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Co-Occurring Bipolar Disorder and Substance Use

Bipolar disorder is a psychiatric condition in which an individual experiences phases of mania and depression with many different symptoms that depend on the type of bipolar disorder and the specific individual suffering from it. Because of the intense highs and lows experienced, drug and alcohol use are both linked to this disorder at abnormally high rates. More than 60% of people with Bipolar 1 develop a substance use disorder, and this includes individuals across the world and not just in a particular geographic area.

Substance Abuse and Co-Occurring Bipolar Disorder

Why Bipolar Disorder and Substance Misuse Co-Occur

Though the reason for this co-occurrence is largely unknown, there are a few reasons why drug and alcohol use may be higher in these individuals. One of the symptoms of mania that occurs often is the participation in risky behaviors that produce pleasurable effects in the brain but may lead to “a high potential for painful consequences.” Because bipolar disorder is caused by genetics, substance use will not lead to the development of this condition. But, having bipolar disorder may point to an increased risk of participating in the illicit use of drugs and alcohol. 

The onset of bipolar disorder and the severity of this condition can be, however, influenced by early use of substances if that use begins before the symptoms of bipolar disorder. Young individuals who begin using substances earlier than the onset of their bipolar disorder are more likely to have more severe symptoms of mental illness and a poorer prognosis.

Bipolar Disorder
Substances Linked to

Bipolar Disorder

Because it is known that individuals with bipolar disorder are more likely to develop substance use disorders, studies have investigated these comorbidities in order to better understand which substances are more likely to be abused. One study found that men and women with manic bipolar disorder are “14 times more likely” to abuse drugs and “6 times more likely” to abuse alcohol than the general public.  

When looking at the difference in drug use between individuals affected by bipolar 1 and bipolar 2, studies have shown the following:

  • Alcohol abuse occurs in about 49% of individuals with bipolar 1 and 39% of individuals with bipolar 2.
  • 20% of individuals with bipolar 1 report using different forms of cannabinoids, while only 5% of individuals with bipolar 2 reported similar use. 
  • Cocaine abuse is seen in 11% of bipolar 1 and 6% in bipolar 2.
  • Sedative hypnotics make up 7% of bipolar 1 and 6% of bipolar 2.
  • Other stimulants besides cocaine and opioid abuse are seen in the same number of bipolar 1 and 2 individuals at 6%.


For individuals dealing with bipolar disorder, the most abused substance is nicotine. About 83% of men and women abused nicotine throughout their entire lives. Though nicotine is not the most concerning substance that can be used, it is the most widely used and can pose many long-term consequences such as an increased risk of diabetes, cancer, lung cancer, gastrointestinal cancer, pancreatic cancer, breast cancer, problems with the cardiovascular system, breathing conditions, decreased immune response, and much more. Nicotine abuse affects the entire body and can cause a person to develop terminal health conditions that could have otherwise been avoided.


One study found that the rate a person drinks can change depending on the phase of their disorder. For example, 32% of individuals struggling with bipolar disorder increase their alcohol consumption during the manic phase while only 10% increase their drinking during the depressive phase. Because both conditions have a high rate of genetic predisposition, individuals who struggle with both disorders are more likely to pass these conditions on. Approximately 45% of people who struggle with bipolar disorder are also diagnosed with an alcohol abuse disorder. When combined, alcohol use and bipolar disorder lead to increased duration of negative symptoms, increased rates of suicide, and decreased responsiveness to treatment.

Illicit Drugs

Though alcohol is most often used, individuals with bipolar disorder may also struggle with drug abuse to stimulants, opioids, and other drugs. This is most often associated with manic episodes where individuals may participate in party drugs, but when clients slip into their depressive phase they may try to self-medicate through the abuse of stimulants.

Bipolar Disorder Treatment

Treating Co-Occurring Bipolar Disorder and Substance Abuse

Unfortunately, bipolar disorder is a lifelong condition that an individual will deal with which can make the treatment of co-occurring substance abuse much more difficult. While it is critical that both conditions be treated at the same time, men and women with BD will need to learn how to manage their disorder for their entire life while also working to manage their sobriety.


The most successful programs take place in a dual diagnosis treatment facility, particularly an inpatient program, where clients are able to commit 100% of their time to their recovery. The goal of these programs is to safely detox the client from whatever substances are in their system, treat the symptoms of their bipolar disorder so that they do not lead to a relapse, provide the individual with a support system, and help them develop a relapse prevention plan that helps them to maintain their sobriety and increased standard of living for the rest of their life. 

Some studies have looked into the best treatments for men and women dealing with co-occurring bipolar disorder and substance abuse. These treatment options include targeted interventions, psychotherapy, group therapy, individual counseling, 12-step programs specifically for individuals with BD, pharmacotherapy, and possibly medical-assisted treatments. Though it is important to try and stay away from further drug use, doctors may prescribe non-addictive medications such as mood stabilizers, anticonvulsants, antipsychotics, and naltrexone.

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