuals to seek out further euphoria through drugs or alcohol.

Third, bipolar disorder and addiction share common genetic and environmental risk factors, which might predispose an individual to develop both conditions.

Lastly, substances can interfere with sleep patterns, which can destabilize mood and contribute to the onset of a bipolar episode.

Thus, the correlation between bipolar disorder and addiction is a significant concern that requires integrated care strategies.


The Highs: Mania and Addiction


Manic episodes in bipolar disorder are characterized by periods of extreme elation, high energy, and hyperactivity, lasting at least one week.

During a manic episode, individuals may exhibit an inflated sense of self-confidence, decreased need for sleep, rapid and pressured speech, racing thoughts, and a tendency to engage in risky behaviors.

They may also be easily distracted and may undertake multiple projects at once, often without the capacity to finish them.

In severe cases, a manic episode can include psychotic symptoms, such as hallucinations or delusions, and may require hospitalization.



The link between mania and addiction is complex and multifaceted.

During manic episodes, characterized by a heightened state of energy and euphoria, individuals with bipolar disorder often exhibit impulsive and risk-taking behaviors.

This could include substance abuse, as the individual may seek to enhance their feelings of elation or attempt to self-regulate their elevated mood state.

Furthermore, the decreased need for sleep and rapid, racing thoughts that accompany mania can lead to increased drug or alcohol use.

The impulsivity and poor judgment associated with mania can also make it more difficult for individuals to resist the urge to use substances3.

Additionally, certain substances of abuse, such as stimulants, can mimic or even trigger manic episodes, creating a vicious cycle.

This complex relationship between mania and addiction underscores the need for integrated treatment approaches that address both issues simultaneously.



The consequences of substance abuse during manic episodes can be severe and wide-ranging.

Substance use can intensify the symptoms of mania, such as increased energy, impulsivity, and risky behaviors, leading to potentially dangerous situations.

It can also extend the duration of the manic episode, leading to a longer period of instability.

The use of substances during manic episodes can exacerbate the challenges of managing bipolar disorder, making it harder to stabilize mood and return to a normal level of functioning.

Furthermore, addiction can interfere with the effectiveness of medications used to treat bipolar disorder and can complicate the process of diagnosing the condition accurately.

Over time, addiction can contribute to a more severe course of bipolar disorder, including more frequent and intense episodes.

Additionally, it can lead to a host of other negative outcomes, such as financial problems, strained relationships, legal issues, and poor physical health.

Thus, addressing addiction is a critical aspect of managing bipolar disorder.

The Lows: Depression and Addiction


Depressive episodes in bipolar disorder are characterized by a period of intense sadness, hopelessness, and a lack of energy or interest in activities that typically bring pleasure.

These episodes, which must last for at least two weeks to meet diagnostic criteria, may also include symptoms like changes in appetite or weight, sleep disturbances, feelings of worthlessness or guilt, difficulty concentrating, and thoughts of death or suicide.

The severity of these symptoms can range from mild to severe, with severe episodes potentially causing significant impairment in daily functioning.



Depression and addiction often occur together, creating a cycle that can be difficult to break.

Individuals with depression may turn to substances as a form of self-medication, seeking temporary relief from the intense feelings of sadness, hopelessness, and other distressing symptoms.

Unfortunately, while substances might provide a temporary reprieve, they often exacerbate depression symptoms in the long term, leading to a worsening of the depressive episode.

Additionally, the physiological effects of substance abuse can lead to mood changes and depressive symptoms, creating a reciprocal relationship where depression can lead to substance abuse, and vice versa.

Furthermore, both conditions share common risk factors, such as genetic vulnerabilities and exposure to stress or trauma, which can increase the likelihood of their co-occurrence.

Therefore, the relationship between depression and addiction is a complex interplay that requires integrated treatment approaches.



The consequences of substance abuse during depressive episodes can be particularly devastating.

Substance use can exacerbate the symptoms of depression, intensifying feelings of sadness, lethargy, and hopelessness.

Furthermore, substances often have a depressive effect on the brain, which can prolong the duration of the depressive episode and potentially lead to more severe depressive symptoms over time.

