Bipolar disorder (BD) is a mental health condition that can cause extreme changes in mood and energy. Having BD may increase a person’s chances of developing a substance use disorder (SUD).

According to the National Alliance on Mental Illness, around 7 million people in the United States have BD.

The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that 21.7–⁠59% of people with BD will also develop an SUD.

Read on to learn more about BD and its connection to SUDs. This article also discusses treatment options and the outlook for BD and SUD.

the legs of a person standing on a spotted carpetShare on Pinterest
Catherine Falls Commercial/Getty Images

BD is a mental health disorder that can cause a person to experience dramatic changes in:

  • mood
  • energy
  • concentration
  • activity levels
  • ability to carry out daily tasks

Someone who has BD will experience periods of mania and depression of varying severity and duration.

During a manic period, a person may feel:

  • elated
  • irritable
  • touchy
  • jumpy
  • a reduced need for sleep
  • a reduced desire for food
  • like talking quickly about many different things at once
  • like their thoughts are racing
  • like they can do a lot at once
  • like engaging in risky behavior, such as eating and drinking excessively
  • unusually important, talented, or powerful

When an individual with BD has a depressive episode, they may feel:

  • sad or depressed
  • empty
  • worried
  • hopeless
  • worthless
  • suicidal
  • slow or restless
  • they have problems sleeping
  • an increased appetite
  • like they have nothing to say
  • forgetful
  • like they are talking slowly
  • trouble concentrating
  • unable to carry out simple tasks
  • little interest in most activities
  • they have a reduced sex drive
  • inability to experience pleasure

A person with BD may also have an episode with mixed features. This means they experience both manic and depressive symptoms in the same episode.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

Was this helpful?

Research from 2021 noted that alcohol use disorder (AUD) was most common in people with BD and SUDs.

However, a person with BD may also use drugs, such as nicotine, cannabis, or cocaine, in a dependent or disordered fashion.

Scientists do not yet fully understand the relationship between BD and SUDs. However, researchers believe there may be several connections between BD and SUDs. These connections include the below.


Information from SAMHSA notes that people with BD may use drugs or alcohol to self-medicate.

For example, a person with this condition may use cannabis to reduce manic feelings or take cocaine to feel energized during depressive periods. This could lead to them relying on drugs to feel “normal.”

Differences in brain structure

Research from 2017 looked into the connection between brain abnormalities, BD, and SUDs in adolescents.

Researchers suggest that abnormalities in the prefrontal cortex (PFC) could be responsible for both BD and SUDs. The PFC is part of the brain that plays an important role in:

  • attention
  • impulse control
  • memory
  • cognitive flexibility, the ability to adapt behavior to the current environment

Researchers found that areas in the PFC that may affect BD overlap with those that may cause SUDs.


Both BD and SUDs can occur in families, leading researchers to believe that they may have genetic causes.

Research from 2017 found that there may be common genetic links to BD and SUDs. However, the researchers note that further study is necessary to confirm these findings.

Generally, bipolar medications are not addictive.

However, if a person stops taking their BD medication, they risk having a relapse of symptoms. This could also lead to a recurrence of SUD.

People sometimes use benzodiazepine and Z-drugs to treat symptoms of BD. Benzodiazepine drugs treat anxiety, which can be a symptom of BD, while Z-drugs treat insomnia, which can occur during manic episodes.

Benzodiazepine drugs include:

  • alprazolam (Xanax)
  • diazepam (Valium)
  • lorazepam (Ativan)
  • midazolam (Versed)

Types of Z-drug include:

  • zopiclone
  • zaleplon
  • zolpidem

Benzodiazepines can be highly addictive, and pharmaceutical companies marketed Z-drugs as nonaddictive alternatives to them. However, recent studies have shown that Z-drugs have the capability for misuse and dependency.

Research from 2018 indicates that both benzodiazepine and Z-drugs have risks for long-term use in people with BD. This means that those who have BD should limit their use of these drugs.

While having an SUD and BD can make both conditions harder to treat, seeking early treatment can be beneficial.

Research from 2021 suggests taking an individual approach when treating people for BD and SUDs. The substance a person is using inappropriately may affect the kind of treatment they require.

Researchers suggest using lithium and valproate to treat someone who has BD and a cannabis or cocaine use disorder.

Scientists have also found that the drug citicoline can reduce cocaine use in people with BD. However, the effects of this treatment may reduce over time.

SAMHSA suggests that certain drugs to treat BD may also treat SUDs. Researchers found that lithium, in combination with divalproex sodium, a mood stabilizer, helped reduce alcohol intake.

Quetiapine is an antipsychotic that can help treat BD. Some studies suggest that it is also useful for reducing alcohol intake or cravings. However, other studies found that quetiapine had no effect. With this in mind, further research is necessary to confirm its effect.

Psychosocial therapy

Psychosocial therapy can help treat mental health conditions that occur alongside SUDs. This form of therapy usually includes three treatment approaches:

  • Sequential: Sequential treatment involves treating the more serious condition first and then the other disorder.
  • Parallel: In parallel treatment, doctors treat both conditions simultaneously.
  • Integrated: Integrated treatment involves treating both disorders simultaneously and then any other issues the person may have.

Signs that a person may have an SUD include:

  • reduced productivity and attendance in work or school
  • frequently getting into trouble
  • using substances in dangerous situations, such as when driving
  • changes in appetite or sleeping patterns
  • sudden mood swings
  • changes in personality
  • agitation
  • giddiness
  • hyperactivity
  • lack of motivation
  • anxiety or paranoia for no reason
  • bloodshot eyes
  • atypically large pupils
  • sudden weight loss or weight gain
  • physical deterioration
  • tremors
  • slurred speech
  • impaired coordination

Additionally, SUDs can also lead to legal, financial, and relationship issues.

If a person notices these signs in themselves or others, they should seek medical advice.

A person may be able to reduce the chances of developing an SUD alongside BD by following their doctor’s advice.

Taking BD medication as a healthcare professional advises can help keep symptoms under control. This may also help reduce the need to self-medicate with drugs or alcohol.

If individuals know they are susceptible to SUDs, they should avoid temptations. This may mean staying out of bars or socializing with people who do not use any substances.

It can be difficult for a person to have both BD and an SUD.

However, by following their treatment plan, an individual can help manage their symptoms.

Those with both BD and an SUD may be more prone to relapses, so it is important that they follow their treatment plan. A person should speak with their doctor if they have difficulties sticking to their treatments.

BD and SUDs have a high tendency to occur together.

Although the exact link remains unknown, researchers believe it may be due to:

  • genetics
  • brain structure
  • a desire to self-medicate

Although BD medications are nonaddictive, benzodiazepines and Z-drugs can be addictive, and people with BD should restrict their use of these drugs.

There are various treatments available for those with BD and an SUD. A person with both conditions should follow their treatment plan carefully, as the risk of relapse is high.

With correct treatment, individuals should be able to manage their BD and SUD symptoms. If a person encounters issues with their BD or SUD, they should speak with a doctor.