Bipolar Disorder and Substance Use: What's Really Going On

On this page

1. Why substance use and bipolar disorder so often go together
2. What self-medication actually looks like
3. How the two conditions feed each other
4. What integrated treatment looks like
5. What you can try on your own
6. When and how to get professional help
7. What family and friends should understand
8. A note on medication
9. The bigger picture
10. Questions people ask

Why substance use and bipolar disorder so often go together

A large share of people with bipolar disorder will also experience a substance use disorder at some point in their lives. This is not a coincidence or a character flaw. It has to do with the nature of the illness itself.

Bipolar mood episodes are intense. Mania can feel like a relentless engine running inside you, and depression can feel like being buried alive. Many people find that alcohol or drugs offer a kind of relief, at least for a few hours. Alcohol might quiet the racing thoughts during a manic phase. Stimulants like cocaine or amphetamines can feel like they lift you out of a depressive slump. Cannabis might seem to take the edge off anxiety or help you sleep.

The problem is that what starts as a way to cope often makes the underlying condition worse. Substance use can trigger mood episodes, make them last longer, and make the medications you take less effective. It is a difficult cycle.

What self-medication actually looks like

Self-medication is the term for using a substance to manage a symptom you cannot otherwise control. It is not the same as recreational use, though the two can overlap. With bipolar disorder, self-medication tends to follow the mood.

During a manic or hypomanic phase, someone might drink heavily to slow down or to feel more sociable. They might stay up for days using stimulants to keep the energy going, even though the body is exhausted. During depression, the pattern flips. Alcohol might be used to numb the sadness, or cannabis to create a fog that dulls the pain.

A sixth-form student in Luton, for instance, might find that after a few weeks of low mood, a couple of drinks help her get through an evening with friends. She does not realise she is drinking more than anyone else. What she notices is that the next morning the low mood is worse, and she needs more to feel okay again.

The pattern is often invisible for a long time because the person themselves may not see it as a problem. The drink or the drug feels like a solution, not a problem. It is only when the consequences start to pile up that the link becomes clearer.

How the two conditions feed each other

Substance use and bipolar disorder do not just coexist. They interact. Alcohol and drugs can destabilise your mood directly. They interfere with sleep, which is one of the most important factors in managing bipolar disorder. A poor night's sleep can tip a stable mood into a manic or depressive episode.

Many psychiatric medications do not mix well with alcohol or street drugs. The combination can reduce the medication's effectiveness or cause unpredictable side effects. If you find that your mood stabiliser or antipsychotic is not working as well as it used to, substance use could be part of the reason.

There is also the question of diagnosis. When someone is drinking heavily or using drugs regularly, it can be hard to tell whether a mood shift is a true bipolar episode or a temporary effect of the substance. This makes it harder for you and your doctor to know what is really happening.

What integrated treatment looks like

The old approach was to treat the bipolar disorder first and then deal with the substance use, or the other way around. That rarely worked because the two are tangled together. Integrated treatment means addressing both at the same time, in the same sessions, with the same team or at least with good communication between providers.

A good integrated treatment plan might include: - A mood stabiliser prescribed by a psychiatrist who knows about your substance use and can choose a medication that is safe with it. - Therapy that focuses on the link between mood states and cravings, not just on the substance itself. - Practical strategies for handling the specific moments when you are most likely to use, such as when you feel a manic phase starting or when depression sets in. - Support for any underlying trauma or stress that might be driving both conditions.

The goal is not necessarily total abstinence from day one, though that may be right for some people. For many, the aim is to reduce harm and to build a life where the substance is not the main tool for managing mood.

An accountant in Vancouver, for example, might work with his therapist to notice that his drinking spikes in the two days before a manic episode. They plan ahead: he keeps his fridge free of alcohol, calls a friend when he feels the restlessness coming, and uses a short walk to let the energy pass. Over time, the drinking decreases without him having to white-knuckle it.

What you can try on your own

Professional help is important, but there are also things you can start doing today.

Keep a simple log for a week. Write down when you drink or use, what your mood was like that day, and how you felt an hour afterward. You might see a pattern you did not notice before. That pattern is useful information, not a judgment.

Learn one or two grounding techniques that do not involve substances. A five-minute breathing exercise, a cold drink of water, or a short phone call with someone who knows your situation can break the automatic link between a mood shift and reaching for a drink or a drug.

Tell one person you trust. It does not have to be a full confession. You can say something like, "I have noticed that when I feel low, I end up drinking more than I mean to, and I want to change that." Saying it out loud makes it real and gives someone else a chance to support you.

