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About the Author
Mat Gorman
Mat Gorman is a board-certified mental health writer and medical researcher with over a decade of experience in addiction recovery education. He specializes in translating complex clinical topics into clear, compassionate content that empowers families and individuals seeking treatment. Mat has collaborated with recovery centers, licensed therapists, and physicians to publish evidence-based resources across the behavioral health space. His passion for helping others began after witnessing the struggles of loved ones facing substance use disorder. He now uses his platform to promote hope, clarity, and long-term healing through accurate, stigma-free information.
Table of Contents
What we know at a glance
- Alcohol and bipolar frequently co‑occur, and when they do, both conditions tend to be worse.
- New longitudinal data show that increases in drinking predict later increases in depression and mania/hypomania—and poorer work functioning. The reverse (symptoms → more drinking) isn’t what best explains the pattern overall.
- Estimates of comorbidity vary by study, sample, and definition, but sizable reviews place lifetime overlap in a high range—often reported between ~40%–70%.
- Best outcomes come from integrated treatment: screen and treat both alcohol use disorder (AUD) and bipolar together, not sequentially.
Living with bipolar disorder is hard enough. Add alcohol, and the picture often gets murkier—symptoms blur together, episodes last longer, and day‑to‑day functioning can slip. This guide pulls together what current research says about bipolar disorder and alcohol, including what’s unique about bipolar 1 disorder and alcohol, why bipolar and alcohol abuse commonly go hand‑in‑hand, and how to get help that treats both—at the same time.
Important: This article is for education, not diagnosis. If you’re in crisis, call or text 988 (U.S.). For treatment referrals, call Nova Recovery Center at (512) 605-2955.
Why bipolar and alcohol so often travel together
Shared vulnerabilities (genes, brain systems, environment)
Bipolar disorder and alcohol use disorder share genetic and environmental risk factors (e.g., family history, adverse experiences). These overlapping risks partly explain why bipolar disorder and alcohol problems commonly co‑occur.
The “self‑medication” story is incomplete
People sometimes drink to take the edge off racing thoughts, anxiety, or insomnia. But recent longitudinal research found that drinking more than your own usual was followed by worse mood symptoms months later, while mood spikes did not drive lasting increases in alcohol use. In other words, alcohol tends to fuel mood instability more than mood instability fuels drinking.
Mania, judgment, and risk
In mania or hypomania, confidence surges and inhibition drops; alcohol can slot right into that moment and compound risky choices, disrupt sleep, and nudge episodes to last longer. Clinical guidance warns that the mix often worsens both conditions and raises safety risks.
Bipolar 1 disorder and alcohol vs. bipolar II and alcohol: what’s different?
Both bipolar 1 disorder and alcohol and bipolar II plus alcohol are linked to tougher clinical courses. The large 2024 cohort study found that drinking increases were tied to later mood symptoms in both subtypes—but the association with mania/hypomania and work functioning was even more pronounced in bipolar II. That doesn’t mean bipolar I is “safer” with alcohol—just that the statistical signal was stronger in II in this dataset.
Bottom line: Across bipolar subtypes, alcohol tends to destabilize mood and erode functioning. Moderation isn’t a free pass; for many, less is safer, and for some, abstinence is essential to regain stability.
How alcohol changes the course of bipolar disorder
Mood symptoms
More drinking today is associated with more depression and more mania/hypomania months from now—a crucial point for planning care and setting expectations.
Functioning (especially work)
Even modest upticks in alcohol use can predict worse workplace functioning later. That’s practical leverage for shared decision‑making (e.g., aligning drinking goals with career priorities).
Safety and relapse risk
Authoritative clinical sources emphasize that co‑occurring alcohol use can make mood swings, agitation, and suicidality more likely—especially when both conditions go untreated.
Assessment: how clinicians sort out “what’s what”
Good evaluation looks at both conditions together and uses a timeline: Were mood symptoms present during sober periods? Did they precede heavy drinking, or only occur during withdrawal? Establishing the sequence helps differentiate primary bipolar symptoms from alcohol‑induced symptoms and guides treatment.
Screening tools you may encounter
- AUDIT (Alcohol Use Disorders Identification Test): quick, validated screen to monitor alcohol use over time—recommended for routine tracking in bipolar care.
- Standard mood scales (PHQ‑9 for depression, Altman for mania/hypomania) are often used alongside alcohol screens.
Treatment that works: integrated and coordinated
Treating bipolar and alcohol abuse (more precisely, alcohol use disorder) works best when both are addressed together, not one after the other. This “integrated” approach consistently outperforms fragmented care.
Core elements you’ll likely see
- Medication for mood stabilization: mood stabilizers and atypical antipsychotics are the backbone of bipolar treatment; the goal is fewer, shorter, and less severe episodes. (For diagnostic and treatment overviews, see NIMH.) Note: antidepressants without a mood stabilizer can sometimes destabilize bipolar mood—so prescribers are careful.
- Evidence‑based therapy for AUD and mood: CBT, motivational enhancement, contingency management, and 12‑step facilitation are standard components and can be combined with bipolar‑specific psychotherapies.
- Medications for AUD: naltrexone, acamprosate, and others may reduce craving/relapse risk; data in patients with bipolar are still developing. A narrative review noted possible benefit of valproate adjunctive to lithium for reducing alcohol consumption in some contexts, while trials of naltrexone/acamprosate in bipolar samples have shown mixed effects on mood or drinking—underscoring the need for individualized plans.
- Family and social support: involving family/supports improves adherence and relapse prevention.
