Holistic Wellness Programs for Treating Addiction and Mental Illness

Philosophers often discuss the difference between “being” and “well-being.” In order to simply “be,” a person or thing must have certain qualities or attributes that define its core essence. These features describe the subject’s basic existence, but they do not address what is necessary to thrive or flourish.

Many treatment facilities tout the core treatments that provide clients with the means to attain sobriety. But there are additional components necessary to help someone achieve the benefits of a happy, healthy life experience.

These benefits address much more than the cessation of problems that led them to treatment in the first place. Instead, they address the broader considerations that make up a fulfilled life and contribute to the person’s “well-being” and not just their “being.”

It is essential for people in recovery to understand and improve all the different parts of their existence, so they can consciously build better lives.

Understanding and Defining Holistic Wellness

“Wellness” is a term that comes up frequently in certain circles, and the term can be used in many ways. Although there are multiple views on exactly what the concept encompasses, the National Wellness Institute, in conjunction with leaders of varying health and wellness fields, has suggested that most models of wellness agree upon the following principles:

  • Wellness is a conscious, self-directed and evolving process of achieving full potential.
  • Wellness is multidimensional and holistic, encompassing lifestyle, mental and spiritual aspects and the environment.
  • Wellness is positive and affirming.

With these principles in mind, the NWI proposes that, “Wellness is an active process through which people become aware of and make choices toward a more successful existence.”1

Wellness is an active process through which people become aware of and make choices toward a more successful existence.

Wrapping all of this together, we can define “holistic wellness” as the condition of being in optimum overall health, which is a blend of physical, mental and spiritual well-being. The condition is the result of consciously choosing to live a quality life; it doesn’t happen by accident. It’s a day-to-day choice involving an active process of increasing self-awareness, as well as community-supported, self-directed action.

What Are Holistic Wellness Programs?

The goal of holistic health is to achieve maximum well-being, where everything is functioning in the best way possible. The path of holistic wellness is a life-long journey that emphasizes personal responsibility and commitment.

The path of holistic wellness is a life-long journey that emphasizes personal responsibility and commitment.

Without specific ways to work toward this goal, people would flounder without any ability to truly make progress. That’s where holistic wellness programs come in.

Holistic wellness programs are an essential part of any well-rounded recovery program. These programs comprise the methods that give people the tools to feel more whole as human beings. The features of holistic wellness programs are designed to take into account the entire person as they move forward in their quest for optimal health and wholeness.

Specific program components may include things like individual therapy, meditation, mindfulness and yoga, which promote positive attitudes and teach practical methods for coping with stressful situations. One may also learn about healthy nutrition, the importance of regular physical exercise and other helpful life practices, such as journaling.

Yoga – Posing for Wellness

Yoga is a technique that uses physical postures and controlled breathing to develop many mental and physical benefits.2The postures used in yoga practice are sometimes difficult to achieve or hold, but the purpose goes far beyond merely becoming a human pretzel.

The challenging poses and movements of yoga help create flexibility and strength as they elongate the spine, improve muscle elasticity, reduce stiffness in the joints and increase overall mobility. The focus required during practice also calms the mind, improves concentration and promotes patience. Regular practice is needed to fully experience these benefits.

For those in recovery, yoga offers some specific advantages. For example, many addictions begin as a coping mechanism or a way of filling an emotional or spiritual void. As a result, people in treatment for addiction must learn to deal with their emotions and environment in healthier ways.

Studies of the biological impact of yoga have noted a correlation between yoga and inhibiting the dopamine surge that typically results from using drugs. The studies found that intense breathing patterns in certain forms of yoga release the body’s natural pleasure-producing endorphins. A healthy yoga practice can help suppress addictive behaviors while restoring the brain’s dopamine functions to healthier levels.

Those in recovery know full well that stressful situations can trigger addictive behavior and cravings. The very process of adjusting to sober living can be stressful. Since yoga emphasizes willpower and stress reduction, those in recovery can learn to combat that stress, better resist temptation and regain control over their bodies.

Since yoga emphasizes willpower and stress reduction, those in recovery can learn to combat that stress, better resist temptation and regain control over their bodies.

Meditation – Doing Something Good for Yourself

Meditation is not an esoteric, mystical exercise best left for ascetic monks. Although there are numerous forms of meditation practice arising from various historic traditions, most of them share a simple common principle: intentionally setting aside time to do something good for yourself.

Meditation involves intentionally setting aside time to do something good for yourself.

That may seem like an oversimplification, but it accurately describes the underlying purpose of meditative practices. Whether the form of meditation incorporates bodily movement or is stationary, both emphasize the good that results from quietness of the mind.

The primary goal of developing a sense of inner calm, sometimes called detachment, enables meditation to fit well within the recovery process. This is because overcoming substance abuse disorders often involves a person establishing distance between themselves and their desire to use.

Meditation encourages the practitioner to view their own impulses from a third-person perspective, as they observe and examine their own thoughts and motivations. This is not always easy, but the skill will enable them to gain a psychological detachment from their cravings, along with the ability to properly understand such desires. This helps cultivate contentedness without the need to resort to alcohol or drug abuse.

