Co-Occurring Bipolar and Substance Use Disorder

According to findings from the National Alliance on Mental Illness (NAMI), 32.1% of adults in the U.S. with a mental illness also experienced a substance use disorder in 2020.¹ The combination of substance use disorders and mental illness is known as co-occurring disorders or, in previously used terminology, a dual diagnosis.^2,3 Bipolar disorder is a prevalently co-occurring mental health issue among people who struggle with substance use disorders.³

Fortunately, there are effective treatment approaches to simultaneously address both co-occurring mental health issues such as bipolar disorder and substance use disorders.³ Our guide will help you learn about co-occurring disorders, risk factors for bipolar and substance use disorders, and how to find treatment near you.

What is Bipolar Disorder?

Bipolar disorder is a mental illness that causes atypical shifts in a person’s mood, energy, and activity levels.⁴ This disorder can have an impact on a person’s daily life, affecting interpersonal relationships and the ability to concentrate and carry out day-to-day tasks.⁴ It is estimated that 4.4% of adults in the United States will experience bipolar disorder symptoms at some point in their lives.⁵

Bipolar disorder symptoms are variable and will present differently from person to person. How symptoms appear, their frequency, duration, and severity will determine which type of bipolar disorder a person has. Because this condition has many variables, it’s difficult to outline specific symptoms for every person. Broadly speaking, these symptoms break down into three categories: depressive episodes, manic episodes, and hypomanic episodes.

Depressive episodes. These are the “lows” of bipolar disorder. Symptoms can include:⁴

• Feelings of hopelessness.
• Lack of energy.
• Difficulty concentrating.
• Sleep disturbances; sleeping too much or not enough.
• Forgetfulness.
• Anhedonia (a loss of interest in things and activities that were once enjoyable).
• Difficultly making decisions.
• Suicidal ideation.

Manic episodes. These are the “highs” of bipolar disorder. Accompanying signs and symptoms can include:⁴

• Feelings of extreme joy, being wired or jumpy.
• A decreased need for sleep.
• Excessively talkative; talking fast and about many topics.
• Experiencing racing thoughts.
• Risk-taking behaviors including unsafe sex, gambling, drinking excessively, or drug taking.
• Feelings of invincibility, or like they are “all powerful.”

Hypomanic episodes. These are similar to manic episodes but less extreme. Some individuals may not know they are experiencing bouts of hypomania, particularly after a depressive episode. Still, those around them may notice unusual changes in behavior.

Co-Occurring Bipolar Disorder and Drug or Alcohol Addiction

Studies support a link between mental health and substance use disorders. When someone struggles with a mental illness they are more likely to develop a substance use disorder than someone who does not have a mental health concern.³ Conversely, people who have a substance use disorder appear to be at higher risk of developing certain mental health issues.³

In 2020, an estimated 1/3 of those with a mental health disorder also struggled with a substance use disorder.¹ People who specifically have bipolar disorder may be even more likely to receive such a dual diagnosis, with research estimates ranging from 30-50% of people with either bipolar I or II developing a substance use disorder during their lifetime.⁶

Can Bipolar Disorder Lead to Drug or Alcohol Addiction?

Despite substance use disorders and mental health issues prevalently co-occurring, each condition is not necessarily caused by the other. In other words, bipolar disorder doesn’t necessarily give rise to eventual drug or alcohol addiction, nor vice versa. It often remains difficult to pinpoint cause or directionality for these conditions; instead, it is often theorized that mental health and substance use disorders commonly co-occur as a result of certain shared risk factors—such as genetic vulnerabilities and similar brain region involvement—that contribute to the development of both.

In some cases, another potential explanation of the co-occurrence involves people with bipolar disorder turning to substances to manage symptoms of the condition. A third theoretical model suggests that problematic substance use results in certain neurochemical changes in specific parts of the brain, with similar disruptions being involved in the development of certain mental disorders in susceptible individuals.⁷

Risk Factors for Bipolar Disorder

Though it continues to be the subject of scientific research, risk factors that increase the likelihood of developing bipolar disorder may occur at a both a genetic and environmental level, and likely involve the interaction of both. Examples of these risk factors include:⁸

• First-degree relative with the disorder.
• Family history of other mental health disorders.
• Exposure to trauma or prolonged periods of stress.
• Substance misuse.

