Linking Bipolar Disorder With Alcohol and Substance Abuse

Bipolar disorder often goes undiagnosed in those who have an alcohol or substance use disorder. Too often, the use of alcohol or drugs masks bipolar episodes. Undetected bipolar disorders create frustration for those who are in treatment or recovery. Bipolar disorder and substance use are linked together in many cases. The failure to address bipolar disorder makes it harder for a person to go through treatment and more likely to relapse.

Bipolar Disorders

The National Institute of Mental Health reports three types of bipolar disorders. The classes are Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder. Bipolar I & II are the two disorders frequently connected to substance use or dependence. A research study found the following:

Bipolar I

Bipolar I is the more severe of the two types of disorders, marked by periods of critical mood changes from depression to mania. 60.7% of people with bipolar I disorder have some co-occurring substance abuse, alcohol use, or dependence.

Bipolar II

Bipolar II includes episodes of hypomania: a mild form of mania, highlighted by elation and hyperactivity. Periods of depression also occur in Bipolar II. 48.1% of people with bipolar II disorder have some alcohol use or substance abuse or dependence.

Cyclothymic Disorder

Cyclothymic Disorder includes periods of hypomanic and depressive symptoms lasting up to 2 years. The disorder does not meet the diagnostic requirements for hypomania or depression.

Signs and Symptoms of Bipolar Disorder

People with bipolar disorders seek to find ways to control their mood episodes. The use of alcohol or drugs does not reduce mania or depression, however. Rather, these substances further destabilize a person’s mood and can cause rapid cycling. The mood changes may cause individuals to feel aggression toward or others or even themselves. Suicidal tendencies or fits of rage increase, especially among males. Other signs or symptoms of bipolar disorder include:

  • Impulsivity
  • Euphoric mood
  • High agitation or irritability
  • Pressured speech
  • Rapid thoughts
  • Decreased need for sleep

Different people have different responses to their episodes of mania. People with bipolar disorders talk about their bouts of mania as times when they feel they can do anything, go anywhere, and become anyone. Others engage in high-risk behavior, take off on road trips without plans, stay up for days, and report they don’t want the feeling of mania to stop. They seek substances that will help them feel good. Another reason they drink or use substances is to help keep them elevated because they know eventually depression will follow.

Profound lows follow elation, bursts of creativity, and feelings of invincibility. Cycling out of mania and into depression can occur rapidly or take place in a steady decline. Thoughts of suicide, desperation, sleep, and sadness can then overtake everything. Normal activities become burdensome and even undoable. During episodes of depression, those with bipolar disorders seek alcohol or substances to lift them out.

According to The National Institute for Health, there are additional issues that can occur with Bipolar Disorder. Many people with bipolar disorder may have other mental health disorders or conditions, as well, such as:

  • Psychosis. Sometimes people who have severe episodes of mania or depression also have psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example:
    -Someone having psychotic symptoms during a manic episode may falsely believe that he or she is famous, has a lot of money, or has special powers.
    -Someone having psychotic symptoms during a depressive episode may believe he or she is financially ruined and penniless or has committed a crime.
  • Anxiety Disorders Deficit/Hyperactivity Disorder (ADHD). Anxiety disorders and ADHD often are diagnosed in people with bipolar disorder.
  • Misuse of Drugs or Alcohol. People with bipolar disorder are more prone to misusing drugs or alcohol.
  • Eating Disorders. People with bipolar disorder occasionally may have an eating disorder, such as binge eating or bulimia.

There are instances when some bipolar disorder symptoms mimic other illnesses, such as schizophrenia. Misdiagnoses such as this can delay treatment and increase the risk of alcohol or substance use in a person’s effort to ease or control the feelings associated with Bipolar Disorder.

Diagnosis of Bipolar Disorders

A doctor or therapist will order tests in order to diagnose a person. Physical exams, different medical tests, or a referral to a psychiatrist are examples of ways to diagnose bipolar disorder. Tests are ordered to rule out other potential physical or psychological illnesses.


There are medications that can assist in controlling the symptoms of a bipolar disorder. Finding the right medication and dosage typically takes time. Doctors and psychiatrists will regulate how the medication affects the brain and body, to ensure the health and safety of the patient. This is done through blood tests. In time, the right dose and medication can be determined.


Treatment centers focusing on treating bipolar disorders and alcohol or substance abuse as co-occurring is vital. People who go undiagnosed and go through treatment will exhibit the symptoms of bipolar disorder and suffer needlessly. A proper diagnosis provides insight on how to proceed with treatment. Diagnosing a person entering treatment can also determine if medication is necessary to help regulate episodes.

An opportunity exists for a person once a bipolar and substance or alcohol use disorder is determined. A treatment plan can be combined with prescribed medications that will help regulate episodes of depression or mania. Comprehensive treatment of a person is vital because being viewed as a whole person—not a disease or disorder—creates a better sense of self. In therapy and recovery, understanding why a person turned to alcohol or other substances helps build a solid foundation in recovery.

According to the National Comorbidity Survey Replication (NCS-R), bipolar disorders affect approximately 2.8% of people 18 years or older in the United States. An average of 4.4% of all adults will experience bipolar disorder at some point in their life. The relatively low numbers of people affected by bipolar disorder contribute to the misdiagnosis. Family members may not recognize the symptoms of bipolar disorder, which delays treatment. Those with bipolar disorder can feel overwhelmed, lost, and unable to control their mood cycles. The urge to use alcohol or substances is increased by these feelings and can lead to abuse or dependence. If you think you or a loved one suffers from bipolar disorder, we can assist you by answering your questions or scheduling an appointment with our knowledgeable and experienced staff. Achieve Medical Center provides comprehensive treatment and testing for Bipolar Disorder. To find out how we can help you, contact Achieve Concierge today at (619) 393-5871.

©2024 Achieve Concierge