How substance use affects bipolar disorder
Among people with bipolar disorder, there are very high rates of addiction comorbidities. A United States National Epidemiologic Survey on Alcohol and Related Conditions found that people diagnosed with bipolar I disorder have a 5.8 times increased lifetime risk of developing substance use disorder.
Research from the UK further highlights the relationship between these disorders. 44% of people with bipolar disorder experience a lifetime history of substance use, and 48% deal with alcohol addiction at some point.
It hasn’t yet been established why people with bipolar disorder are at heightened risk of developing substance use disorder, but evidence points to similarities between the neurobiological and genetic underpinnings of both.
What is known, however, is that individuals with comorbid bipolar disorder and substance use disorder may have greater cognitive impairment than those with bipolar disorder alone and, as such, require a comprehensive, holistic approach that treats both conditions at the same time.
In this article, we look at the comorbidity of these two conditions in more detail and outline how you can get help for both.
Key takeaways
- Many people with bipolar disorder also experience a co-occurring substance use disorder.
- Drugs and alcohol often exacerbate the symptoms of bipolar disorder.
- The comorbidity between substance use disorder and bipolar disorder can lead to several adverse health outcomes, such as early onset of illness and increased risk of suicide.
- Medication and behavioral therapies are options for treating a dual diagnosis of bipolar and substance use disorder.
What is bipolar disorder?
Bipolar disorder, which was formerly called manic depression, is a lifelong mood and mental health condition characterized by extreme mood swings and severe changes to thinking patterns, energy levels, and behavior.
A key feature of bipolar disorder is manic and hypomanic episodes. These can last for a few days to several months and can cause significant interference to day-to-day activities, work, and relationships.
Symptoms of mania include:
- Increased energy, activity, and agitation
- A distorted sense of well-being or self-confidence
- Needing much less sleep than usual
- Being overly talkative and speaking at a rapid speed
- Racing thoughts
- Being easily distracted
- Unwise, impulsive decisions
Major depressive episodes are also a component of bipolar disorder. As with mania, the symptoms are severe enough to impact daily life and cause a loss of interest in most activities.
Symptoms include:
- A depressed mood
- Feeling no pleasure in doing most things
- Weight loss or gain
- Sleep changes
- Restlessness or acting slower than usual
- Fatigue
- Feelings of worthlessness or guilt
- Difficulty concentrating
- Suicidal ideation
What is substance use disorder?
Treatable mental health conditions that alter a person's brain and behavior, rendering them unable to control their use of certain substances. This affects their day-to-day life and social relationships. It also increases their risk of other health issues.
Alcohol is commonly a substance that individuals cannot control their consumption of, but illicit and prescription medications are also substances that are used. These include:
- Cannabis
- Cocaine
- Heroin
- Hallucinogens
- Inhalants
- Amphetamines
Do drugs and alcohol make bipolar worse?
Substance use can make the symptoms of bipolar disorder worse and vice versa. Certain substances, for example, can trigger or worsen manic and/or depressive episodes:
Alcohol is a depressant and can intensify depressive symptoms, but research has also found that excessive drinking can heighten symptoms of mania or hypomania.
Stimulants (such as cocaine and amphetamines) can provoke or prolong manic or hypomanic episodes.
Cannabis may appear to reduce anxiety or low mood in the short term, but can have a long-term impact on cognition.
Further, during manic or depressive phases, people with bipolar disorder may already struggle with impulsivity or decision-making. Substance use can make risky behavior, self-harm, or suicidal thoughts more likely.
The impact of substance use disorder on bipolar disorder
For those with bipolar disorder, coexisting substance use disorder is associated with a broad variety of negative outcomes, including:
- Earlier onset of illness
- Increased severity of disease
- Accelerated progression of disease
- Increased frequency of relapses
- More negative and cognitive symptoms
- Elevated risk of switching phases or mixed phases of bipolar
- Problems or delays with diagnoses
- No treatment or inadequate treatment
- Poorer social support
- Increased psychosocial problems, such as debt and reduced job performance
- Somatic comorbidities, including Hepatitis C and AIDS
- More frequent relapses
- Increased risk of suicide
- Worse compliance with treatment
- Reduced response to medication-based treatment
Can substance abuse cause bipolar disorder?
Not exactly. Substance abuse doesn’t cause bipolar disorder in the traditional sense, but research has been done on why they are so likely to co-occur. In general, the connections between substance use disorder and bipolar disorder have been grouped into three categories:
Disorder fostering disorder
This theory is based on the notion that one disorder may increase the risk of the other. So, bipolar disorder may compel individuals to use substances to cope with their symptoms.
Conversely, it is believed that chronic substance abuse may unmask bipolar disorder by intensifying symptoms to a clinically significant level. This occurs because the substance exacerbates pathophysiological changes in neurotransmitter systems or signaling pathways in the brain that already are irregular and underlie bipolar disorder.
