Untangling Bipolar Disorder and Substance Abuse

Medically Reviewed By William C. Lloyd III, MD, FACS

Roughly half of people living with a mental health condition such as bipolar disorder also have a problem with substance abuse.

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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 living with symptoms of bipolar disorder, it can be hard to function normally. It can also be difficult to function normally if you're inappropriately using alcohol, drugs, or both.

If you have both a mental illness and a substance abuse disorder, your doctors may use the term “dual diagnosis.” A dual diagnosis of bipolar disorder and substance use disorder is a very tangled web. Both conditions can be difficult to manage, but it's important to know that neither is occurring as a result of a lack of commitment or any moral failing. Resources and support are available to help, and recovery is possible.

Why bipolar disorder and substance use disorders are connected

Studies suggest that about half of all people living with a severe mental illness, including bipolar disorder, may use substances inappropriately. In a specific study of people with bipolar disorder, 56% of participants used drugs harmfully and 44% lived with alcohol use disorder.

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 conditions 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 manic episodes 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 may 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 inappropriate substance use makes bipolar disorder worse and bipolar disorder makes substance abuse disorders worse.

Living with 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 prescription medications, or drop out of treatment.

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

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

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

Untangling the web

The key to untangling substance use disorder and bipolar disorder is to treat both conditions. Untreated bipolar disorder makes substance use disorder treatment much harder, and untreated substance use disorder 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 with guidance from a medical professional.

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

  • You can treat substance use disorder 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 disorder group therapy

Very focused treatment is usually beneficial. One type of group therapy, called integrated group therapy (IGT), combines substance use disorder group therapy with bipolar disorder 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 individual substance use disorder counseling.

Key takeaways

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

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

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

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

  • Recognizing and treating both conditions together is the best way to untangle the web.
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  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
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jul 8
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