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Co-Occurring Disorders: Bipolar & Addiction

While substance use disorder and bipolar disorder are two distinct conditions, they often appear alongside each other, just as many other mental health conditions that co-occur with addiction.

Bipolar disorder is a risk factor for developing substance use disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 30 to 50 percent of individuals with bipolar may develop an addiction.

What is bipolar disorder?

Bipolar disorder is a mental health condition that is often chronic and requires life-long treatment. It was once referred to as “manic depression” due to the way it presents with strong mood swings, ranging from intense highs (mania) to lows (depression). It can affect one’s energy, thinking, behavior, and sleep. Consequently, those who experience bipolar may struggle with their day-to-day activities and the functioning of their relationships.

These disorders are more common than you might think. According to the National Alliance on Mental Illness, approximately 2.3 million Americans have bipolar disorder. 

There are different types of bipolar disorder, including:

  • Bipolar I Disorder: characterized by intense mood swings from high manic states to low depressive states. This type occurs in 1-3 percent of the US population.
  • Bipolar II Disorder: described as still experiencing mood swings (from high to low) but not as extreme as bipolar I disorder. This type of bipolar occurs in 3-5 percent of the US population.
  • Cyclothymic Disorder: chronic mood swings that aren’t as intense, are less frequent, and occur for shorter periods than bipolar I and bipolar II.

What are the bipolar disorder symptoms?

Broadly speaking, the main symptoms of bipolar disorder fall into two categories: mania symptoms and depressive symptoms.

Manic episode symptoms

  • Having a lot of energy
  • Feeling jumpy/wired
  • Insomnia or restlessness
  • Talkativeness
  • Racing thoughts
  • Restlessness
  • Feeling impulsive or doing impulsive things like shopping
  • Irritability/agitation

Major Depressive symptoms

  • Feeling sad, low mood, empty
  • Hopelessness
  • Tiredness/exhaustion
  • Difficulty concentrating
  • Feeling like you aren’t getting enough sleep
  • Suicidal thoughts
  • Changes to appetite

Bipolar disorder treatment options

Like other mental health conditions, bipolar disorder is treatable with medication and/or therapy. There are also other lifestyle recommendations to support someone with bipolar, such as regular exercise, eating well, having a regular routine, keeping track of your mood cycles, staying in regular contact with a physician, taking medication as prescribed, and developing a support network that you connect with regularly.

If left untreated, people with bipolar are at greater risk for developing substance use disorder, becoming justice-involved, and feeling suicidal. According to the National Alliance on Mental Illness, approximately 40 percent of people with untreated bipolar disorder will engage in alcohol abuse or drug abuse. 

What are the risks of developing bipolar?

While bipolar can occur at any age, people are at a higher risk if they have a family history of mental illness. Addiction and bipolar are risk factors for one another; experiencing bipolar disorder can lead people to misuse substances, and substance use can cause changes in the brain that create a higher risk of developing bipolar disorder.

Substance use can also exacerbate symptoms of bipolar disorder. 

The relationship between addiction and bipolar disorder

As mentioned above, substance use disorders co-occur extremely often with bipolar I and bipolar II. As many as 56 percent of people with bipolar have a history of drug abuse and lifetime prevalence of substance use disorder in bipolar I disorder is as high as 40 percent.

The symptoms of substance use disorder can also mimic the signs of bipolar. For example, one can appear manic when taking stimulants like meth. Conversely, a person may appear depressed when using central nervous system depressants, like drinking a lot a lot of alcohol or taking opioids. 

The substances most commonly misused by people with bipolar include alcohol and cannabis, followed by cocaine and then opioids. Research has consistently shown that substances have a negative effect on bipolar and can cause more frequent and prolonged episodes, as well as poor adherence to treatment plans and lower quality of life. For this reason, it is recommended that people who have a dual diagnosis of bipolar disorder and substance use disorder seek treatment for both conditions. 

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