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  Key Messages

  • Substance misuse rates are high in bipolar disorder
  • Combination of bipolar disorder and substance misuse can lead to greatly reduced health and quality of life
  • Substance use and bipolar disorder mood symptoms are closely connected

  Take Action

  • Assess and monitor your substance misuse
  • Seek evidence-based help/treatment for substance use problems
  • Explore self-help strategies for cutting down/stopping substance use

  Learn more

Why controlling substance use is important to your quality of life

People with bipolar disorder are three times as likely as those without bipolar disorder to drink too much alcohol, and seven times as likely to struggle with substance misuse.5 This is especially worrisome as research has shown that the combination of bipolar disorder and substance misuse can lead to greatly reduced quality of life and a poor expectation of future health.6 Substance use and mood symptoms are closely connected: substance use can cause mood symptoms and mood symptoms can cause substance use. For example, the symptoms of hypomania and mania, such as impulsivity (doing things without thinking) and disinhibition (doing things you would normally stop yourself from doing, like stealing or having unprotected sex), often increase the chance of substance use. Similarly, people with symptoms of depression may seek comfort by using alcohol or other substances to try to feel better or avoid painful emotions. Increased substance use also contributes to the onset of mood episodes and is associated with increasing the risk of suicide.7

People with bipolar disorder are two to three times more likely to smoke cigarettes; about 30-70% of people with bipolar disorder smoke.8 As with other substance use, smoking and bipolar disorder probably have a two-way connection (each affects the other) as well as sharing common risks factors (for example, environmental and genetic factors). Smoking is related to the most frequent causes of death for people living with bipolar disorder: cancer, cardiovascular diseases, strokes and respiratory diseases.11

How you can take action

There hasn't been a lot of research on the best way to treat someone who is dealing both with bipolar disorder and substance misuse (this is called dual diagnosis, which means having two conditions at the same time). A few research studies have been done with mood stabilizing medications and it looks like the bipolar disorder medications usually given work well even when substance misuse is occurring.14 There have been a few studies of psychological treatment (for example, cognitive behavioural therapy) for dual diagnosis individuals and these have shown improvements in depressed mood and possibly substance use.15,16

Fortunately, many communities have programs for those dealing with substance use disorders, including drug and alcohol counselors, detoxification facilities, residential treatment centers and support groups like Alcoholics Anonymous. It seems likely that individuals with bipolar disorder would benefit from these programs as much as those without bipolar disorder.

However, most people with bipolar disorder for whom substance use makes it more difficult to manage mood symptoms do not have a substance use disorder. So these cases can be categorized differently, as “high risk” substance use. That is, the person can be using alcohol or other substances in a way that will have negative effects over the long-term and certainly might make manic/hypomanic or depressive symptoms worse, but this person does not have a diagnosable substance use disorder. It is estimated that 15% of the general population use alcohol at a risky level – and that percentage is likely to be higher in people with bipolar disorder. The positive news here is that research shows that individuals falling in this risky drinking category can successfully use self-management strategies, especially if they have some support.

For help quitting smoking, there are a range of useful medications and behavioural treatments (for example, Cognitive Behavioural Therapy) available. However, at present, there hasn’t been high quality research looking at the safety and usefulness of these treatments in people with bipolar disorder. Therefore, it’s important to keep in mind the unknown risks and benefits of these treatments when deciding with your health care provider whether or not to include them in your wellness plan.11

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