Mania and Substance Abuse

Bipolar disorder involves manic or euphoric episodes and commonly co-occurs with substance abuse. Learn more about how mania and substance abuse are related.

Bipolar disorder encompasses alternating states of high moods (mania) and low moods (depression). Manic episodes are characterized by periods that last from a few hours to more than a few weeks. During this time, individuals report feeling more irritable, restless, energetic or euphoric.

Mania can co-occur, or happen at the same time as, substance abuse. Several studies have suggested that when an individual with bipolar disorder is in a manic state, they are more likely to engage in behaviors like unprotected sex, gambling, drug use or spending excessive amounts of money in a short time. Learn more about how manic episodes affect substance abuse and vice versa.

Effects of Drug Use on Mania

Various substances can induce manic episodes in individuals diagnosed or predisposed to bipolar disorder. Individuals should use caution when taking prescribed medications, such as antidepressants, steroids and drugs that treat Parkinson’s disease, among many others. Besides prescribed medications, alcohol and other illegal substances have also been known to cause manic episodes.

Alcohol and Mania

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol use co-occurs with bipolar disorder more often than alcohol use and depression alone. Some alarming statistics on alcohol and mania include:

• About 28% of individuals diagnosed with any bipolar disorder are dependent on alcohol
• About 16% of individuals diagnosed with any bipolar disorder meet the criteria for abusing alcohol
• Alcohol abuse may worsen the clinical outcome of individuals diagnosed with bipolar disorder

Research is still unclear as to whether alcohol use triggers manic episodes or if bipolar disorder predisposes individuals to abuse substances like alcohol.

Methamphetamine and Mania

Using methamphetamines creates sensations very similar to how individuals would feel during a manic episode. Currently, there is not enough research to determine if using methamphetamines induces manic episodes. However, in a study conducted in 2016, individuals who were diagnosed with bipolar I disorder and used methamphetamines were directly compared to individuals who were diagnosed with bipolar disorder alone. This study did not find many statistically significant differences between the two groups.

Marijuana and Mania

With the rise of medical and recreational marijuana legalization in many states, there is substantially more published data on marijuana and mania. A study conducted in 2015 found that using marijuana could potentially worsen manic symptoms in individuals already diagnosed with bipolar disorder. The same study found that using marijuana may be a risk factor for the development of manic symptoms. Another study also found a link between marijuana use, manic symptoms and acute psychosis. Individuals reported feeling an array of symptoms associated with mania, including:

• Depersonalization/derealization
• Anxiety
• Irritability
• Auditory hallucinations

However, it should be noted that individuals can still experience psychotic symptoms from using marijuana without a diagnosis of bipolar disorder.

Cocaine and Mania

Cocaine use can produce feelings of euphoria that emulate how an individual might feel during a manic episode. When taken during a manic episode, cocaine tends to amplify the effects of the episode, increasing pleasure, energy and mental alertness.  A 2012 study confirmed that individuals with bipolar disorder are more likely to use cocaine during manic phases.

Risks of Using Drugs During a Manic Episode

In a study published in 2011, there was a link between increased risky sexual activity and co-occurring bipolar and substance abuse disorders. This study found that individuals were more likely to pursue risky sexual behaviors while in a manic versus a depressive state.

Statistics on Mania and Addiction

There is significantly more published literature on bipolar disorder and addiction than there is on mania and addiction. Nevertheless, studies suggest that brain functioning is different in individuals with bipolar disorder, which might predispose individuals with bipolar disorder to addiction.

In a study conducted in 2017, there were several differences found in brain scans of male and females diagnosed with bipolar disorder. These findings showed that:

• Individuals with bipolar disorder had decreased gray matter volume in their brain scans
• In females with bipolar disorder, researchers found activated brain regions associated with internalizing behavior and emotional processing that could impact addictive behavior
• In males with bipolar disorder, activated brain regions were associated with attention and other executive processes  that could impact addictive behavior

In another study conducted in 2019, specific genetic factors were attributed to individuals with bipolar disorder, including biological processes that overlap with addiction. Some of these include:

• Insulin regulation
• Ion channels, which are involved in many psychiatric conditions
• Neurotransmitter pathways

Both of these studies suggest that the pathways involved in bipolar disorder overlap substantially with many psychiatric disorders and involve abnormal brain circuits, similar to individuals who experience addiction. In the future, it is likely that specific brain circuits that are activated during manic episodes will be determined, as well as how they relate to addiction and other co-occurring conditions.

Can Mania Lead to Substance Abuse?

Studies suggest that mania can lead to substance abuse. However, there are many predisposing factors besides a diagnosis of bipolar disorder that must be taken into account. Research has still not determined if being diagnosed with bipolar disorder and having manic episodes predisposes individuals to use substances. Research has also not determined if the reverse is true: using substances predisposes individuals to develop bipolar disorder or manic episodes. More likely, cause and effect are specific to the individual affected by co-occurring manic episodes and substance abuse.

Treating Mania and Co-Occurring Substance Use Disorders

Thankfully, manic episodes (bipolar disorder) can be treated together with substance use disorders. Bipolar disorder treatment focuses on stabilizing moods and alleviating severe manic or depressive symptoms. Some of these treatments include:

• Cognitive behavioral therapy
• Group therapy
• Inpatient care
• Mood stabilizers
• Anticonvulsant medications
• Antidepressant medications
• Anti-anxiety medications
• Antipsychotic medications

If you or a loved one struggle with co-occurring mania and substance abuse, help is available. The Recovery Village operates treatment centers across the United States that provide integrated care options for people with comorbid mental health and substance use disorders. Contact a representative at The Recovery Village to learn about specialized treatment options and how you can get started on the road to recovery.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Bonnie Bullock, PHD

Bonnie is a medical communications specialist at Boston Strategic Partners, a global health industry consulting firm. Her recent work in mental health includes developing conference materials for clinical studies in mood disorders and copy-editing clinical manuscripts. Read more