When and how to get professional help

If you have tried to cut down on your own and found you cannot, or if the substance use is causing serious problems with your health, relationships, or work, it is time to involve a professional. Start with your GP or family doctor. They can refer you to a psychiatrist who understands both bipolar disorder and substance use.

You can also look for therapists or psychiatrists who specialise in dual diagnosis, which is the term for having both a mental health condition and a substance use disorder. Many of the professionals listed in the Therapy O'Clock directory have experience in this area. A session or two can help you understand whether integrated treatment is right for you.

Some people find peer support groups helpful, especially ones designed for people with both conditions. Groups are not for everyone, but they can reduce the sense of having to figure this out alone.

What family and friends should understand

If you are reading this because you care about someone with bipolar disorder who uses substances, it can be confusing and frightening. You might see the drinking or drug use as the main problem, while they see it as their only solution.

It helps to separate the behaviour from the person. You can dislike the drinking and still love the person. You can also set boundaries. It is fair to say, "I will not be around you when you are using," without abandoning them.

The existing page on How to Support Someone With Bipolar Disorder covers this in more detail, including how to have conversations without blame.

A note on medication

If you are prescribed mood stabilisers, antipsychotics, or other medications for bipolar disorder, tell your doctor honestly about your substance use. They need to know to keep you safe. Some combinations can be dangerous. Your doctor can talk through options, which may include adjusting doses or choosing a different medication that works better with your situation.

Do not stop any medication on your own. The withdrawal or sudden change can trigger a severe mood episode. If you are worried about a medication, bring that worry to your doctor.

The bigger picture

Bipolar disorder and substance use together are not a life sentence. Many people find a way through it. The key is to stop treating them as separate problems. When you understand that the substance use is often a misguided attempt to manage the bipolar symptoms, you can start to address the real need underneath.

For more background on the mood episodes themselves, the page on What Is Bipolar Disorder? Mood Episodes Explained is a good place to start. If you are unsure whether you are experiencing hypomania or full mania, How to Tell Hypomania From Mania: Key Differences can help clarify.

Questions people ask

Can alcohol trigger a manic episode?

Yes. Alcohol disrupts sleep and can destabilise your mood. For some people, even a single episode of heavy drinking can tip them into a manic or hypomanic phase within a day or two.

Is cannabis safe for people with bipolar disorder?

There is no clear evidence that cannabis is safe. Some people find it calming in the short term, but it can also trigger mania, psychosis, or longer depressive episodes. The effects vary widely from person to person.

What is the first step if I want to cut down on drinking but I also have bipolar disorder?

Talk to your doctor or psychiatrist first. Do not change your medication on your own, and be honest about how much you drink. They can help you plan a reduction that does not destabilise your mood.

How do I know if I am self-medicating or just drinking socially?

Ask yourself what happens when you do not drink or use. If you feel irritable, anxious, or unable to cope with your mood without it, that is a sign you may be using it to manage symptoms.

Can therapy help with both conditions at once?

Yes. Therapies like cognitive behavioural therapy and dialectical behaviour therapy can be adapted to address both mood regulation and substance use together. Look for a therapist who lists dual diagnosis or co-occurring disorders as a specialty.

What if I cannot afford a therapist who specialises in both?

Start with your GP. They can refer you to public mental health services that offer integrated care. Some community mental health centres also have low-cost or sliding-scale options.

Does integrated treatment mean I have to quit completely?

Not necessarily. Some people choose abstinence, but many integrated programmes focus first on reducing harm and understanding the pattern. The goal is to build other coping skills so the substance becomes less central.

Can I take my bipolar medication if I have been drinking?

It depends on the medication and how much you have drunk. Some combinations can be dangerous. If you have been drinking, it is safest to wait until you are sober and then take your medication as usual, but ask your doctor about your specific prescription.

How do I bring this up with my family without them panicking?

Start with what you are already doing to manage it, not just the problem. You might say, "I have noticed a pattern with my mood and drinking, and I am working on it. I wanted you to know so you understand what is happening."

Is it common for people with bipolar disorder to also have an addiction?

Yes. It is one of the most common co-occurring conditions. The rates are higher than in the general population, partly because of the way mood episodes drive the urge to use substances.

What if I relapse after trying to stop?

Relapse is part of the process for many people. It does not mean you have failed. The important thing is to notice what led to it and to go back to your plan or your treatment team without shame.

Can medication for bipolar disorder help with cravings?

Some mood stabilisers and antipsychotics can reduce the intensity of cravings, but they are not a direct treatment for substance use. The main benefit is that when your mood is more stable, the urge to self-medicate often lessens.