While the full benefits from meditation may take time, neuroscientists have found that even short-term meditation can have profoundly positive effects on the brain. In one study, after just five 20-minute sessions of meditative technique, participants had increased blood flow to an area of the brain vital to self-control. After 11 hours of accumulated practice, the scientists found actual physical changes in the brain around this same area.3

By building a stronger awareness of themselves and their environment, people in recovery can realize the impact drugs and alcohol have had on their lives and start to discover their triggers. Meditation fosters an appreciation for the mind and body, which builds motivation to treat oneself with respect.

Meditation fosters an appreciation for the mind and body, which builds motivation to treat oneself with respect.

Mindfulness – Moment-by-Moment Awareness

Mindfulness can be a form of meditation, but it is worth distinguishing here in our overview of holistic wellness. Mindfulness-based interventions have shown compelling evidence of significant benefit for people in recovery from addictive disorders.

Though it has roots in Buddhist meditation, the common secular practice of mindfulness was established through the work of Jon Kabat-Zinn and his Mindfulness-Based Stress Reduction program, which was launched at the University of Massachusetts Medical School in 1979.

In its most basic definition, mindfulness means maintaining a moment-by-moment awareness of thoughts, feelings, bodily sensations and surrounding environment. It also involves acceptance of thoughts and feelings without judging them. By removing the tendency to determine what is “right” or “wrong” with a certain thought or feeling, a person is more able to concentrate on what they’re sensing in the moment, rather than comparing it with the past or imagining the future.

Mindfulness means maintaining a moment-by-moment awareness of thoughts, feelings, bodily sensations and surrounding environment.

Thousands of studies have documented the physical and mental health benefits of mindfulness. Because the practice promotes nonjudgmental acceptance of moment-to-moment thoughts, mindfulness has been shown to interrupt the tendency to respond to experiences using harmful behaviors, such as substance use. As the individual learns to respond with awareness and not to react automatically, they are also more likely to resist cravings.4

For individuals in recovery, the struggle with temptations toward drugs or alcohol is inevitable. Mindfulness meditation is one way to gain awareness of these thoughts, accept them without feelings of guilt or shame and learn how to cope in healthier ways.

Physical Fitness – Strong Body and Mind

It’s no secret that regular exercise is good for the body. But physical exercise is also one of the most effective ways to improve mental health. Exercise has a profound and positive impact upon symptoms of depression, anxiety, ADHD and more. In addition to boosting overall mood, exercise relieves stress, improves memory and helps people sleep better.

In addition to boosting overall mood, exercise relieves stress, improves memory and helps people sleep better.

But don’t worry, there’s no need to become a hardcore fitness devotee. Research indicates that even modest amounts of exercise can make a real difference, as evidenced by the popularity of such things as the scientific 7-minute workout.5

No matter what fitness plan or routine one may settle into, there are definitely worthwhile rewards for the efforts. Here are some outstanding examples of the mental health benefits of exercise:6

  • Reduce Stress. Working out can relieve physical and mental tension and increases concentrations of norepinephrine, a chemical that can moderate the brain’s response to stress. Regular exercise keeps energy flowing throughout the body, which enhances its stress reducing properties.
  • Boost Happy Chemicals. Exercise releases endorphins, which create feelings of happiness and euphoria. Studies have shown that exercise can even alleviate symptoms among people suffering from depression or anxiety due to increased levels of the brain chemicals dopamine and serotonin.
  • Improve Self-Confidence. Physical fitness boosts self-esteem and improves self-image. Regardless of a person’s particular physique, even moderate exercise can quickly elevate self-perception and self-worth. Engaging in a competitive sport, or just setting your own fitness goals leads to feelings of accomplishment, which also improve feelings of self-confidence.
  • Prevent Cognitive Decline. While it won’t stop the aging process, exercise boosts the chemicals in the brain that support and prevent degeneration of the hippocampus, an important part of the brain for memory and learning. Science has found that people who exercise have sharper cognitive functioning and better ability to concentrate.
  • Alleviate Anxiety. During and after exercise, chemicals released in the body can help people with anxiety disorders calm down even more effectively than a 20-minute soak in the hot tub. The anxiety-reducing effects of even just a brisk daily walk can be highly beneficial to individuals in recovery.
  • Boost Brainpower. More than merely preventing decline, studies have shown that cardiovascular exercise can create new brain cells and improve overall brain performance. Some studies show that the brain volume in those who exercise regularly is greater than in those who do not.
  • Regular workouts increase levels of a protein known as BDNF. This is believed to help with the executive functions of the brain, such as decision making, higher thinking and learning.
  • Sharpen Memory. Regular physical activity enhances the ability to learn new things. Research has linked brain development with levels of physical fitness, and one study showed that running sprints improved vocabulary retention among healthy adults.
  • Help Control Addiction. Dopamine, which is known as the brain’s “reward chemical,” is released in response to any form of pleasure, including sex, drugs, alcohol or food. One aspect of addiction involves dependency on the substances that produce dopamine. But exercise can help in recovery, since working out can effectively diminish and distract from cravings, while providing a new, healthy reward pathway.
  • Increase Relaxation and Improve Sleep. Often those in recovery find their body processes are interrupted, including circadian or sleep rhythms. Exercise can help reboot the body clock, enabling people to relax and have more regular sleep cycles. Those who get a higher quality of sleep tend to function better during their daytime activities, have a more positive frame of mind, and have better emotional self-regulation.
  • Get More Done. Those who exercise regularly have been shown to have higher energy levels, which leads to greater productivity. Sedentary people tire more easily and quickly, leaving less mojo for work and play. Exercise increases stamina and strength, increasing energy levels that benefit the individual throughout the day.