Harm‑reduction vs. abstinence
We don’t yet have definitive, bipolar‑specific trials telling us whether strict abstinence or structured moderation yields better long‑term bipolar outcomes. The 2024 cohort underlines that any increase in drinking can destabilize mood; many people choose abstinence to simplify recovery, while others work with harm‑reduction goals under close monitoring.
Practical strategies you can start using (with your care team)
Make alcohol visible in your care plan
Track drinks (a simple log works) and bring it to appointments. Even small changes matter; your team can help you troubleshoot patterns before mood destabilizes.
Protect sleep and rhythm
Bipolar brains are sensitive to rhythm disruptions. Alcohol fragments sleep and circadian cues—so protect bedtime, morning light exposure, and meal timing. (Clinicians frequently coach this alongside medications.)
Build a “bad‑day” script
List what you’ll do when cravings or early mood signs show up (text a friend, change environment, decaf swap, brief walk, urge‑surfing). Keep it short and visible.
Treat the whole picture
If trauma, anxiety, or ADHD are in the mix, ask for integrated care pathways; co‑occurring conditions affect cravings, sleep, and relapse risk.
When to seek help (and where)
- If your drinking is increasing, if your mood symptoms are worsening, or if you’ve had a recent episode, talk with your clinician about AUDIT screening and integrated next steps.
- For treatment referrals in the U.S., contact Nova Recovery Center (512) 605-2955. It’s free and available 24/7.
FAQs About Bipolar Disorder and Alcohol Addiction
How does alcohol affect bipolar 1?
Alcohol can intensify manic and depressive episodes in bipolar 1 disorder. It disrupts sleep, impairs judgment, and can make mood swings more severe, often leading to longer or more frequent episodes.
Are people with bipolar disorder more sensitive to alcohol?
Yes, many individuals with bipolar disorder are more sensitive to alcohol’s effects. Even small amounts can trigger mood instability, worsen symptoms, or interact negatively with medications.
What is the leading cause of death in people with bipolar disorder?
Research shows that suicide is one of the leading causes of premature death among individuals with bipolar disorder. Alcohol misuse can increase this risk by deepening depression and impairing judgment.
Can alcohol trigger psychosis in bipolar disorder?
Alcohol use can increase the likelihood of psychosis, particularly during manic or mixed episodes. Withdrawal from heavy drinking may also trigger psychotic symptoms in some cases.
What should you avoid if you have bipolar disorder?
It’s best to avoid alcohol, recreational drugs, and irregular sleep schedules, as they can destabilize mood. Following a consistent treatment plan and limiting stress also supports stability.
Do people with bipolar disorder need to stay sober?
While not everyone chooses abstinence, sobriety is often recommended because alcohol tends to worsen bipolar symptoms and complicate recovery. Many find long-term stability easier when alcohol-free.
What does alcohol do to bipolar symptoms?
Alcohol can worsen both manic and depressive phases. It often heightens impulsivity during mania and deepens hopelessness during depression, making recovery more challenging.
What mental illness is most associated with alcoholism?
Alcohol use disorder commonly co-occurs with mood disorders like bipolar disorder, as well as anxiety and depression. Integrated treatment helps address both conditions effectively.
How Nova Recovery Center Helps with Bipolar I and Alcohol Addiction
At Nova Recovery Center, we understand the unique challenges of treating alcohol addiction and abuse as a primary diagnosis when bipolar I disorder is also present as a secondary condition. Our integrated approach addresses both conditions simultaneously, ensuring that alcohol use disorder treatment does not overlook the mood instability that can complicate recovery. Clients benefit from evidence-based therapies, such as cognitive behavioral therapy and motivational enhancement, which target harmful drinking behaviors while also building coping skills for bipolar-related mood swings. Medication management is carefully coordinated by licensed professionals to stabilize mood while supporting long-term sobriety. In addition, our structured recovery programs emphasize relapse prevention, daily routines, and peer accountability, which are especially beneficial for individuals navigating both bipolar I disorder and alcohol addiction. Family involvement and education help create a supportive environment for lasting recovery, while holistic therapies nurture mind, body, and spirit. With our continuum of care, clients can move through detox, residential treatment, and outpatient support seamlessly, receiving the individualized attention they need. Nova Recovery Center is committed to empowering each person with tools for sustainable recovery and improved quality of life.
Sources referenced in this article
- Mayo Clinic. Bipolar disorder and alcoholism: Are they related? (Feb 13, 2024).
- Sperry SH, et al. Longitudinal Interplay Between Alcohol Use, Mood, and Functioning in Bipolar Spectrum Disorders.JAMA Network Open (June 7, 2024).
- Michigan Medicine. Bipolar disorder and alcohol: It’s not as simple as “self‑medication.” (July 23, 2024).
- NIAAA. Mental Health Issues: AUD and Common Co‑occurring Conditions (updated May 8, 2025).
- Grunze H, et al. Comorbid Bipolar and Alcohol Use Disorder—A Therapeutic Challenge. Frontiers in Psychiatry(2021).
- NIMH. Bipolar Disorder (Revised 2025).
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Medical Disclaimer
The content on this page is intended for educational purposes only and should not be taken as medical advice, diagnosis, or treatment. Bipolar disorder, alcohol use, and related conditions require care from a qualified healthcare professional. Do not begin, stop, or adjust any medications or treatment plans without first consulting your doctor. If you are experiencing severe mood changes, alcohol withdrawal symptoms, or thoughts of self-harm, call 911 in the United States or seek emergency medical help immediately. For confidential mental health support, you can dial 988 to connect with the Suicide & Crisis Lifeline, available 24/7.
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