Bipolar Disorder and Substance Use: Signs Families Should Know and Treatment Options

Written by the medical team at Day One Rehabilitation Center, Nakhon Nayok, Thailand · Medically reviewed by Dr. Pichayut Kasemphakdeephong (Psychiatrist)

Bipolar disorder is a mood disorder marked by periods when mood and energy shift well outside a person’s normal range. At times energy may be unusually high — sleeping very little without feeling tired, talking a lot, thinking quickly, feeling unusually self-assured, spending large amounts of money, or engaging in risky activities. At other times mood may be low, with little energy, little motivation, and a loss of interest in things the person used to enjoy.

The picture becomes more complicated when bipolar disorder occurs alongside substance use, because yaba, crystal meth (ice), cocaine, cannabis, alcohol, and other psychoactive substances can also change mood, sleep, energy, and behavior.

Families may wonder, “Is going without sleep for several nights, talking non-stop, and spending heavily a sign of bipolar disorder, or is it the drugs?” Conversely, when a person’s mood drops after stopping a substance, it may not be clear whether this is a depressive episode of bipolar disorder or a symptom related to the substance itself. Answering these questions requires looking at the history of symptoms, the timing of substance use, sleep patterns, behavior before substance use began, and how symptoms evolve after stopping — not diagnosing from a mood change alone.

What Are the Symptoms of Bipolar Disorder, and How Is It Different From Everyday Mood Swings?

The word “bipolar” is often used casually to describe someone whose mood changes quickly — cheerful one moment, irritable the next. But bipolar disorder is not simply about mood going up and down from day to day.

What matters is a period during which mood, energy, sleep, thinking, and behavior change clearly and noticeably enough to affect a person’s life.

During a manic or hypomanic episode, families may notice:

Mood that is unusually elevated or upbeat, or unusually irritable
High energy and taking on many activities at once
Sleeping only a few hours yet still feeling energetic
Talking a lot, talking fast, or jumping quickly between topics
Racing thoughts, feeling as if several ideas are happening at once
Unusually inflated confidence in one’s own abilities
Planning grand projects or believing one can accomplish far more than is realistic
Spending large sums of money, shopping, investing, or making transactions without thinking them through
Driving fast or engaging in other risky activities
Changes in sexual behavior or social behavior compared with usual
More irritability or conflict with people around them
In severe cases, thoughts out of touch with reality, hearing voices, or paranoia may also occur

Bipolar disorder can also involve depressive episodes, which may include low energy, loss of interest in things once enjoyed, disrupted sleep, reduced concentration, feelings of worthlessness, hopelessness, withdrawal from others, and in some cases thoughts or behaviors of self-harm.

Some people have one type of episode much more prominently than the other, so not everyone with bipolar disorder has identical symptoms, or swings quickly from happy to sad the way it’s often portrayed.

Can Yaba, Ice, and Other Substances Cause Symptoms That Look Like Bipolar Disorder?

Yes — especially stimulants such as yaba, crystal meth (ice), and cocaine. While the drug is active, a person may become more alert, unable to sleep, talkative, high-energy, quick-thinking, more confident, easily irritated, or prone to risky behavior — some of which can resemble a manic episode.

If use continues to the point of going without sleep for several nights, symptoms can intensify into confusion, paranoia, hearing voices, or thoughts out of touch with reality.

Conversely, once the stimulant’s effects wear off, some people enter a period of exhaustion, sleeping a great deal, low energy, low mood, and lack of motivation — which can look similar to a depressive episode.

So a person who uses yaba and then can’t sleep, talks a great deal, or spends heavily should not automatically be assumed to have bipolar disorder — and someone with a history of bipolar disorder should not have every behavior attributed to the illness without also assessing substance use.

What psychiatrists typically need to consider: whether symptoms began before or after substance use; whether manic or depressive episodes ever occurred during periods without substance use; how symptoms change after stopping use; any prior treatment history; and whether family members have ever been diagnosed with a mood disorder.

What Happens When Bipolar Disorder Occurs Together With Addiction?

Some people use alcohol or other substances to try to manage their own mood — drinking to fall asleep, using a substance to feel better when mood drops, or using to escape stress. But substance use can throw sleep and mood further out of balance.

For someone who already has bipolar disorder, irregular sleep and sleep deprivation deserve particular attention, because major changes in sleep can occur alongside a mood episode, while stimulants can further prevent sleep and increase alertness.

When bipolar disorder and addiction occur together, families may encounter problems such as:

Mood and behavior changing so much they become hard to predict
Irregular sleep or ongoing sleep deprivation
Inconsistent use of psychiatric medication
Returning to substance use when mood changes
Heavy spending or debt problems
Risky activities undertaken without much thought
Conflict with family or a partner
Impact on school or work
Mood symptoms flaring up again after substance use
In some cases, hearing voices, paranoia, or thoughts out of touch with reality

Both issues should therefore be assessed together — not treating mood without asking about substance use, or trying to stop substance use while overlooking bipolar disorder.