Journaling – Insights for Life

Journaling is an effective tool with widespread use among those recovering from an addiction. It has been called the least expensive, most accessible form of therapy, and it can produce meaningful results for those who take advantage of it for gaining insights into their own life.

Keeping a journal is straightforward; it requires writing down brief thoughts, ideas, observations, stories, important events, successes during recovery or even a simple record of an exercise routine.

There are numerous methods and styles of journaling, and each person can adopt an approach that fits their personality and schedule. There’s no need to be verbose; even a single word that captures a feeling or mood can provide powerful insights, which lead to better understanding and discernment.

Writing in a journal encourages people to think critically and examine their thoughts and assumptions. Clearer thinking helps overcome negativity, reduces stress and may even lower the risk of relapse. Journaling is also a way to track progress and increase motivation. Journals are private expressions, recorded without fear of judgment.

Journaling also helps with stress relief. Just putting down on paper the emotions being experienced in recovery can give them a place to reside, other than rattling around in one’s head. Think of journaling as a repository for thoughts, feelings, hopes, dreams, and goals. A place to safely unload all the things that might be taking up too much space in one’s head.

Writing in a journal encourages people to think critically and examine their thoughts and assumptions.

The point is not the subject of the writing or the amount of writing. Instead, it’s about taking the time to write and engage in personal introspection. After journaling for a few months, many are amazed when they look back to see where they were and where they are now. In some cases, they are encouraged by how far they’ve come. Other times they may be surprised to find they’re revisiting old habits.7

Holistic Individual Therapy – Building Skills for the Future

Recovery and rehabilitation frequently involves therapy. Holistic therapy takes an integrated approach and pays attention to the connections between a person’s mind, body and spirit.

Unlike some forms of therapy, which seek to treat the symptoms, holistic therapy sessions try to uncover the underlying causes that led to substance abuse or contributed to other unhealthy behaviors. Holistic therapists use multiple approaches to address issues and encourage self-awareness and self-acceptance in those in recovery.

One such therapy is mindfulness-based cognitive therapy (MBCT). This is a type of CBT that utilizes the mindfulness training so important in cultivating a healthy mind-body connection. MBCT is based on Jon Kabat-Zinn’s mindfulness stress reduction program, and has been found useful in treating individuals in addiction recovery. MBCT combines the concepts of CBT, which involve reframing dysfunctional thought patterns that lead to self-destructive behaviors, with meditative practices.

Holistic therapists use multiple approaches to address issues and encourage self-awareness and self-acceptance in those in recovery.

Counselors or therapists typically provide a variety of services to people in treatment for substance use disorders, including assessment, treatment planning and counseling. Individual counseling often focuses on reducing or stopping substance use, skill building, adherence to a recovery plan and social, family and professional/educational outcomes.8

Nutrition Education – Fueling the Healing Process

Improper nutrition can severely hinder the normal functioning of the body, including its ability to heal and overcome illness. Drugs and alcohol can further amplify the disruptive effects of a poor diet. Improving nutrition is essential for diminishing and correcting some of the biochemical and digestive problems often developed during addiction.9

Improving nutrition is essential for diminishing and correcting some of the biochemical and digestive problems often developed during addiction.

Proper nutrition helps those in recovery (and everyone else) feel better because nutrients give the body energy, help build and repair organ tissue and strengthen the immune system. Many people experience damage to vital organs, as well as nutritional deficiencies, during the course of their drug or alcohol abuse. Establishing good nutrition provides them with the crucial building blocks needed to begin restoring the damage to the brain and the body.

Mood and attitude are also affected by nutrition. Changes in the diet can alter brain structure both chemically and physiologically, thus influencing behavior. Certain foods have been connected to increased production of brain chemicals like serotonin, which enhances a person’s mood.

Using healthy food and regular meals to fuel the healing process is an important strategy for reaching optimal well-being and energizing the recovery process. In many cases, just feeling better due to proper diet can even reduce the risk of relapse, since the temptations may have less appeal.

Examples of nutritious meal options that enhance both psychological and physical healing and wellbeing include:

  • Lean protein sources
  • Omega 3 fatty acids
  • Whole grains
  • Fresh vegetables and fruits
  • Nuts, seeds, and legumes

Limiting caffeine, sugary beverages, sugary treats, and processed foods will also improve overall health.

Other Holistic Activities

Any activity that fosters feelings of serenity will benefit someone in recovery. Adding these activities into the weekly or daily wellness routine can augment the effects of psychotherapy and other recovery activities. Holistic activities help to cement the positive effects of sobriety by providing ongoing coping tools that can be accessed as needed.

