While bipolar disorder can raise your risk of substance use or misuse, co-treatment options and other support are available.

Bipolar disorder is a chronic mental health condition characterized by shifts in mood. There are different types of bipolar disorder, but all involve some combination of depressive and manic or hypomanic episodes.

Having bipolar disorder comes with several serious risk factors, including a higher chance of attempting suicide and an increased risk of developing a substance use disorder (SUD) compared with the general population.

“SUD” refers to when a person continues to use substances despite experiencing negative or harmful consequences. These substances can be alcohol, illegal drugs, or other drugs, including prescription medications like opioids.

A co-occurring SUD can complicate the diagnosis and treatment of both conditions. People with bipolar disorder and an SUD may have greater health challenges that affect their ability to follow and complete treatment regimens.

However, both bipolar disorder and SUD are very treatable. You’re not alone, and help is available.

We’ll go over how common SUDs are in people with bipolar disorder, why they co-occur so frequently, and what can be done to treat them separately and together.

How common is bipolar disorder?

Approximately 4.4% of U.S. adults will experience bipolar disorder within their lifetimes. It can significantly impact your ability to function in daily life, creating strain in relationships, at work, and at home.

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SUDs are common in people with bipolar disorder. In fact, the lifetime prevalence of SUDs in people with bipolar I disorder is at least 40%. Some statistics put it as high as 59%.

The statistics break down differently depending on the type of bipolar disorder and the substance used:

Bipolar I disorder36%40%10%8%
Bipolar II disorder22%10%4%0%

People with bipolar disorder and a co-occurring SUD frequently experience worsened effects of each. This may include more frequent and longer manic or depressive episodes, lower quality of life, and a higher chance of relapse (using substances again after quitting them).

People with bipolar disorder and cannabis use disorder are also more likely to attempt suicide than those without an SUD.

You’re not alone

If you’re experiencing suicidal thoughts for any reason, help is available 24/7. You can call 988 in the United States to reach the Suicide and Crisis Lifeline, or visit the Suicide and Crisis Line’s website to talk with someone.

If your bipolar disorder symptoms or substance use is causing regular stress to your mental health, it can be valuable to find a therapist to work with regularly.

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It’s unclear exactly why SUDs are so common in people with bipolar disorder. Researchers believe some people with bipolar disorder first misuse substances as a way to self-medicate. Both disorders also have a key shared risk factor: having a history of trauma or physical, sexual, and emotional abuse.

The depression, anxiety, or racing thoughts accompanying bipolar disorder can be exhausting, scary, and stressful. Feelings of relaxation, euphoria, and the sense of distraction substance use can provide can seem a welcome relief to people with untreated bipolar disorder.

Some other symptoms can increase your risk of substance use as well. When in a manic state, people with bipolar disorder may be prone to pleasurable activities that have a high potential for negative consequences. This can include things like shopping sprees, sex without a condom or other barrier method, or substance use and misuse.

If you don’t have access to therapy, medication, or the ability to make necessary lifestyle changes, substances may seem like your only way to find immediate relief from symptoms or other emotional pain.

However, substance misuse to self-medicate isn’t a long-term solution to managing bipolar disorder or healing from trauma.

Common substances

Alcohol and cannabis are the most commonly used substances for people with bipolar disorder, followed by cocaine and opioids.

People with bipolar disorder are more likely to use cannabis and have a cannabis use disorder than the general population. Researchers have connected cannabis use in people with bipolar disorder to:

  • an earlier age of onset
  • longer manic episodes
  • increased suicide attempts

Research into the effects of certain substances on mood episodes in people with bipolar disorder is ongoing. Some medical experts disagree about findings that cannabis can worsen the progression of bipolar disorder.

If you are interested in helping researchers learn about the best ways to treat bipolar disorder, check out ClinicalTrials.gov. Before joining a clinical trial, be sure to get the go-ahead from your doctor.

Someone with bipolar disorder may use sedative substances to lessen the symptoms of mania. They may use stimulants to temper a depressive state.

However, self-medication through substance use has serious health risks, including overdose and death. It’s not a sustainable or effective treatment plan.

Substances can also worsen a manic or depressive episode by exaggerating symptoms.

Sedative vs. stimulant

Some substances, like alcohol and opioids, have a sedative (depressant) effect, while other substances, such as cocaine and meth, have a stimulant effect.

Cannabis has sedative, stimulant, and hallucinogenic properties, depending on its components. Alcohol also has some stimulatory effects early on, such as raising dopamine.

Depressants slow your bodily processes and can lead to feelings of sluggishness, wooziness, and fatigue. Stimulants boost your brain activity, causing the central nervous system to kick into overdrive. This can make you feel energized and invincible.