Overlapping neurobiological pathways
Another possible reason why mood disorders and substance use disorders so often occur together is something called kindling. This idea originally comes from epilepsy. It refers to the way repeated brain disturbances, like seizures, can make brain cells more sensitive over time. As the brain becomes more sensitive, it takes less and less to trigger another episode.
A similar pattern can happen with drugs like alcohol or cocaine. These substances can make the brain more reactive, which may lead to people using them more often and in larger amounts. Mood disorders can also follow this kind of pattern, where each episode of depression or mania becomes more intense and happens more frequently over time.
So, the kindling theory suggests that in people who are more vulnerable, the brain may be wired in a way that makes it easier for both substance problems and mood disorders to take hold — and to keep getting worse.
Genetic factors
Research shows that both substance abuse and mood disorders can run in families, which means genetics play a role. If someone in a family struggles with addiction, it’s more likely that someone else might also have a mood disorder, and vice versa. This suggests that certain genes might increase the risk of both.
These genes could:
- Make someone more likely to develop a mood disorder, which they might then try to cope with by using drugs or alcohol.
- Affect how the brain reacts to drugs the first time they're used, making addiction more likely. Over time, this could lead to a mood disorder.
- Shape the brain in a way that makes someone more likely to develop both addiction and mood issues, especially if their brain is more sensitive to stress or repeated episodes.
There’s also a condition called substance-induced mood disorder, which is different from true bipolar disorder. It happens when mood symptoms (mania or depression) are directly caused by drug or alcohol use or withdrawal. These symptoms can sometimes clear up after stopping the substance, but not always.
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Behavioral addictions and bipolar disorder
Aside from a higher prevalence of substance use disorder, individuals with bipolar disorder are also more likely to experience other behavioral addictions. For example, bipolar disorder has one of the highest rates of cigarette smoking of any mental health disorder. Those with bipolar disorder are also more likely to have gambling addiction.
Treating bipolar disorder and substance use disorder
When bipolar disorder and substance use disorder (SUD) occur together, which is common, treating both at the same time is essential. These conditions can feed into each other, making symptoms more severe and recovery more complex. An effective treatment plan often involves a combination of medical, psychological, and lifestyle approaches tailored to each individual.
Medications
Medications can help stabilize mood and reduce cravings or withdrawal symptoms. The goal is to manage bipolar symptoms without increasing the risk of relapse into substance use.
Common medications include:
- Mood stabilizers to prevent manic or depressive episodes
- Atypical antipsychotics to help control mood swings and psychotic symptoms
- Antidepressants are sometimes used with caution, and always alongside a mood stabilizer to avoid triggering mania
- Medications for substance use, such as naltrexone (for alcohol or opioid dependence), acamprosate (for alcohol), or buprenorphine (for opioids).
Medication plans are closely monitored to avoid interactions and support long-term recovery.
Inpatient treatment
In more severe cases, inpatient treatment may be necessary. This provides a structured environment where individuals can receive round-the-clock care, safely detox from substances, and begin mood stabilization. Inpatient programs often combine medication, therapy, and support for both disorders.
Lifestyle changes
Building healthy routines is an important part of managing bipolar disorder and substance use disorder. Lifestyle changes can help regulate mood and reduce the risk of relapse.
Helpful lifestyle strategies include:
- Avoiding alcohol and recreational drugs
- Getting regular sleep and maintaining a consistent sleep schedule
- Eating a balanced diet
- Exercising regularly to improve mood and reduce anxiety
- Managing stress through mindfulness, meditation, or relaxation techniques
- Creating a supportive environment with healthy relationships
Cognitive behavioral therapy (CBT)
CBT helps individuals recognize and change unhelpful thoughts and behaviors. In people with bipolar disorder and substance use disorder, CBT can:
- Improve coping strategies
- Reduce substance cravings
- Help manage mood swings and emotional triggers
- Increase awareness of relapse warning signs
CBT is often delivered one-on-one but can also be part of group therapy.
Integrated group therapy
Integrated Group Therapy (IGT) is designed specifically for people with both bipolar disorder and substance use disorder. Unlike traditional group therapy, IGT addresses both conditions at the same time.
Benefits include:
- Learning how bipolar symptoms and substance use affect each other
- Building practical skills to manage both conditions
- Sharing experiences in a supportive, understanding group environment
IGT focuses on long-term recovery and relapse prevention, helping individuals feel less isolated and more in control.
Whether you're dealing with a diagnosis like bipolar disorder, struggling with substance use, or just feeling overwhelmed, you're not alone. At Resilience Lab, we connect you with licensed therapists who can support you with personalized, evidence-based care. Find your top matches today.
You can also learn more about different mental health challenges, explore the benefits of therapy, and take your first step toward feeling better through the Resilience Lab blog.
References
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