Other holistic activities or therapies might include:

  • Massage therapy. A relaxation massage helps muscles release the toxins that build up in the body due to daily stress and worry
  • Acupuncture. The use of tiny needles on specific areas of the body help open up blocked energy, leading to stress reduction and reduced cravings
  • Equine therapy. Being involved in the care, feeding, and exercising of a horse is an excellent source of accountability, leading to improved self-confidence. Bonding with a horse is also deeply satisfying on an emotional level
  • Gardening therapy. Being outdoors provides sun exposure that translates to increased vitamin D, which benefits mood. The process of cultivating plants, vegetables, or flowers is rewarding, giving one a sense of accomplishment
  • Aromatherapy. Essential oils can be used topically or inhaled through vapors to induce relaxation and reduce stress
  • Hypnotherapy. A hypnotherapist can guide the individual toward changing negative thoughts and replacing them with affirming thoughts and behaviors
  • Guided meditation. These audio files are available on apps or downloads and offer a soothing voice to guide one into a meditative state, which induces relaxation.

Bringing It All Together

Hopefully, this overview of holistic wellness programs was encouraging and highlighted the many benefits of such an approach to recovery. But more than as just a means to recovery, programs focused on holistic wellness bring together the tools and knowledge for lifelong preventative and restorative health solutions. This provides the essentials for achieving a healthy body and mind, allowing each person to take responsibility for their own well-being as they progress in their recovery journey.


  1. Six Dimensions of Wellness. (n.d.). Retrieved from http://www.nationalwellness.org
  2. Pizer, A. (2016, April). What is Yoga? Retrieved from https://www.verywell.com/what-is-yoga-3566739
  3. Tang, Y.; Lu, Q.; Geng, X.; Stein, E. A.; Yang, Y. and Posner, M. I. (2010, August). Short-term Meditation Induces White Matter Changes in the Anterior Cingulate. Retrieved from http://www.pnas.org/content/107/35/15649.full
  4. Marcus, M. T. and Zgierska, A. (2009). Mindfulness-Based Therapies for Substance Use Disorders: Part 1. Substance Abuse, 30(4), 263. Retrieved from http://doi.org/10.1080/08897070903250027
  5. Reynolds, G. (2013, May). The Scientific 7-Minute Workout. The New York Times. Retrieved from http://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout
  6. Breene, S. (2013, March). 13 Mental Health Benefits of Exercise. Retrieved from http://www.huffingtonpost.com/2013/03/27/mental-health-benefits-exercise_n_2956099.html
  7. Howes, R. (2011, January). Journaling in Therapy. Retrieved from https://www.psychologytoday.com/blog/in-therapy/201101/journaling-in-therapy
  8. Treatment for Substance Abuse Disorders. (2015, September). Retrieved from http://www.samhsa.gov/treatment/substance-use-disorders
  9. Miller, R. (2010, May). Nutrition in Addiction Recovery. Retrieved from http://mhof.net/sites/default/files/Addiction%20and%20Recovery%20Report.pdf
Bipolar Disorder & Addiction

Bipolar disorder is a serious mood disorder that’s characterized by alternating episodes of extremely high and very low moods. According to the Depression and Bipolar Support Alliance, bipolar disorder affects around 5.7 million adult Americans each year, and it’s the sixth leading cause of disability in the world.1

Bipolar disorder is the sixth leading cause of disability in the world.

Bipolar disorder commonly co-occurs with substance use disorders. Results of the U.S. National Comorbidity Survey found that 71 percent of people with bipolar disorder reported at least one lifetime substance use disorder.2 Alcohol dependence was reported by 61 percent of respondents, and 40.7 percent reported drug dependence.

How Substance Abuse Affects Bipolar Disorder

According to an article published in the journal Science & Practice Perspectives, people with bipolar disorder who abuse alcohol had an earlier onset of symptoms, more frequent hospitalizations and more mental illnesses.3

Those who suffer from bipolar disorder and a co-occurring substance use disorder are also the highest risk group for suicide. This is largely due to the combination of risk-taking behaviors and major depressive episodes that characterize bipolar disorder and the loss of inhibition and a deepening of despair that often characterize intoxication.

If you or someone you love suffers from co-occurring bipolar disorder and a substance use disorder, then the sooner treatment begins, the better the outcome is likely to be. Each disorder worsens the other, and left unchecked, co-occurring disorders can lead to devastating disability.

That said, even severe cases of co-occurring bipolar disorder and addiction can be successfully treated, as long as an individual remains committed to treatment and fully engaged in the treatment plan.

Even severe cases of co-occurring bipolar disorder and addiction can be successfully treated as long as an individual remains committed to treatment and fully engaged in the treatment plan.

Signs and Symptoms of Bipolar Disorder

Bipolar disorder is characterized by four types of mood episodes. These are mania, hypomania, depression and mixed episodes. Each type of episode can last for weeks or months, especially when left untreated, and each has its own set of signs and symptoms. Signs of bipolar episodes are those that others may notice, while symptoms are those that an individual with bipolar will feel.


