Untangling Bipolar Disorder and Substance Abuse


Chris Iliades, MD

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Bipolar disorder is a mental illness that causes mood swings between depression and a high-energy state called mania. If you're suffering from symptoms of bipolar disorder, it can be hard to function normally. It can also be difficult to function normally if you're abusing alcohol, drugs, or both.

Sometimes these are woven together. If you have both a mental illness and a substance abuse issue, your doctors use the term “dual diagnosis.” A dual diagnosis of bipolar disorder and substance abuse is a very tangled web.

Why Bipolar Disorder and Substance Abuse Are Connected

Studies show that about half of all people with a severe mental illness, including bipolar disorder, are substance abusers. A specific study on people with bipolar disorder found that 56% abuse drugs and 44% abuse alcohol.

People with a high risk for dual diagnosis include men, military veterans, people struggling to make ends meet, and people with chronic illness.

Explanations for the connection include:

  • The symptoms of bipolar depression, including anxiety and lack of energy, are hard to live with. Drugs or alcohol may offer temporary relief, especially if bipolar disorder is not being treated.

  • Both afflictions share a genetic predisposition for flawed neurotransmitter synthesis. Chemicals like dopamine and glutamate play a key role in the biology of both mental health maintenance and substance abuse.

  • The symptoms of bipolar mania may cause bad judgment and risky behavior. Affected individuals may feel invulnerable. This can make it harder to resist abusing drugs or alcohol.

  • The effects of alcohol and drugs on your brain and your body may trigger an underlying mental illness like bipolar disorder, or they make symptoms worse.

The Dangers of Dual Diagnosis

The temporary relief that a drug or a drink offers may seem like a way out, but it's never a good decision with bipolar disorder. There is no doubt that substance abuse makes bipolar disorder worse and bipolar disorder makes substance abuse worse. Having both conditions can lead to these dangerous situations:

  • You’re less likely to respond to bipolar disorder treatment—you may miss appointments, stop taking your drugs, or drop out of treatment.

  • You’re more likely to have severe bipolar symptoms and need to be treated in a hospital.

  • You’re more likely to attempt and die of suicide.

  • You’re more likely to suffer from complications of substance abuse, such as legal problems, health problems, or drug overdose.

Untangling the Web

The key to untangling substance abuse and bipolar disorder is to treat both problems. Untreated bipolar disorder makes substance abuse treatment much harder, and untreated substance abuse makes bipolar disorder treatment harder. Here are treatment basics:  

  • The first step is to safely withdraw from drugs or alcohol. This may require detoxing in a hospital or treatment center.

  • The next step is to start treatment for both conditions.

  • Bipolar disorder is usually treated with a drug called a mood stabilizer. You may benefit from other drugs and from a form of psychotherapy called talk therapy as well.

  • You can treat substance abuse with group therapy and psychotherapy. Alcoholics Anonymous, Narcotics Anonymous, outpatient treatment, and halfway houses may all be valuable. You might also benefit from prescription drugs.

Bipolar Group Therapy

Very focused treatment is usually beneficial. One type of group therapy, called integrated group therapy (IGT), combines substance abuse group therapy with bipolar group therapy. You’ll learn about both conditions and about preventing a relapse. In a study sponsored by the National Institute on Drug Abuse, people in the IGT group were about twice as likely to be drug- and alcohol-free during and after treatment as people who received only substance abuse counseling.

Key Takeaways

  • Many people with bipolar disorder use drugs or alcohol to try to ease their bipolar disorder symptoms.

  • About 50% of people with bipolar disorder simultaneously suffer from substance abuse, a condition called dual diagnosis.

  • Substance abuse makes bipolar disorder worse and harder to treat.

  • Bipolar disorder makes substance abuse worse and harder to treat.

  • Recognizing and treating both conditions together is the best way to untangle the web.
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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Jun 13, 2017

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Medical References

  1. Attention to Bipolar Disorder Strengthens Substance Abuse Treatment. National Institutes of Health. National Institute on Drug Abuse. http://www.drugabuse.gov/news-events/nida-notes/2010/04/attention-to-bipolar-disorder-strengthens-su...
  2. Mental Health by the Numbers. National Alliance on Mental Illness. http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
  3. Dual Diagnosis. National Alliance on Mental Illness. http://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis
  4. What is bipolar disorder? National Institutes of Health. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

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