Bipolar disorder and addiction – dual diagnosis

The relationship between bipolar disorder and addiction runs in both directions. Manic episodes can lead someone to drink or use drugs, sometimes to sustain a heightened state, sometimes to manage the agitation. But substance use also destabilises mood. Research in Alcohol and Alcoholism has shown that alcohol use and withdrawal affect many of the same brain chemicals involved in bipolar disorder. This means alcohol can directly trigger bipolar symptoms, not just exist alongside them.

A 2023 study in the journal Alcohol and Alcoholism found that when both conditions occur together, symptoms are more severe and last longer. Rates of crisis are higher, and overall health impacts are greater than with either condition alone. Treating one without the other means the untreated condition keeps feeding the one you’re trying to address.

Our page on what is dual diagnosis? explains how co-occurring conditions interact. At Castle Health, both are assessed and treated together from the start, under a single psychiatric-led plan. Alcohol is used as the main example throughout this page because most research is on that dual diagnosis. But the picture with other substances is similarly complex.

Research suggests bipolar disorder is frequently missed even when someone has been in contact with services for a long time. Bipolar disorder doesn’t always feel like illness. Hypomanic episodes – periods of elevated mood and high energy – can feel like things are going well. It’s one of the reasons the condition gets missed for so long, and why people sometimes aren’t sure if what they’re experiencing is serious enough to act on. Patterns of elevated mood can go unnoticed and unasked about. It’s the low periods that tend to bring someone to seek help. 

For most people with both conditions, residential treatment is the most appropriate starting point. Dual diagnosis is complex, and detox and early mood stabilisation both carry real clinical risk. 

We offer Inpatient bipolar disorder and addiction treatment at Castle Craig in Scotland and Smarmore Castle in Ireland. Our long-term residential programmes are consultant psychiatrist-led, with 24/7 medical supervision throughout the most clinically demanding stage of treatment. There’s no fixed timeline, and treatment runs long enough to address both conditions properly.

Where the presentation is less acute, or where residential treatment has already provided a stable foundation, outpatient bipolar disorder and addiction treatment may be a sufficient level of care. 

During your initial assessment, we’ll discuss which setting is likely to give you the best clinical outcome. If residential care is what you need, we’ll explain why, so you can make an informed decision.

Detoxing from alcohol or drugs can be a complex process. When bipolar disorder is also present, that complexity increases. Alcohol withdrawal can trigger mood episodes directly. This isn’t just because detox is a difficult experience, but because alcohol and bipolar disorder affect some of the same pathways in the brain.

Our psychiatrists manage detox and mood stabilisation together. Medication may be prescribed during this phase, including mood stabilisers, anti-anxiety medication, or antidepressants. Where antidepressants are used, they’re prescribed alongside a mood stabiliser. Prescriptions are guided by what’s clinically right for you, and reviewed throughout your stay. For many people with bipolar disorder, ongoing medication management remains part of a healthy, stable life.

The therapies we use are chosen because the evidence supports them for co-occurring mood disorders and addiction.

Types of therapy we offer for co-occurring bipolar disorder and addiction:

• Cognitive Behavioural Therapy (CBT): CBT is the evidence-based core of our programme. For bipolar disorder and addiction, it targets the thought patterns that link mood states to substance use, helping you recognise the internal triggers.
• Individual counselling: One-to-one sessions allow you to explore your personal history, your relationship with both conditions, and the specific patterns that need to change.
• Group therapy: In a residential community, group therapy draws on the specific understanding of people who are living with the same challenges and experiences.
• Psychoeducation: Understanding what bipolar disorder is, and why it interacts with addiction, is a good starting point for making sense of your own experience.
• Family therapy: Addiction and bipolar disorder affect the people around you as well. Family therapy supports communication and prepares the people in your life for the reality of ongoing support.

A consultant psychiatrist is involved from the moment you arrive, with assessment, prescribing, and treatment planning happening together.

Recovery from addiction is achievable. Living well with bipolar disorder requires ongoing management, and we’ll help you understand what that may involve.

When you’re ready, taking the first step on the road to recovery starts with a confidential call to our admissions team.

For many people, that first conversation is the hardest one. But our team has had it thousands of times. They know what it takes to make that call, and they won’t pressure you to make any decision.

After your initial call, we’ll carry out a clinical assessment to understand your specific situation. This includes a psychiatric review, so that your treatment plan accounts for both conditions from day one. We’ll talk you through what the programme involves, answer your questions honestly, and help you prepare for admission.

Prescribing is always individual and always led by a consultant psychiatrist. Mood stabilisers such as lithium, valproate, and lamotrigine are commonly used. If needed, anti-anxiety medication may also be prescribed. Research published in the Journal of Psychopharmacology found that naltrexone was well-tolerated in people with co-occurring bipolar disorder and did not destabilise mood. The British Association for Psychopharmacology (BAP) recommends it to support alcohol abstinence in this group. We’ll always explain what we’re recommending and why, and prescribing decisions won’t be made without you understanding the rationale.

A full psychiatric assessment takes place on admission, carried out by a consultant psychiatrist. This assessment covers both your history of addiction and your behavioural and psychological patterns over time. Because substance use can mask or mimic mood disorder symptoms, and vice versa, accurate diagnosis depends on this combined picture. The assessment shapes your treatment plan from day one, and the diagnosis is reviewed as treatment progresses.

Yes, with appropriate medical supervision. Detox when bipolar disorder is present carries additional clinical complexity. Alcohol withdrawal can directly affect some of the same pathways in the brain involved in bipolar disorder. That’s why we provide 24/7 medical oversight throughout detox. Research in Alcohol and Alcoholism supports the importance of close clinical monitoring during this phase. Speak to our admissions team before making any changes on your own.

Treatment costs vary depending on the programme, duration, and the clinical needs involved. Our admissions team can walk you through costs honestly and in full, including what is covered, what the options are, and whether any alternative funding routes might be available to you. There’s no obligation in asking.