DUAL DIAGNOSIS

Treatment For A Bipolar Dual Diagnosis

Q: What are the criteria for dual diagnosis?

There are currently no diagnostic criteria for dual diagnosis or co-occurring disorders, but dual diagnosis can be established based on the separate criteria for the mental health condition and the substance use disorder.

Q: Can someone be diagnosed with both BPD and bipolar?

Yes, about 20% of people with bipolar disorder have comorbid borderline personality disorder, and approximately 20% of people with borderline personality disorder have bipolar disorder.

Q: Can you treat bipolar disorder without medication?

It depends on the individual, but medication and therapeutic interventions are often indicated for bipolar disorder, particularly with its high rate of suicide. If you want to treat your bipolar disorder without medication, it’s important to work with a medical team to develop the appropriate care plan.

Bipolar disorder is a serious, chronic mental health condition that’s characterized by unusual changes in mood, energy, and activity levels. About 30% to 50% of people with bipolar disorder will develop substance use disorder, which complicates the diagnosis and treatment of their conditions.[1]

If you or a loved one is struggling with bipolar disorder and a substance use disorder – dual diagnosis – treatment is available.

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Common Symptoms of Bipolar Dual Diagnosis

There are several types of bipolar disorder with different shifts in mania, hypomania, and depression periods:

Bipolar I disorder: One manic episode that may be preceded or followed by hypomania or major depressive episodes.

Bipolar II disorder: One major depressive episode and at least one hypomanic episode, but no manic episodes.

Cyclothymic disorder: Two years of many periods of hypomania symptoms and periods of depressive symptoms.

Other types: Bipolar and related disorders induced by certain drugs or alcohol or because of a medical condition.[2]

Manic and hypomanic episodes may include:
Jumpiness
Increased energy or agitation
An exaggerated sense of well being and self-confidence
Decreased need for sleep
Unusual talkativeness
Racing thoughts
Distractibility
Poor decision making

Major depressive episodes may include:
Depressed mood
Loss of interest in activities
Significant weight loss
Either insomnia or sleeping too much
Either restlessness or slowed behavior
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Decreased ability to concentrate
Suicidal thoughts or actions

When bipolar disorder occurs with a substance use disorder, the symptoms can vary and may overlap with the symptoms of using the specific drug.

Bipolar Dual Diagnosis Statistics

Substance use disorders are extremely common among individuals with bipolar I and bipolar II disorders:

Substance use disorders occur in about 40% of bipolar I patients

Alcohol and cannabis are the most often abused, followed by cocaine and opioids, in people with bipolar
In people with bipolar type I, 61% had a lifetime history of substance use disorder

In people with bipolar type II disorder, 48% had a lifetime history of substance use disorder[3]

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Treatment Centers for Bipolar Disorder Dual Diagnosis

A formal dual diagnosis treatment program can be effective for treating co-occurring substance use disorders and bipolar disorder. There are several levels of care to ensure that you have a tailored treatment plan that’s appropriate for your stage of the recovery process:

Inpatient Treatment

Bipolar inpatient treatment, also known as bipolar residential treatment, offers 24/7 supervision and support. This is important for people who don’t have a stable home environment or who need intensive care and support, such as teens.

Outpatient Treatment

For people who require more flexibility, outpatient treatment allows you to pursue therapies without compromising on the responsibilities of day-to-day life. There are different levels of outpatient treatment, but they may involve therapy sessions that take place during the day. Instead of sleeping in the facility, you can go home at night to spend time with family and sleep in your bed.

While there’s no permanent cure for bipolar disorder or substance use disorder, treatment environments offer a range of therapeutic activities for bipolar disorder to learn to manage the challenges of the condition and avoid relapse.

Cost of Dual Diagnosis Treatment for Bipolar Disorder

The cost for dual diagnosis treatment for bipolar disorder can vary by the facility, the treatment plan, and other factors. Fortunately, dual diagnosis for bipolar disorder may be covered by some insurance policies, either fully or in part.

What Does Treatment For a Bipolar Dual Diagnosis Look Like?

Treatment for bipolar disorder dual diagnosis requires treating both conditions simultaneously with an individualized care plan that considers the person’s symptoms, needs, preferences, and responses to treatment.

Medications are often indicated for bipolar dual diagnosis, including:
Mood stabilizers
Atypical antipsychotics, such as quetiapine
Antidepressants, such as fluoxetine

Because some medications can be dangerous when mixed with substances, it’s crucial to be under the care of a mental health professional.

Several types of therapy may be used to treat bipolar disorder and substance use disorder:

Cognitive behavioral therapy (CBT): CBT for bipolar therapy helps you identify the harmful or negative thoughts, behaviors, and beliefs to make them more balanced and healthier.

Motivational interviewing: This therapy helps you determine your own motivation for recovery.

Contingency management: Indicated for substance use disorder, this therapy offers rewards for adherence to the treatment program and abstinence.

Experiential therapy: This therapy involves activities, animals, art, and other interventions for emotional exploration.
Relapse prevention: This is a targeted therapy that helps with recognizing relapse triggers and adapting to them to stay abstinent.

Twelve-step facilitation: This therapy integrates 12-step mutual support groups to develop peer support and share with others.[4]

Related Programs & Therapies

Learn More About Other Co-Occurring Disorders

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