Signs and symptoms of a manic episode include:

  • Feelings of grandiosity and self-importance
  • Talking rapidly
  • Alternating moments of incredible elation and intense pessimism
  • A reduction in hours of sleep per night
  • Engaging in risk-taking behaviors
  • Impaired judgment
  • Irrational thoughts and behaviors
  • Hallucinations


Psychotic symptoms are absent during periods of hypomania, which has symptoms that are similar to but far less intense than those of the manic phase. During hypomania, a person will likely:

  • Be capable of managing day-to-day activities
  • Feel happier, more energetic or more irritable than usual
  • Need less sleep
  • Feel capable of taking on more responsibility at work or school
  • Be more likely than usual to engage in high-risk behaviors, including substance abuse
  • Feel like the bipolar disorder is under control


The depressive phase of bipolar disorder is marked by severe lows and includes signs and symptoms such as:

  • Feelings of hopelessness, helplessness and sadness
  • A loss of interest in activities you once enjoyed
  • Fatigue and sleepiness
  • Appetite changes or changes in weight
  • Feelings of guilt and self-hatred
  • Thoughts of death or suicide

Mixed Episodes

Bipolar symptoms aren’t always cut and dry. A mixed episode is a combination of symptoms for mania and depression.

Five types of bipolar disorder are commonly diagnosed:

  • Bipolar I Disorder is the most severe form of the disorder and is characterized by one or more mixed or manic episodes and one or more major depressive episodes.
  • Bipolar II Disorder is characterized by lower highs than bipolar I disorder. Bipolar II is diagnosed after one or more major depressive episodes and at least one hypomania episode.
  • Bipolar Not Otherwise Specified doesn’t follow a pattern. For example, you may have very rapid swings between manic and depressive episodes, or you may experience recurring hypomanic episodes without any depressive episodes.
  • Cyclothymia is a mild form of bipolar disorder that’s characterized by alternating hypomanic episodes and milder episodes of depression. These alternating episodes must last for at least two years to be diagnosed as cyclothymia.
  • Bipolar with Rapid Cycling is characterized by having four or more depressive, manic or hypomanic episodes in a 12-month period. Rapid cycling can occur with any of the types of bipolar.

Substance Use Disorders: Addiction and Dependence

Addiction is characterized by continuing to use a psychoactive substance even though it’s causing problems in your life. Addiction affects the structures and functions of the brain and is widely considered to be a diagnosable, treatable and preventable brain disease. If you’re addicted to drugs or alcohol, a number of psychological and physiological mechanisms are likely at work, including learned, reinforced behaviors and changes in the way the chemicals in your brain function.

Signs and symptoms of addiction include:4

  • Using drugs or alcohol despite negative consequences to your health, relationships, finances or legal status
  • A loss of control over the frequency of using drugs or alcohol, the duration of use and the amount consumed
  • A loss of interest in hobbies and activities you once enjoyed
  • Increasingly neglecting your responsibilities at home, work or school
  • Taking serious risks as a result of drug-seeking or drug-taking behaviors
  • Hiding the extent of your drug use from family and friends
  • Problems in your relationships with family, friends or coworkers
  • Neglecting personal hygiene

Dependence is characterized by changes in brain function that reach a tipping point at which the brain now needs a psychoactive substance in order to function “properly.” When the substance is withheld from the body, withdrawal symptoms set in as your brain’s way of telling you it can’t operate normally without the substance of abuse present. Withdrawal symptoms are the main indication that physical dependence has occurred.

Why Bipolar Disorder Commonly Co-Occurs with a Substance Use Disorder

A number of theories attempt to explain the high prevalence of bipolar disorder co-occurring with a substance use disorder.3


One theory proposes that having a mood disorder increases the risk of developing a substance use disorder, and vice versa. The effects of a mood disorder often lead to self-medication with drugs or alcohol. Substance use may seem to reduce symptoms initially, but almost always worsens a mental disorder.

Someone with bipolar disorder may try to suppress feelings of rage or anger with an opiate like oxycodone; someone else may try to lift a depressed mood with cocaine or another stimulant. In many cases, chronic substance abuse causes mild symptoms of mental illness to worsen to a clinically significant level, due to changes in already-abnormal neurotransmitter activity. As such, it can be difficult to determine which occurred first: the substance abuse or the bipolar disorder.

It can be difficult to determine which occurred first: the substance abuse or the bipolar disorder.


Kindling occurs when repeated disruptions sensitize brain cells and lead to symptoms that become more frequent and severe over time. Some substances, like alcohol and cocaine, sensitize neurons, and this makes them more easily disrupted. This may help explain the progression of a substance use disorder from chronic abuse to addiction, and it may explain why mood disorders often progress as well, with symptoms worsening over time and increasingly shorter periods of remission occurring between episodes.


