Bipolar disorder and substance use disorders often occur together: research summarized in StatPearls, a peer-reviewed medical reference, finds that 30% to 50% of people with bipolar disorder meet criteria for an alcohol or other substance use disorder. Each condition can make the other worse, leading to more frequent mood episodes and a harder recovery. The most effective approach is integrated dual diagnosis treatment that addresses both at the same time.
People often search for “bipolar and substance abuse,” though clinicians today use the term substance use disorder, which focuses on the condition rather than blame. Whatever words you use, if you’re living with both, you are not alone, and help that treats the whole person is available.
How Common Is Bipolar and Substance Abuse Together?
The overlap is striking. According to StatPearls, 30% to 50% of people with bipolar disorder meet criteria for alcohol and other substance use disorders. The National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA) both list substance use disorders among the conditions that commonly occur with bipolar disorder, along with anxiety disorders and ADHD.
More broadly, the National Institute on Drug Abuse (NIDA) reports that, based on the 2023 National Survey on Drug Use and Health, about 35% of U.S. adults with a mental disorder also have a substance use disorder. When two conditions happen together, they’re called co-occurring disorders or a dual diagnosis.
Why Bipolar Disorder and Substance Use Are Linked
There is no single reason. NIDA describes several ways mental illness and substance use disorders become connected:
Shared Risk Factors
Genetics, trauma and stressful environments can raise the risk of both conditions. Mayo Clinic lists family history, periods of high stress and drug or alcohol misuse as risk factors for bipolar disorder.
Self-Medicating Symptoms
People may turn to substances to cope. NIDA notes some people use drugs or alcohol to manage symptoms like anxiety or depression. NAMI explains that both the lows of depression and the highs of mania can lead people toward substance use.
Substances Can Trigger or Worsen Mood Episodes
The relationship runs both ways. The APA notes that drugs and alcohol may trigger mood episodes in vulnerable people, and NIDA points out that cocaine use may worsen the symptoms of bipolar disorder. Learn more about how alcohol affects depression.
How Substance Use Affects Bipolar Disorder
When bipolar disorder and substance use occur together, outcomes tend to be harder. StatPearls reports that people with both conditions experience:
- A more severe course of illness
- More frequent depressive and manic episodes
- Reduced quality of life
StatPearls also notes that co-occurring conditions, including substance use disorders, are linked to more intense symptoms and a higher risk of suicide. Substances can also interfere with treatment: NAMI cautions that drugs and alcohol can disturb emotional balance and interact with medications. Mayo Clinic lists substance misuse as both a risk factor for bipolar disorder and a complication of untreated illness.
If you or someone you love is having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline. For an emergency or a possible overdose, call 911, and if opioids may be involved, give naloxone if it is available.
Signs Both Conditions May Be Present
- Drinking or using drugs more during manic or depressive periods
- Using substances to sleep, calm down or feel “normal”
- Mood episodes that seem to follow periods of heavy use
- Skipping bipolar medication, or mixing it with alcohol or drugs
- Trouble telling which symptoms come from mood and which from substances
For a refresher on mood symptoms, see our guide to the signs of mania or visit our bipolar disorder hub.
Treating Bipolar Disorder and Substance Use Together
If you’re facing bipolar and substance abuse at the same time, treating one condition while ignoring the other rarely works. NIDA reports that integrated treatment, which addresses both conditions at the same time, leads to better outcomes than treating them separately. Mayo Clinic likewise notes that substance misuse needs to be treated along with bipolar disorder, because it makes the disorder very hard to manage. StatPearls adds that involving an addiction specialist can improve outcomes. Learn more about dual diagnosis treatment.
What Integrated Care Can Include
- Psychiatric care and medication management: Mood stabilizers and other bipolar medications work best when a prescriber knows your full substance use history.
- Therapy: Approaches like CBT, DBT and motivational interviewing help you manage moods, handle cravings and build coping skills.
- Family therapy: Helps loved ones understand both conditions and support recovery.
- Healthy routines: NIMH recommends regular sleep, meals and exercise, tracking your moods and avoiding substance use.
- Peer support and relapse prevention: Groups and a written relapse prevention plan can help you spot early warning signs for both mood episodes and return to use.
A Note on Withdrawal Safety
If you drink heavily or use benzodiazepines regularly, don’t stop suddenly on your own. Alcohol and benzodiazepine withdrawal can be life-threatening and need medical supervision. Read more about medical detox and when you may need it.
Frequently Asked Questions
Can substance use cause bipolar disorder?
Substance use can trigger mood episodes in people who are vulnerable, and Mayo Clinic notes that some bipolar-type mood conditions are triggered by drugs or alcohol. A full evaluation by a mental health professional helps clarify the diagnosis.
How many people with bipolar disorder have a substance use disorder?
StatPearls reports that 30% to 50% of people with bipolar disorder meet criteria for an alcohol or other substance use disorder, making it one of the most common co-occurring conditions.
Should I treat my bipolar disorder or my substance use first?
Ideally, both at the same time. Research shows integrated treatment leads to better outcomes than treating each condition separately.
Can I drink alcohol while taking bipolar medications?
Alcohol can interact with medications and disturb mood stability. Talk with your prescriber, and get support if cutting back feels hard.
Get Help for Bipolar Disorder and Substance Use in Lancaster, PA
You deserve care that treats the whole picture. The Ranch Pennsylvania Outpatient Services provides integrated dual diagnosis care in Lancaster, combining mental health treatment with our addiction treatment programs. Our partial hospitalization program offers full-day support five days a week, with optional housing at our Outpatient Residence, and our intensive outpatient program lets you keep living at home. If medical detox is needed first, it can be coordinated with residential care at The Ranch Pennsylvania. Verify your insurance to get started. Our admissions team is available 24/7, and calls are free and confidential.