How Is Bipolar Disorder Treated When It Occurs Together With Addiction?

The treatment approach depends on which mood episode the person is currently in, what substance is being used, whether withdrawal is present, whether the person is getting enough sleep, and how significant the safety risks are.

Assessing Manic Episodes, Depressive Episodes, and the Effects of Substance Use

The early stage of treatment requires gathering detailed information, especially the timeline of symptoms — for example, whether there was a period of sleeping little but having high energy before starting to use yaba or ice; whether there was a period of heavy spending or risky behavior unrelated to substance use; and how symptoms have continued or changed since stopping use.

Information from family is very valuable, because during a manic episode, some people feel they are full of energy, performing well, or not having any problems at all — so they may not see the changes in themselves the way people around them do.

Treating Mood With Medication as Assessed by a Psychiatrist

Medication plays an important role in treating bipolar disorder. A psychiatrist may consider mood-stabilizing medications or antipsychotic medications depending on the nature and severity of symptoms.

Medication choice is not the same for everyone, because it depends on whether the person is currently in a manic episode, a depressive episode, or has mixed features, as well as any other medical conditions, other medications being taken, and the substances involved.

A person diagnosed with bipolar disorder should not stop medication on their own just because they feel better, because a return to normal mood does not mean the illness is gone. Continued treatment and follow-up with a psychiatrist help reduce the chance of a relapse of symptoms.

Another important point: depressive episodes in bipolar disorder are treated differently from ordinary depression. The use of antidepressants must therefore be under a psychiatrist’s supervision — medication should never be bought or adjusted independently.

Treating Addiction Alongside Bipolar Disorder

Stopping substance use alone may not be enough if the person receiving treatment does not yet understand how mood, stress, sleep, and cravings are connected to one another.

Therapy can help a person see their own patterns, such as:

“During the times I feel very energetic, I think I can control everything, so I go back to using and keep going out for several nights.”

“When my mood drops, I don’t want to think about anything, so I go back to drinking to be able to sleep.”

Once these patterns become clearer, a plan can be made to respond before behavior progresses to a return to substance use or a severe mood episode.

For someone who does not yet see substance use as a problem, motivational conversation can help the person explore for themselves what short-term effects the substance provides, and how it is affecting sleep, mood, finances, work, or relationships in the longer term.

Restoring Sleep and Building a Consistent Routine

Sleep is one of the most important things for someone with bipolar disorder. Staying up late occasionally does not always mean symptoms are flaring up — but if sleep clearly decreases over several days and the person still doesn’t feel tired, especially alongside high energy, excessive talking, racing thoughts, or risky behavior, this deserves attention.

Once symptoms have stabilized, treatment should help establish consistent sleep and wake times, taking medication as prescribed, reducing triggers that disrupt sleep schedules, and gradually returning to school, work, exercise, and other activities as the person is ready.

Families should help watch for each person’s own specific warning signs — such as starting to sleep less, talking more, spending more money, starting to go out every night, or reconnecting with a group of friends who use substances — in order to seek help early.

What Should Families Do When Someone With Bipolar Disorder and Addiction Refuses Treatment?

A manic episode is a situation families may find difficult to talk about, because the person may feel they are not ill at all — instead feeling that they are thinking clearly, full of energy, or more capable than usual. Saying “you have bipolar disorder” or arguing about every point can increase conflict.

Families should start from observable behavior, such as, “The last three nights we’ve seen you sleep only a few hours and still go out constantly — we’re worried about your sleep,” or “You’ve been spending a lot more money than usual lately — we’d like you to talk with a doctor about what’s going on.”

If substance use is also involved, ask without blame what substance is being used, when it was last used, and how symptoms change during periods of use. This information is more useful for assessment than trying to force the person to accept a diagnosis right away.

During periods of severe symptoms, families may need to help limit access to large amounts of money, a car, or anything else that increases risk, as appropriate — prioritizing safety over winning an argument.

If there is severe confusion, an inability to care for oneself, potentially dangerous behavior, severe psychotic symptoms, or thoughts or behaviors of self-harm, the person should receive a medical assessment as soon as possible.

Outpatient or Residential Treatment: Which Is Right for Bipolar Disorder With Substance Use?

Not everyone with bipolar disorder needs residential treatment. If symptoms are stable, there is no emergency, medication is taken consistently, and substance use can be stopped or controlled, outpatient follow-up may be enough.

Anyone who wants an assessment for bipolar disorder, mood swings, sleep problems, or co-occurring substance use can start with an outpatient assessment at Piti Clinic, our mental-health clinic on Pradiphat Road, Saphan Khwai, Bangkok, where specialists assess symptoms, substance-use history, sleep, medication use, and risk before planning appropriate treatment.