Both substance use disorders and mood disorders have genetic risk factors, and some genetic influences may increase the risk of developing both bipolar disorder and an addiction. This may occur in three ways:

  • The genetic variable makes an individual vulnerable to a mood disorder, which that person may then self-medicate, leading to addiction.
  • The genetic variable causes the brain to respond to drug exposure in a way that leads to chronic abuse, which then causes changes that lead to or uncover the mood disorder.
  • The genetic variable causes the brain to develop in a way that makes it vulnerable to both addiction and bipolar through mechanisms like sensitized neurons and kindling.

Diagnosing Co-Occurring Bipolar and Addiction: Integrated Screening and Assessment

The Substance Abuse and Mental Health Services Administration has developed a best-practices protocol for the integrated screening and assessment of co-occurring disorders.5 Individuals who seek treatment for a mental health issue will be screened for a substance use disorder as a matter of course, and those who seek treatment for a substance use disorder will be screened for mental illness. The screening process serves to answer the question of whether a co-occurring disorder may be present.

If the screening is positive, a detailed and thorough assessment will take place, and if the presence of a co-occurring disorder is established, this assessment will serve as the basis for an individualized treatment plan.

According to the Substance Abuse and Mental Health Services Administration’s 10 Guiding Principles of Recovery, there is no single way to treat addiction, because nobody responds to the same treatments in the same way. Every individual has a unique combination of issues, needs and preferences when it comes to treatment, and these must be addressed through a unique, personalized treatment plan.6

Every individual has a unique combination of issues, needs and preferences when it comes to treatment, and these must be addressed through a unique, personalized treatment plan.

Why Integrated Treatment is Essential for Co-Occurring Disorders

If you suffer from co-occurring bipolar and substance use disorders, choosing a dual diagnosis treatment program is crucial for improving your chances of long-term recovery from each disorder.

Treating only the bipolar disorder won’t address the issues underlying the substance use disorder, which will typically continue to worsen the bipolar symptoms. Conversely, treating only the substance use disorder won’t help curb the self-medicating and risk-taking behaviors that are associated with bipolar disorder, which will likely contribute to relapse very quickly.

Integrated treatment for co-occurring disorders is a meaningful collaboration among the treatment teams for both disorders, each of which is treated in the context of the other. An enormous body of research shows that specialized, dual diagnosis treatment for co-occurring disorders has a far better outcome than stand-alone treatments for a substance use disorder and other mental illness.

Integrated treatment for co-occurring disorders is a meaningful collaboration among the treatment teams for both disorders.

It is important to find an evidence-based integrated treatment program if you have a co-occurring disorder.7 This type of treatment involves treatment specialists who are trained to treat both substance use disorders and serious mental illnesses. These specialists:

  • Strive to meet all of the various unique needs of people with co-occurring disorders
  • Use treatment interventions that are appropriate for an individual’s particular stage of recovery
  • Administer treatment therapies in group, individual and family settings
  • Involve the individual in the development of a treatment plan
  • Integrate medication services with other treatment protocol

Using a combination of behavioral therapies and medication is the most effective way to treat a co-occurring disorder. A holistic approach to treatment is essential and should include both traditional and complementary treatment therapies that address issues of the body, mind and spirit.

Medications Used for Treating Bipolar Disorder

Bipolar disorder can be successfully managed with a variety of medications, depending on the symptoms.8

  • Mood stabilizers help control manic and hypomanic episodes and include drugs like lithium and lamotrigine.
  • Antipsychotics like risperidone and aripiprazole help control symptoms that other medications have been unable to affect.
  • Antidepressants effectively treat depression, but since these medications can trigger a manic episode, they’re usually taken with a mood stabilizer or antipsychotic. Common antidepressants include fluoxetine and citalopram.
  • Combination medications are those which contain both an antidepressant and a mood stabilizer.
  • Anti-anxiety medications in the benzodiazepine family may be prescribed for short-term use to reduce anxiety and improve sleep.

Treatment Therapies for Co-Occurring Bipolar Disorder and Addiction

Psychotherapy, or talk therapy, helps individuals learn to change their way of thinking and behaving. Research shows that psychotherapy is highly effective for treating both bipolar disorder and substance use disorders.

Group Therapy

Peer groups are valuable sources for developing coping skills and strategies. Sharing similar experiences provides a strong sense of belonging to people who may otherwise feel disenfranchised. Group members hold each other accountable and help one another evaluate their thoughts and behaviors. The opportunity to help others itself can also help bring about meaningful change.

Family Therapy

Family therapy is essential for restoring function to the household and improving communication among family members. Both bipolar and addiction take a major toll on the functioning of the family system, and fostering a healthy home environment goes a long way toward preventing relapse.

Family therapy is essential for restoring function to the household and improving communication among family members.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy helps you learn to identify and evaluate self-destructive thoughts, beliefs and attitudes and replace them with healthier ways of thinking and behaving. It also helps you cope with symptoms and recognize the signs that point to a mood shift. Research shows that cognitive-behavioral therapy is highly effective for treating those with bipolar disorder.9

Dialectical Behavior Therapy

A 2013 study found dialectical behavior therapy to be a promising treatment for bipolar disorder, according to an article published in Psychiatric Times.10 Originally developed to treat people with suicidal thoughts and actions, dialectical behavior therapy involves teaching participants four sets of essential behavior skills:

Mindfulness – the practice of being aware and present in the moment

Distress tolerance – how to tolerate, rather than eliminate, painful situations

Interpersonal effectiveness – how to say no to people and ask for what you want in a way that promotes healthy relationships and a high level of self-respect

Emotional regulation – how to control your emotions and change those you want to change

Interpersonal Therapy

Bipolar disorder and addiction both have a strong influence on your interactions with others. Interpersonal therapy addresses your various relationships and explores how your interactions with others affect your disorders and vice versa.

