Medically Reviewed By

Brittany Kowalski, LCSW, ACS, CCS

Clinical Director, Speranza Behavioral Health · Last clinically reviewed July 2026

Bipolar Disorder and Addiction: A Guide to Dual Diagnosis Treatment

Bipolar disorder has one of the highest rates of co-occurring substance use disorder of any psychiatric condition — with studies consistently showing that 45–60% of people with bipolar disorder will develop a substance use disorder at some point in their lives. This is not coincidence. The neurobiological characteristics of bipolar disorder — mood instability, impulsivity, the vulnerability to highs and lows — create a powerful set up for substance use. And substance use, in turn, dramatically worsens bipolar course and treatment outcomes.

This guide explains the relationship between bipolar disorder and addiction, and what effective, integrated dual diagnosis treatment looks like.

Understanding Bipolar Disorder

Bipolar disorder is a mood disorder characterized by episodes of mania (or hypomania) — elevated, expansive, or irritable mood with increased energy, decreased need for sleep, and often poor judgment — alternating with episodes of depression — low mood, loss of energy, hopelessness, and potential suicidal ideation.

Bipolar I involves full manic episodes (often severe enough to require hospitalization) and depressive episodes. Bipolar II involves hypomanic episodes (less severe) and significant depressive episodes. Cyclothymia involves milder mood oscillations.

Why Bipolar Disorder and Addiction So Frequently Co-Occur

Mania and Substance Use

Manic and hypomanic episodes are characterized by:

• Impulsivity and poor judgment — substances are more likely to be used when impulsive decision-making is dominant
• Elevated mood and grandiosity — which can include conviction that one can use recreationally without consequences
• Decreased sleep — stimulants may be used to capitalize on the high-energy manic state
• Pleasure-seeking — the mania-driven drive for pleasurable, exciting experience amplifies substance appeal

Depression and Substance Use

The depressive phase of bipolar disorder drives substance use through the same self-medication pathway seen in unipolar depression:

• Alcohol and opioids for emotional numbing
• Stimulants to combat low energy and anhedonia
• Cannabis for sleep and mood management

Shared Neurobiological Roots

Bipolar disorder and addiction share neurobiological vulnerabilities — particularly in dopamine system regulation and prefrontal cortex function — that may explain both their high co-occurrence and the genetic associations between them.

How Substance Use Worsens Bipolar Disorder

This is the critical clinical point:

Substances destabilize mood cycles. Alcohol, stimulants, and other substances disrupt the neurobiological regulation of mood in ways that worsen bipolar cycling — potentially triggering manic episodes, deepening depressive episodes, and accelerating rapid cycling.

Substance use dramatically worsens medication adherence. Mood stabilizers (lithium, valproate, lamotrigine) require consistent blood levels to be effective. Substance use disrupts this consistency — through missed doses, pharmacological interactions, and the lifestyle disruption of active addiction.

Substance use masks diagnosis. Active substance use can produce mood symptoms that mimic bipolar disorder (stimulant-induced mania, alcohol-induced depression), making accurate diagnosis — and therefore effective treatment — more difficult.

What Integrated Treatment for Bipolar Disorder and Addiction Looks Like

Accurate Dual Diagnosis Assessment

The assessment at Speranza Behavioral Health separates substance-induced symptoms from primary mood disorder symptoms — typically by evaluating mood history during periods of extended sobriety. This distinction informs treatment planning significantly.

Mood Stabilization

Stabilizing bipolar mood swings is foundational to addiction recovery. Untreated or undertreated bipolar disorder makes addiction recovery nearly impossible. Our psychiatrists evaluate and manage:

• Mood stabilizers (lithium, valproate, lamotrigine)
• Atypical antipsychotics for bipolar mania
• Careful avoidance of antidepressant monotherapy (which can trigger mania)

MAT Considerations for Bipolar and Addiction

For opioid use disorder co-occurring with bipolar, buprenorphine is generally appropriate. For alcohol use disorder, naltrexone has some evidence. Benzodiazepines are generally contraindicated given their mood-destabilizing and addiction potential.

Integrated Psychotherapy

• CBT for bipolar disorder — addresses the thought patterns and behaviors of both depression and mania
• DBT — highly effective for the emotional dysregulation and impulsivity common in bipolar disorder
• Psychoeducation — understanding the illness, recognizing prodromal symptoms, building a wellness plan
• Interpersonal and Social Rhythm Therapy (IPSRT) — regulating daily rhythms (sleep, meals, activity) to stabilize mood cycles

Dual Diagnosis Treatment for Bipolar and Addiction at Speranza

Speranza Behavioral Health in Woodbury, NJ provides integrated dual diagnosis treatment for bipolar disorder and addiction in our PHP and IOP programs — with addiction psychiatry on staff for medication management.

Call (866) 814-0126 for a free, same-day assessment. We serve all of South Jersey.

Related Reading:

• What Is Dual Diagnosis?
• Depression and Addiction
• What Is DBT and How Does It Help Addiction?

About the Author

Brittany Kowalski

Brittany Kowalski is a licensed clinical social worker (LCSW) and behavioral health advocate at Speranza Behavioral Health in Woodbury, NJ. With over a decade of experience in addiction recovery and mental health treatment, she specializes in dual diagnosis care, trauma-informed therapy, and evidence-based outpatient programs serving South Jersey communities.