Risk Factors for a Substance Use Disorder

Several of the risk factors for substance use disorder parallel those of bipolar disorder. Factors that may contribute to the development of high-risk patterns of substance use include:⁹

• Family history of substance use disorders.
• Mental health issues.
• Trauma, particularly in childhood.
• Family rejection of identity or sexual orientation.
• Association with others who use substances.

What Are the Symptoms of Co-Occurring Bipolar Disorder & Addiction?

Certain symptoms of bipolar disorder and substance use disorder may overlap, which can makes the diagnosis of such a mental health condition more difficult.⁶ It is not uncommon for symptoms of bipolar disorder to be misdiagnosed due to the similar symptoms that many substances can cause or vice versa.⁶ These symptoms can vary depending on the type of substance the person is misusing and whether the symptoms in question are associated with active intoxication or withdrawal.⁶

For instance, if a person is misusing cocaine it can cause increased energy and paranoia.⁶ These symptoms may be mistaken as episodes of mania. Conversely, the effects of cocaine misuse may be solely attributed to its use and the symptoms of bipolar may be missed.

How to Diagnose Co-Occurring Bipolar Disorder and Substance Use Disorder

Only a qualified mental health or medical professional can diagnose bipolar or substance use disorder. In order to diagnose co-occurring disorders, a doctor or other addiction treatment professional may perform different assessments, including:¹⁰

• Screening tools such as the Composite International Diagnostic Interview for Bipolar Spectrum Disorders.
• Thorough interview to get a history of substance use behavior and mental health symptoms.
• Use of the Diagnostic and Statistical Manual of Mental Disorders for individual diagnoses of each involved mental health or substance use disorder.
• Lab tests or other blood work to rule out other possible causes of presenting symptoms.

How to Help a Loved One with Bipolar Disorder and Addiction

If you know someone struggling with co-occurring bipolar and substance use disorder, you may be wondering how you can help them. You can take steps to support and assist your loved one to reach out to get the professional treatment they need.

Ways to help your loved one with co-occurring disorders includes:

• Educate yourself about addiction, co-occurring disorders, and bipolar disorder.
• Plan what you want to say and write it down. Remember to remain empathetic, avoid stigmatizing language, and do not blame or shame your loved one.
• Choose a neutral time and place to have a conversation with your loved one.
• Set boundaries and maintain them.
• Research inpatient addiction treatment in New Jersey.
• Offer to go with them to the doctor or to tour rehab facilities.
• Seek support and help for yourself, such as joining a support group, taking with a trusted friend or family member, or getting into therapy.
• Help your loved one find support groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).

What to Expect in Bipolar and Substance Use Disorder Treatment

There is no one-size-fits-all approach to treatment for co-occurring disorders. Integrated  approaches that address both the substance use and mental health disorder simultaneously can be especially helpful in managing symptoms of both^10,11

Professional addiction treatment specialists will conduct a thorough assessment to create the most effective treatment plan, which will incorporate both evidence-based therapies (e.g., medications, cognitive-behavioral therapy, relapse prevention training) and adjunct therapeutic approaches (such as music therapy and mindfulness). Therapy sessions may consist of a mixture of both group and individual therapy.

Treatment for Co-Occurring Bipolar and Substance Use Disorder

If you or someone you love is struggling with both bipolar and substance use disorder, effective treatment is available. At our inpatient addiction treatment center in New Jersey we have proven programs to address co-occurring disorders. Our different levels of addiction treatment enable us to help people achieve positive treatment outcomes and meaningful recovery.

Sunrise House Treatment Center offers evidence-based treatment and different levels of addiction treatment to help people with bipolar and substance use disorders. to find out if your insurance covers some or all of your co-occurring disorder treatment. You can also contact our helpful admissions navigators at to learn more about our center, ways to pay for rehab, and how you can get started with rehab admissions.