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Bipolar Disorder

Alcohol, Drugs and Bipolar Disorder: A Bad Combination

The risks of alcohol and drug use for those with bipolar disorder

One of the more common themes in university students' bipolar stories is the role that substance use has had in the course of their disorder. Sometimes it's simply part of the stormy adolescence that precedes their diagnosis. For others, it's more a part of the storm that follows. But either way it's almost never a helpful or curative part of their narrative.

The explanation of why alcohol and drugs don't mix well with bipolar disorder isn't simple. It really needs to be considered from multiple perspectives.

First, it's fairly obvious that the introduction of mind altering chemicals into the brain doesn't exactly help to sustain mental stability. With almost all recreational drugs there is some kind of "high" associated with experience. That's why people do it. But following any substance induced high, there's almost always the experience of coming down. And usually that translates into a "low" mood feeling.

Think of how you feel the morning after being intoxicated, or four to five hours after smoking pot or snorting cocaine. It's usually not a pleasurable experience. The problem is that the anticipation of feeling low is not apparent for the individual at the time that he or she desires the high. Whoever thinks ... "I want to feel hung over and depressed so I'm going to drink some alcohol." Obviously if most individuals applied an objective analysis of the outcomes of substance use, then most wouldn't drink or get high.

But when we're pleasure seeking or perhaps just trying to get rid of uncomfortable feelings, the thought processes leading to our choices aren't necessarily rational or balanced. In fact, for those with bipolar disorder who struggle with mood instability, the use of drugs and alcohol only adds to the ups and downs. It absolutely doesn't smooth them out.

And then there's the seductive and dangerous element of disinhibition, particularly in relation to alcohol. Alcohol lowers inhibitions. That's partly why it feels so good. The shy or insecure person gets to be more outgoing and confident. The person who's too tightly wrapped gets to let loose and be stupid. And the person who's chronically anxious and fearful gets to relax.

So what's wrong with disinhibition?

Well nothing really, if you're able to apply good judgment and adequate impulse control. You can drink some, enjoy your time with friends and usually return to the normal rhythms of your life. The problem is that everyone with bipolar disorder intermittently becomes hypomanic or manic. It's what defines the diagnosis. And in these elevated mood states, bipolar individuals almost always experience some degree of impaired impulse control. During the elevated mood phase they're usually feeling up, energized, gregarious and cognitively accelerated. The problem is that once their mood extends above the mildly elevated range, they often lose the capacity to modulate or turn down their mood-related intensity. It's like the wheels of hypomania become lubricated and they keep picking up speed.

That's what's wrong with alcohol-related disinhibition. It further greases the wheels of elevated mood. The challenge faced by those with bipolar disorder is one of figuring out how to do the opposite. They've got to become skillful at applying the brakes and slowing back down to a healthy speed.

In the weekly bipolar support group that I lead, university students frequently speak of the danger that alcohol represents for them. One student likened it to throwing some gasoline on a slow burning fire. When she drinks, she usually wants to drink more; and when she does, she almost always become destabilized - either upward, downward or both.

If university students with bipolar disorder could be successful just having a beer or perhaps a glass of wine, then I don't think most would be adversely affected by doing so. However, that's a big if!

Often within the culture of late adolescence and young adulthood, drinking isn't just for the mild relaxation from a bottle of beer or the taste of a good glass of wine. Drinking usually occurs in social settings where the intent is to become buzzed, if not fully intoxicated. Furthermore, peer pressure to participate makes it very difficult to put on the brakes.

Over my 20+ years of working with university students, I've probably seen more than 150 bipolar students. I don't think I've ever seen someone with bipolar disorder who was appreciative of the role that drugs or alcohol had in their life. Their narratives unfold in the opposite direction. And for those who have benefited from their difficult life lessons and have been successful in curtailing their drug and alcohol use, they almost always report increased mood stability.

It's pretty simple. If you want to live well with bipolar disorder, then drugs and alcohol don't factor into the equation.

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Russ Federman is Director of Counseling and Psychological Services at the University of Virginia. He is also co-author of Facing Bipolar: The Young Adult's Guide to Dealing with Bipolar Disorder (New Harbinger Publications), see