Social Rhythm Therapy

Keeping a routine and getting adequate sleep are both crucial for recovering from co-occurring disorders. The body’s circadian rhythms are deeply affected by bipolar disorder. Resetting and stabilizing your biological clock for better sleep, daily functioning and overall mental health can make a big difference in your recovery.

Challenges in Recovery from Bipolar Disorder and Addiction

Recovery from a substance use disorder can be particularly challenging if you have bipolar disorder. The nature of manic and depressive episodes, such as the prevalence of risk-taking behaviors during a manic episode and the feelings of hopelessness that characterize a depressive episode, can lead to disengagement with your treatment plan. This can quickly lead to a relapse.

Although research shows that people with bipolar disorder recover more slowly when alcohol abuse or addiction co-occurs, with the right dual diagnosis program and a high level of engagement in treatment, many people can and do recover from bipolar disorder and addiction.

With the right dual diagnosis program and a high level of engagement in treatment, many people can and do recover from bipolar disorder and addiction.

Choosing a Recovery Program

If you have bipolar and a substance use disorder and you’re ready to get the help you need to recover from both disorders, choosing a residential dual diagnosis treatment program is essential for the best possible outcome. Residential treatment programs enable you to focus solely on recovery, and they offer an enormous amount of support during treatment. Components in choosing a treatment program include:

  • State accreditation. Make sure the facility is accredited by the state it’s in.
  • Licensing. Ensure the mental health professionals and addiction specialists are fully licensed and well trained.
  • Research-based treatment protocol. Find out whether the program uses a research-based, best-practices treatment protocol and adheres to the National Institute on Drug Abuse’s Principles of Effective Treatment.11
  • Statistics. Ask about the program’s outcome statistics. Treatment programs should have readily available statistics concerning their success rates, and they should be forthcoming with that information.
  • Personal preferences. Make sure the program and the facility are a good match for your personal preferences. For example, if you’re vegetarian, are meatless options available for meals?
  • Are the residential facilities clean and comfortable? Does the facility feel like a hospital or a home?
  • A holistic approach. High-quality treatment programs will offer a number of holistic, research-based complementary therapies like yoga, art therapy, acupuncture or nature therapy.
  • Insurance. Does the facility accept your insurance? Keep in mind that under the Mental Health Parity and Addiction Equity Act of 2008, insurance companies must offer the same level of benefits for mental health and addiction recovery services that they do for standard medical treatments.12

Recovering from a co-occurring disorder isn’t easy, but the hard work pays off in a dramatically higher quality of life and sense of self-efficacy and well-being. Hope is the foundation of recovery, which is a process of change that occurs from the inside out and leads to better health and wellness and a self-directed life.13 As long as you have hope for a better future in which you’re able to strive to reach your full potential, there’s always a high potential for long-term recovery.


  1. Bipolar Disorder Statistics. (n.d.). Retrieved from http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_bipolar_disorder
  2. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005, June). Prevalence, Severity, and Comorbidity of Twelve-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847357/
  3. Quello, S. B., Brady, K. T., & Sonne, S. C. (2005, December). Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Science & Practice Perspectives, (3)1, 13-21. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/
  4. About Addiction: Signs and Symptoms. (2015, July 25). Retrieved from https://ncadd.org/about-addiction/signs-and-symptoms/signs-and-symptoms
  5. Substance Abuse Treatment for Persons with Co-Occurring Disorders. (2005). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64196/
  6. SAMHSA’s Working Definition of Recovery: 10 Guiding Principles of Recovery. (2012). Retrieved from https://store.samhsa.gov/shin/content/PEP12-RECDEF/PEP12-RECDEF.pdf
  7. Integrated Treatment for Co-Occurring Disorders. (2009). Retrieved from http://store.samhsa.gov/shin/content//SMA08-4367/Brochure-ITC.pdf
  8. Bipolar Disorder: Treatment & Drugs. (2015, February 10). Retrieved from http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/treatment/con-20027544
  9. Psychotherapies. (n.d.). Retrieved from http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml
  10. Duerr, H. A. (March, 2013). DBT Holds Promise for Patients With Bipolar Disorder. Retrieved from http://www.psychiatrictimes.com/bipolar-disorder/dbt-holds-promise-patients-bipolar-disorder
  11. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
  12. Implementation of the Mental Health Parity and Addiction Equity Act. (2016, March 18). Retrieved from http://www.samhsa.gov/health-financing/implementation-mental-health-parity-addiction-equity-act
  13. Recovery and Recovery Support. (2015, October 5) Retrieved from http://www.samhsa.gov/recovery
The Role of Environment in Addiction

Drug and alcohol addiction impacts 23.5 million Americans each year. The sad truth is, though, that only around 11.2 percent of those people seek professional treatment. There are numerous factors that can contribute to addiction—trauma, mental illness, peer pressure—but out of all of the possible causes, there is one that affects every single person: environment.

