Bipolar & Substance Abuse Disorders: A Complex Diagnosis that Demands Integrated Medical & Psychological Care

The word “bipolar” has become colloquially associated with anything that changes rapidly or is unpredictable: the weather, technology, sports teams, politics, or even a teenager’s attitude. But for roughly 46 million people worldwide, being “bipolar” is far more serious than typical unpredictability, mood swings, or temperamental behavior. And, when bipolar disorder is complicated by substance use disorder (SUD), the situation can become incredibly dangerous for the individual and those around them.

Recognizing the symptoms of bipolar and the complicating factors of substance use disorder is crucial for physicians, mental health advocates, law enforcement, and anyone who lives with or loves someone who suffers with bipolar tendencies. To break through the stigma, World Bipolar Day aims to raise awareness of bipolar disorders with activities that provide education, support, and improve sensitivity around the illness. Most importantly, shedding the stigma around any mental illness starts with understanding the disorder itself and devising a holistic treatment and support plan that addresses the prevalence of confounding substance use disorders.

The Bipolar/SUD Connection

The statistics are startling: People with bipolar disorders are 11 times more likely to also have a substance use disorder. Over half of people diagnosed with bipolar disorder have a history of illicit drug abuse and 44% of bipolar patients have abused or are dependent on alcohol.

What drives this connection? In many patients, it’s the struggle to simply feel okay.

Bipolar disorder causes extreme and lengthy fluctuations from manic, hyperactivity to deep, debilitating depression, with episodes lasting for days or even weeks at a time. During the manic period, patients have boundless energy, can’t sleep, and feel invincible. The euphoria may even drive them to engage in dangerous behaviors like high-risk sex, spending sprees, extreme activities, and other behaviors that can have a dramatic impact on their health, safety, and their family. During the depressed stage, patients suffer from extremely low energy, lack of motivation, have zero interest in daily activities, and are highly susceptible to suicidal thoughts.

With both mental and physical symptoms that swing widely like a pendulum, those with bipolar disorder often turn to substances to help them feel “better.” During a depressive stage, stimulant drugs like cocaine, amphetamines, and methamphetamine can restore the “high” of the manic phase, helping to pull patients out of the depression, albeit artificially and certainly with substantial risk to their overall health. Others turn to alcohol in the hopes to simply temper the wild swings but with obvious negative effects. 

Dual Diagnosis Demands Dual Approach

These co-existing disorders create a serious challenge when patients seek treatment. Treating bipolar disorder most often requires the use of antipsychotic and mood stabilizing medications. But many of these conflict with alcohol and other substances. That means the patient must be detoxed first in order to treat the underlying bipolar condition. 

At the same time, patients are often resistant to treatment that eliminates the euphoria. They’ve experienced such debilitating lows that they crave the “high,” and the thought of eliminating that — to restoring to a normal baseline — sounds dull, boring, and not at all appealing. As a result, many avoid seeking treatment until they’ve reached a depressive state, but that’s also when they’re most vulnerable — approximately 15% of people with bipolar disorder commit suicide and 25-50% attempt suicide at least once. 

That’s why treating bipolar and substance abuse disorder demands a holistic approach that not only addresses the substance issue but also teaches the patient lifestyle techniques that contribute to healthy mood and brain function. A comprehensive care team that includes both medical and psychological specialists working together is crucial for dealing with the physical addiction and the mental health challenges. 

In addition to enabling safe, medically supervised detox and providing access to safe, effective medications, this dual-treatment approach incorporates healthy habits that are critical for long-term success, such as a nutritious diet, exercise, better sleep habits, all of which naturally contribute to a healthy brain.

Family and Community Support Is Vital

In addition to treatment, having the emotional support of family and friends is essential for successful bipolar/SUD treatment. Recognizing that the individual 1) can’t control their sometimes wild and erratic swings, 2) is at serious risk of grave consequences as a result, and 3) needs a supportive environment for recovery is critical. Family and friends must be sensitive to the complexities of the co-existing disorders and treatment and provide as much intellectual, emotional, spiritual, and occupational support as possible.

A large part of the challenge around treating bipolar/SUD — or any mental health issue, for that matter — is the stigma around coming forward with issues related to our emotional or mental state. If someone suffers a broken arm, we have no problem discussing the details surrounding how it happened and the diagnosis and treatment, but so many feel fear and shame around an impaired brain. That silence puts so many people at risk. 

If you know someone suffering with bipolar/SUD, or any mental health issue, it’s imperative that you reach out. Let them know you’re concerned and offer to go with them to see their primary care doctor. Many communities also have local mental health crisis centers where individuals can get an immediate assessment and referral to a mental health professional.

Of course, if the situation is urgent and your loved one is in immediate danger, don’t hesitate to call 911 and explain the situation. Many people avoid this out of fear it will result in a law enforcement response, which could further intensify the situation. But if you explain the circumstances, most agencies will send an ambulance, rather than the police, and most emergency responders are trained in mental health triage. 

Finally, if you or someone you love is dealing with a serious mental health issue, contact the National Suicide Prevention Lifeline at 1-800-273-TALK or text HOME to 741-741, the Crisis Text Line. These services are confidential and free, and you’ll be connected immediately to an individual who can help, provide local resources, and send information about help in your area directly to your device. 

To learn more about World Bipolar Day and ways to get involved, visit

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