The withdrawal symptoms from substances can also mirror or worsen depressive symptoms, such as sleep disturbances, loss of energy, and cognitive difficulties.

In addition to impacting the course of depression, addiction can interfere with the effectiveness of treatments for depression and can lead to misdiagnosis.

Over time, the repeated use of substances to cope with depressive symptoms can lead to dependence or addiction, creating additional health, social, and economic challenges.

In the most severe cases, the combination of depression and addiction can increase the risk of self-harm or suicide, underscoring the need for comprehensive and integrated treatment strategies4.

Dual Diagnosis: Challenges in Treatment


Treating individuals with both bipolar disorder and addiction, or dual diagnosis, presents several complexities.

First, both conditions can exacerbate each other’s symptoms, making each disorder more severe and difficult to treat.

Second, they may interfere with the effectiveness of each other’s treatments.

For instance, substance abuse can reduce the effectiveness of medications used to manage bipolar disorder and can complicate the side effect profiles of these medications.

Moreover, detoxification from substances can trigger bipolar episodes, and mania or depression can increase the likelihood of relapse in substance use.

Third, diagnosis can be challenging, as the symptoms of substance abuse can mimic or mask those of bipolar disorder.

Lastly, the added challenge of dealing with the stigma associated with both conditions can often prevent individuals from seeking help5.

Therefore, the management of co-occurring bipolar disorder and addiction requires an integrated and comprehensive approach that addresses both conditions simultaneously.


Emerging Treatments and Therapies


Traditional treatment methods for bipolar disorder and addiction focus on a combination of pharmacotherapy and psychotherapy.

For bipolar disorder, mood stabilizers such as lithium or anticonvulsants are commonly used to manage the symptoms.

Antipsychotics and antidepressants may also be used depending on the specific symptoms present.

For addiction, detoxification is often the first step, followed by medications that help manage the initial withdrawal symptoms, cravings, and co-occurring mental health conditions.

Psychotherapy, including cognitive-behavioral therapy (CBT), is a crucial component of treatment for both conditions.

CBT helps individuals recognize and change harmful thought patterns that lead to destructive behaviors.

Other therapeutic approaches include family therapy, relationship therapy, and group therapy.

Self-help groups, like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), can also be a valuable source of support.



Cornerstone Healing Center is a respected trauma-based facility that focuses on providing specialized care for individuals facing dual diagnosis and addiction.

With a holistic approach, we prioritize the healing of the mind, body, and soul.

Our comprehensive treatment programs address the underlying trauma that often coexists with addiction, recognizing its profound impact on individuals’ well-being.

Through evidence-based therapies, personalized treatment plans, and a supportive environment, we aim to empower individuals to overcome their challenges, find lasting recovery, and achieve holistic healing.



While bipolar disorder and addiction are serious and complex conditions, it’s important to remember that they are also treatable, and countless individuals have successfully managed them and lead fulfilling, balanced lives.

If you or a loved one is struggling with dual diagnosis and/or addiction, please get in touch with us for a free and confidential assessment.

Remember, you are not alone in this fight; help is available, and it’s okay to reach out!



[1] Genetics of bipolar disorder

[2] The impact of substance use disorders on recovery from bipolar depression: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder psychosocial treatment trial

[3] The neurobiology of impulsivity and substance use disorders: implications for treatment

[4] Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage

[5] Stigma in people living with bipolar disorder and their families: a systematic review


Published: 7/7/2023

Main Contributor: Julie Miller

Co-Contributor: Susana Spiegel 


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Author & Reviewers

julie miller recovery writer and author
Julie is a recovery advocate, with over two years sober. She is a recovery speaker who believes people can change for the better. Her mission is to write factual, helpful information about addiction, treatment, and recovery. She believes that no one should be left in the dark about the process at any stage of their recovery.
lionel estrada lisac clinical director

Lionel is the Clinical Director of Cornerstone’s treatment facilities in Arizona. He has had over 4 years at Cornerstone. He is personally in recovery and passionate about helping others overcome substance abuse and mental health challenges, he is trained as an EMDR, adopting a trauma-informed approach to treat the underlying issues of conditions.

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