Epidemiological studies show that substance abuse and bipolar disorder are strongly associated. The reasons include of self-treatment and poor self-control during hypomanic/manic periods. Substance abuse influences the outcome of bipolar disorder and makes diagnosis more difficult. Patients with bipolar disorder who abuse substances tend to have a worse outcome and greater suicidal risk. If good outcomes are to be achieved, substance abuse in these patients cannot be ignored. An integrated treatment approach of both conditions together probably gives the best results.
Keywords: substance abuse, alcohol, bipolar disorder, outcome, suicide, clinical implications