People with bipolar disorder have high rates of co-occurring substance use disorders. This can lead to negative consequences including increased risks of psychosis, suicide and self-harm through reckless actions.

People with bipolar disorder have high rates of co-occurring substance use disorders. Many complex biological and personal factors lead to the development of these comorbid disorders, but the case is often simple: people with bipolar disorder frequently start using alcohol or other drugs to cope with their symptoms.

Unfortunately, the negative consequences of co-occurring bipolar and substance use disorders include increased risks of psychosis, suicide and self-harm through reckless actions.

Drug Abuse as a Hindrance to Bipolar Treatment

Treatment of bipolar disorder typically involves both therapy and medication. In the case of bipolar disorder, medication is essential. While trauma and personal factors can worsen and trigger bipolar symptoms, the disorder is biologically driven and persists even when people make significant psychological breakthroughs in therapy.

The medications most frequently prescribed for bipolar disorder are a class of mood stabilizers called anticonvulsants. Medications like lamotrigine and oxcarbazepine for bipolar disorder can help prevent or lessen symptoms of depression and mania. One of the biggest risks for people with bipolar disorder is thinking their symptoms have been cured, discontinuing medications and experiencing a serious manic or depressive episode.

Substance abuse significantly increases the risk that a person with bipolar disorder will stop taking their medications and trigger a recurrence of symptoms that may have been controlled for a long time. Using substances also interrupts the therapeutic process, causing people to forget or abandon skills or insights from therapy. The consequences of dropping out of bipolar disorder treatment can be severe, leading to hospitalization or even attempted suicide.

Effects of Substance Abuse on Bipolar Disorder

Bipolar disorder is characterized by alternating mood episodes. Some people with bipolar disorder may simply shift from manic episodes to symptom-free periods, while many others experience manic or hypomanic episodes followed by depressive episodes.

People with bipolar disorder may use the same substances in both manic and depressive periods or use multiple substances with different effects. Drugs like alcohol and marijuana can help people feel calmer during manic periods or may act to heighten feelings of creative inspiration. Alcohol can also numb the pain associated with a depressive episode. Whereas, Stimulants can temporarily boost energy.

Some of the biggest risks for people with co-occurring mood and substance use disorders come from the residual effects that occur between periods of use. Most substances that boost mood or energy cause people to experience dysphoria and lethargy after their effects wear off. These effects can be especially severe for people with bipolar disorder and may trigger a mood episode.

Alcohol and Bipolar

Co-occurring bipolar disorder and alcoholism are common. Approximately 46 percent of people with bipolar disorder have had an alcohol use disorder in their lives. People with bipolar disorder often use alcohol to regulate their thinking and mood during both manic and depressive episodes.

Combining bipolar and alcohol use can be especially dangerous. For people with bipolar disorder whose symptoms are otherwise controlled, alcohol can induce a serious depressive episode. It can also complicate manic symptoms and make people more likely to act on delusions or have other psychotic symptoms.

People who drink also tend to be more irritable and volatile. Using alcohol can make someone with bipolar disorder have less stable moods. It can also make them more likely to become aggressive and angry, even to the point of having what some people call a “bipolar rage episode.”

Marijuana and Bipolar

Marijuana and bipolar symptoms interact in a similar way as alcohol and bipolar. Cannabis can have a calming effect that makes it easier to rest and focus during episodes of anxiety or mania. Unfortunately, it can just as easily trigger severe anxiety, paranoia and panic.

Under the influence of marijuana, bipolar symptoms are more likely to progress into psychosis. Research shows marijuana can trigger psychotic symptoms, especially in vulnerable individuals like people with mental health conditions such as bipolar disorder. In addition, marijuana use is linked with longer and more frequent mood episodes for people with bipolar disorder.

Stimulants and Bipolar

People use stimulants for many reasons. In small doses, stimulants can increase mental energy and focus. They can also induce feelings of mild euphoria or empowerment that make challenging activities more engaging and less stressful.

For people with bipolar disorder, stimulants have additional risks. They can trigger manic symptoms and episodes even in people whose symptoms are managed by mood-stabilizing medications. This is why people with co-occurring bipolar and attention-deficit hyperactivity disorder are rarely prescribed the stimulants. For instance, Adderall and bipolar disorder do not mix well.

Despite these risks, people with bipolar disorder frequently abuse stimulant drugs, often in an attempt to prolong the more pleasant symptoms of hypomania.

Statistics on Bipolar Disorder and Drug Abuse

Nearly 60 percent of people with bipolar disorder have had a substance use disorder at least once. Alcohol is the substance most commonly abused by people with bipolar disorder and in general. People with bipolar disorder are 14 times more likely to abuse drugs and six times more likely to have alcohol dependence than the general population. Substance abuse in people with bipolar disorder is also linked to higher rates of suicide, hospitalization and accidents, as well as lower rates of participation in treatment.

Can Drug Abuse Cause Bipolar Disorder?

Bipolar disorder is rooted in genetic and biological factors and cannot be caused solely by environmental factors or adult behavior like substance abuse. However, using substances can trigger mood episodes in people who already have the disorder. In addition, substance use in adolescence may cause people who are vulnerable to develop bipolar disorder more rapidly or to become symptomatic.

Treating Bipolar Disorder and Co-Occurring Substance Abuse

Bipolar disorder is usually treated with a combination of psychiatric medication and therapy. People with bipolar disorder work with therapists to recognize signs and triggers of mood episodes and how to change their behavior to assist the mood-regulating effects of bipolar disorder medications. They may need to process past trauma and explore interpersonal issues.

Integrated treatment is essential for an effective medical response to co-occurring disorders. This means that each individual component of a treatment plan should serve the same goals and be coordinated by professionals who communicate regularly with one another. Integrated treatment rests on the principle that treating mental health and substance use disorders at the same time leads to better outcomes for each.

Living with bipolar disorder can be challenging, especially for people who are also struggling with addiction, as relying on drugs or alcohol to relieve bipolar disorder symptoms can be extremely risky, even life-threatening. However, with the right treatment for their substance use disorder, people with co-occurring mental health conditions can make lasting and meaningful changes to help them live happier lives.

If you or a loved one are struggling with bipolar disorder or another co-occurring mental health disorder in addition to substance use, contact The Recovery Village. A representative can discuss integrated treatment options with you and help you or your loved one find the best place to start or continue the recovery journey.

a man in a purple shirt smiling at the camera.
Editor – Devin Golden
Devin Golden has worked for various print and digital news organizations. Devin's family has been affected by addiction and mental health disorders, which is a large part of why he wants to help others who have either directly or indirectly been affected by these diseases. Read more
a woman wearing glasses sitting in a chair.
Medically Reviewed By – Stephanie Hairston, MSW
Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more
Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.