Environment and the Brain’s Reward System

A person’s social interactions with others and their personal circumstances impact the risk of developing an addiction. When someone lives in an environment that does not challenge their mind or that makes them feel bad due to rocky relationships with loved ones, they are not stimulating the reward system in their brain. That lack of stimulation means that they are more likely to abuse drugs or alcohol in an effort to improve the way that they feel.

Poor social stimulation includes:

  • Poor relationships with family
  • A boring job situation
  • Poor interactions with co-workers
  • A lack of friends
  • Lack of respect at work or at home
  • Conflict in any relationship

Trauma or Abuse

Almost 50 percent of women and 60 percent of men experience traumatic situations at least once in their lifetime. That’s more than half of the country’s population. How do so many people cope with these stressful and painful memories? Many of them drink or do drugs. The reality is, though, that using only makes things worse. It might mask the pain for a moment, but it doesn’t resolve it. Instead, the symptoms compound into ugly globules of depression, anger and self-hatred. Soon they’ll have no choice but to feed their addiction, even though substance abuse is no longer covering up the pain.

Peer and Family Influences

A person’s quality of life, peer interactions and family influences greatly impact the way that they view the world—including their decisions regarding drugs or alcohol . If they work in a job that encourages alcohol consumption, then they are subconsciously influenced by the behavior of their peers and co-workers. Or if a loved one takes a prescription medication and leaves it in a location that they can access easily, they might be tempted by its presence and know where to turn if a conflict arises.

These influences make it almost impossible to stop using once a person becomes addicted. It’s time for them to take back control, and the first step is separating from anyone who pressures them into using or who uses around them.

Finding the Help They Need

It’s no secret that addiction is harmful to a person’s life, their relationships and their health. In order to find the help they need, it is important to look past what their peers are doing and look into themselves. They should make their own decisions. Many times those decisions include entering into a new, encouraging environment and surrounding themselves with others who will support them and help guide them back to sobriety.

Each person’s situation is unique. Their story is their own. Finding a treatment facility that fits a person perfectly can be a challenge, but it is vital to their success. A high-quality program will look into past traumas and living environments in order to pinpoint the root cause of their addiction. From there, they will finally be able to heal and grow into the person they want to be.

Is Addiction a Disease or a Choice

Is addiction a disease or a choice? That question has fueled countless debates over the years. Though there is solid evidence supporting both sides, the scientific and biological proof that drives the concept of addiction as a disease is paramount.

What causes a person to first pick up a bottle or take a few pills may be a choice, but the deeper issue of addiction is anything but. Like other diseases, addiction is the product of a series of environmental, psychological and biological factors baked together into a dangerous concoction.

What is the Disease Theory?

The disease theory of addiction essentially looks at addiction as a medical illness that can’t be controlled without ongoing treatment. Addiction has been classified as a physical disease due to the cycles of cravings and withdrawal symptoms it produces. It changes the way the brain functions, leading people to do things against their expressed will. This is where choice ends and chronic illness begins.

Addiction and the Brain

Drugs tap into the brain’s communication system and physically change the way the brain processes information. This causes the brain’s reward system to be flooded with feel-good chemicals, sending the user into a state of euphoria. The overstimulated reward system of the brain reinforces the behavior of drug use, leading to the desire to use again.

These pathological changes in the brain result in overpowering urges to use. Even if a person expresses a sincere desire to quit using, they’re drawn to take whatever steps are necessary to obtain their drug of choice. The disease completely overwhelms them—their thoughts, feelings and actions—until the only thing they’re able to focus on is using, as though their life depends on it.

Addiction and Survival Instincts

The survival instinct drives people to seek out resources that will trigger the brain’s reward sensors, i.e., when people eat, they feel full and satisfied. As time passes and behaviors are positively and consistently rewarded, a body begins to make the connection between the act and the feeling of pleasure it produces. Eventually, people start to crave the behavior more and more until it becomes an automated routine.

Addictive drugs evoke patterns of behavior similar to those prompted by natural rewards. As the user falls deeper into addiction, though, that single behavior starts to take precedence over all other instincts, including eating, sleeping, working or even caring for children. Addiction becomes their dominant survival instinct, which is one reason giving it up is so challenging. Their body yearns for it and feels the need to fulfill its instinctual goal.

Treating Addiction as a Disease

It is no secret that treatment can help people quit using, avoid relapse and successfully recover, but finding a treatment center that focuses on treating addiction as a disease may be the most effective option. It focuses on mental health as a whole, digging into a person’s past and exposing events that may have triggered them to start using in the first place . This allows people to heal from the inside out, removing the baggage that has held them down for so long.

Types of treatments used to heal mind and body include:

  • Individual therapy
  • Meditation
  • Art therapy
  • Yoga
  • Group therapy