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People with bipolar disorder experience mood episodes categorized as depressive, manic, or hypomanic. Periods of stable mood that occur between these episodes are called euthymic.

There are different types of bipolar disorder, but the most common types are bipolar I disorder and bipolar II disorder. Here’s a breakdown of how symptoms differ between the two:

Bipolar disorder typeManiaHypomaniaDepression
bipolar I disorder
bipolar II disorder

People experiencing a depressive episode may feel hopeless, fatigued, and sad. They may isolate themselves from others and no longer find joy in their relationships or hobbies. Depression can prevent someone from functioning in their daily life. In its severe form, it can lead to self-harm or suicidal thoughts.

Learn more about the role of depression in bipolar disorder.

Manic episodes often manifest as a surge of energy, focus, and confidence. But while mania is often described as “feeling on top of the world,” it has unique health risks. People experiencing a manic episode may have impaired decision making skills, go days without sleeping, or talk excessively.

Hypomania refers to a milder form of these episodes and symptoms. Learn more about how to distinguish mania and hypomania.

Either one could add to your risk of substance use or misuse.

A substance use disorder (SUD) is more than drinking socially or using drugs sometimes. An SUD is actually a mental health condition that impairs a person’s ability to control their substance use.

SUDs occur on a spectrum: mild, moderate, and severe.

Symptoms of an SUD include:

  • psychological dependence on the substance, or thinking you must have it
  • physical dependence on the substance, or a chemical reliance
  • irritability or anxiety when not using the substance
  • developing a tolerance to the substance, which requires a larger intake to achieve the same results
  • complete inability to control substance use, in severe cases
  • withdrawal symptoms after substance use is stopped or interrupted

People with an SUD may go through periods when they don’t feel or seem like themselves. In addition to behavioral changes from the effects of the substance, psychological and physical dependence on a substance can impair someone’s judgment and decision making skills.

Very little research has examined specific treatments that can help people with both bipolar disorder and SUD. There are gold standard treatments for bipolar and SUD separately, but what the best approach is for treating both together is not as clear.

To further complicate things, people who have both bipolar disorder and SUD face greater health challenges than those who have neither or just one condition, which poses great challenges to complying with their treatment plans.

The recommended treatment approach for SUD depends on the type of substance, length of dependency, and personal health factors, among others.

Bipolar disorder treatment consists of multiple options. It can take time to find the best approach for the person.

Treatment options for SUD in people with bipolar disorder may include:

  • medications, including mood stabilizers, antipsychotics, or antidepressants
  • talk therapy, in particular cognitive behavioral therapy (CBT) and interpersonal and social rhythm therapy
  • community-oriented therapies, such as attending support groups, family-focused therapy, or long-term residential treatment centers
  • lifestyle strategies, such as removing the substance from your environment, limiting contact with people who use the substance, and establishing a routine and new habits

The person with the conditions, their doctors, and possibly their friends or family members can be part of a larger treatment strategy. Often, social support from others is an essential part of managing and recovering from an SUD.

Check out FindTreatment.gov to find SUD treatment facilities near you.

Bipolar disorder is not the only risk factor for SUD. Others include:

  • Genetics: A tendency to develop an SUD runs in families, but this isn’t the only determining factor. Just because a parent or close relative has an SUD does not mean you will. However, seeing a parent use a substance — or being encouraged to use it by a parent — can increase SUD risk.
  • Trauma and PTSD: People who experience or have experienced abuse or neglect may be more likely to develop an SUD. This is especially true for people with post-traumatic stress disorder (PTSD).
  • Chronic pain: Some people use substances to alleviate pain and symptoms of other conditions. This can be especially true when a person with chronic pain doesn’t have access to medical care.
  • ADHD: Research has found that people with attention deficit hyperactivity disorder (ADHD) and bipolar disorder have an increased risk of developing an SUD.

Having one or more of these risk factors is not a guarantee you will have an SUD. However, it’s important to be aware of the ways you may be uniquely vulnerable so you can take preventive measures.

Bipolar disorder is a mood disorder that can have wide-ranging quality of life and health impacts. People with bipolar disorder have been statistically shown to be more likely to develop a substance use disorder (SUD) than the general population.

Researchers believe a potential cause for the high rate of SUDs in people with bipolar disorder is self-medicating to treat symptoms of mania and depression. Alcohol and cannabis are the most commonly misused substances.

While both bipolar disorder and SUDs have established treatment approaches, further study is needed on how to best treat both conditions together.

It’s essential that both bipolar disorder and SUD be addressed and managed for the best possible treatment outcome. Support groups, therapy, medication, and lifestyle strategies can help both conditions.