Families can also come in for a consultation first if the person is not yet ready to see a specialist — particularly when the family is unsure whether what they’re seeing is a symptom of bipolar disorder, an effect of substance use, or both occurring together.

If there has been repeated substance use, an inability to stop using in the same environment, inconsistent use of psychiatric medication, significantly disrupted sleep, mood symptoms that flare up in connection with substance use, or if the family is unable to manage the situation on an ongoing basis, residential treatment may be the more appropriate option.

Treating Bipolar Disorder and Addiction Together at Day One Rehabilitation Center

Someone with bipolar disorder together with addiction should have both their mood symptoms and their substance use addressed at the same time, because if mood is brought under control but the person still returns to substance use, sleep and mood can become unbalanced again. At the same time, if substance use stops but bipolar disorder goes untreated, mood symptoms can themselves become a factor that disrupts continued recovery.

At Day One Rehabilitation Center, residential treatment allows the care team to continuously monitor mood, sleep, behavior, psychiatric medication use, and symptoms after stopping substance use, within an environment that limits access to substances and triggers during the early stage.

A psychiatrist can assess and adjust treatment according to symptoms, while individual and group therapy help the person in treatment understand their triggers, practice managing cravings, notice warning signs of a mood episode, and plan to prevent a return to substance use.

Recovery also places importance on daily routine — especially consistent sleep and wake times, taking medication regularly, exercise, and a gradual return to responsibilities in daily life.

The goal, therefore, is not simply to calm mood or stop substance use while the person is at the center, but to help the person in treatment and their family understand their own warning signs and have a plan for responding once they return to their usual environment.

Frequently Asked Questions About Bipolar Disorder and Substance Use

Do mood swings mean someone has bipolar disorder?

Not always. Everyday mood can change in response to life events. Bipolar disorder requires looking at changes in mood together with energy, sleep, thinking, behavior, how long symptoms last, and their impact on daily life — it should not be diagnosed from the term “mood swings” alone.

Can yaba or ice cause symptoms that look like bipolar disorder?

Yes. Stimulants can cause sleeplessness, excessive talking, alertness, irritability, increased confidence, and risky behavior, which can resemble a manic episode. Diagnosis must therefore consider the relationship between symptoms and substance use, and track symptoms after stopping use.

Can substance use cause a relapse of symptoms in someone with bipolar disorder?

Yes. Substances can disrupt sleep, mood, decision-making, and continuity of treatment, which can make the illness harder to control — especially if psychiatric medication is stopped or sleep deprivation occurs at the same time.

Can someone with bipolar disorder drink alcohol?

Someone with bipolar disorder should discuss alcohol use with their psychiatrist, especially if they are taking medication, because alcohol can affect sleep, mood, and decision-making, and may interact with certain medications. If drinking cannot be controlled, alcohol use should also be assessed as a separate problem.

Can bipolar disorder be cured?

Bipolar disorder is a condition whose symptoms can be managed. Many people who receive appropriate treatment are able to study, work, maintain relationships, and live well. Treatment usually focuses on controlling symptoms, preventing relapse, taking medication consistently, and maintaining regular sleep and routines.

If symptoms improve, can someone stop bipolar medication on their own?

Medication should not be stopped or reduced without medical guidance. A return to normal mood may be a result of treatment that is working well. Stopping medication should be discussed with a psychiatrist to assess risk and plan appropriately.

For someone with bipolar disorder and addiction, which should be treated first?

It is not necessary to choose only one. In many cases, both mood symptoms and addiction should be treated at the same time, prioritized according to safety, intoxication or withdrawal symptoms, the severity of mania or depression, and each person’s physical condition.

Does bipolar disorder require residential treatment?

Not for everyone. If symptoms are stable and can be monitored, outpatient treatment at Piti Clinic may be a good starting point. But if there is co-occurring substance use, an inability to control use, repeated relapses, inconsistent medication use, or an environment that makes recovery difficult, residential treatment at Day One Rehabilitation Center may be a more suitable option.

Bipolar Disorder and Addiction Should Be Treated Together

When someone in the family clearly starts sleeping less, talking a great deal, has high energy, is spending heavily, engaging in risky behavior, or has mood changes alongside a history of substance use, what matters is not rushing to conclude “it’s bipolar disorder” or “it’s the drugs” — but assessing when these changes began and how they relate to substance use.

Bipolar disorder can be managed, and addiction can be treated and recovered from as well. Addressing both at the same time helps ensure treatment doesn’t leave a gap between managing mood and preventing a return to substance use.

For someone whose symptoms are stable, starting with an outpatient assessment can help clarify the problem and plan treatment. For someone with more complex co-occurring substance use, residential treatment may help them stop using, restore sleep, monitor mood, and build a new routine on an ongoing basis.

Families do not need to wait until symptoms become severe or until the person accepts every part of the problem first. Noticing changes in sleep, mood, energy, spending, and substance use, and seeking guidance as soon as unusual signs appear, can help someone enter treatment sooner.