When Addiction and Bipolar Overlap

The week was too high, or the crash after the drinking was too flat, and someone said bipolar. You do not have to settle that word tonight. You do have to keep the person safe, and you do have to tell a clinician about the mood and the substance use in the same conversation.

If someone might hurt themselves, will not wake, or cannot breathe, call 911. If you are struggling or thinking about suicide, call or text 988.

Say the high weeks out loud

Call a prescriber, a psychiatrist, or a program that treats mood and substance use. Describe the stretch of little sleep, the irritability, the crash, and what was being used. NIMH's bipolar brochure draws the line at episodes that are intense, last most of the day, and come with changes other people can see. Between episodes, mood often returns to a usual baseline. A single wild weekend is not that history. Drugs, including ones that were prescribed, can mimic or worsen the swing. Thyroid disease can look similar. That is why you want an exam.

If an antidepressant is offered by itself, ask about a mood stabilizer first. NIMH says antidepressants are not used alone for bipolar disorder, because they can trigger a manic episode or rapid cycling. Lithium and valproate are examples of stabilizers. Lithium is also described as lowering suicide risk for some people. Report side effects. Do not stop the medicine because a good week made it feel unnecessary, and do not add an herb from a bottle. The FDA has not approved supplements to treat bipolar disorder.

If the picture is mostly the low side, read what depression looks like next to substance use. If the fear is panic, this guide on anxiety alongside using walks through that overlap. Bring the elevated weeks anyway. People sometimes seek help only for the depression, and the high stretches get missed.

Do not clean it up at home

Bipolar care usually continues, and it does not disappear because someone white-knuckled a month. Proper treatment helps many people function. It is not a promise about one building.

Do not turn "stop the alcohol" into a sudden quit if the drinking has been heavy, and do not stop a benzodiazepine to make the list look simpler. Either stop can lead to seizures. Before you plan a weekend quit, read what alcohol withdrawal can look like and ask a clinician. If opioids are part of this, this overview of the medicines covers methadone, buprenorphine, and naltrexone without doses. Do not drop those to prove the mood is the only problem.

Before you accept a bed, ask who looks at the mood over weeks rather than one night. Ask whether psychiatric care is in the building. Ask whether an antidepressant would be started alone. Ask where a seizure would be treated if alcohol or a benzodiazepine is in the picture. A brochure that says dual diagnosis is not the same as a clinician who can hold both. Ask these questions before you drive.

Search FindTreatment.gov and ask about co-occurring care, not only detox. Call or text (800) 653-9376 if you want help finding a program that will look at the mood swings and the using together.

Additional Resources

Sources cited on this page:

• NIMH: Bipolar Disorder
• NIMH: Finding help for co-occurring substance use and mental disorders
• SAMHSA: Finding quality treatment
• SAMHSA TIP 45: Detoxification and Substance Abuse Treatment (settings and patient placement)
• 988 Suicide & Crisis Lifeline
• SAMHSA FindTreatment.gov
• SmarterRecovery about page (referral disclosure)

Common Questions