Yes. For a man with bipolar disorder, drinking tends to make mood episodes longer, harder to treat, and more dangerous. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) warns that long-term alcohol exposure on top of depressive or manic symptoms may lead to longer mood episodes, poorer cognitive function, and a higher risk of suicide [1].
NIAAA adds that treatment is most likely to succeed when both conditions are addressed, which is why the drinking belongs in any plan for bipolar disorder treatment.
Bipolar Disorder and Alcohol: How Common Is Alcohol Use Disorder?
Bipolar disorder is a mental illness that causes clear shifts in mood, energy, activity levels, and concentration [2]. The two most common forms are called bipolar I disorder, with manic episodes lasting at least 7 days, and bipolar II disorder, with depressive episodes and milder hypomanic ones. Cyclothymic disorder rounds out the bipolar spectrum disorders.
NIAAA reports that in clinical populations, people with bipolar disorder have the highest rate of alcohol use disorder among the mental health conditions it reviews, about 42 percent. A 2021 review in Frontiers in Psychiatry summarized US survey data putting lifetime alcohol use disorder at 62.3 percent, including 39.1 percent for what the DSM-IV called alcohol abuse [3]. In one US outpatient sample it cites, 49 percent of men with bipolar disorder had alcohol use disorder, compared with 29 percent of women.
For a family, a husband or son with bipolar disorder who drinks heavily fits a common pattern. The guide to co-occurring disorders covers how mental health conditions and substance use feed each other.
What Alcohol Does in Manic and Depressive Episodes
What happens when a man with bipolar disorder drinks depends partly on the phase he is in.
Mania and Alcohol
During manic episodes, NIMH lists symptoms such as an elevated or irritable mood, racing thoughts, less need for sleep, rapid speech, feeling unusually powerful, and an excessive appetite for pleasurable activities. Hypomanic symptoms follow the same pattern at lower intensity. Alcohol loosens inhibition further. For some men, the mix ends in a fight or a spending spree he regrets.
Severe manic or depressive episodes can also include psychosis, such as hallucinations or delusions, according to NIMH. Heavy stimulant use can produce a similar picture, covered in the chapter on meth-induced psychosis, so clinicians ask about other drug use too.
Alcohol and Bipolar Depression
NIMH describes depressive episodes as stretches of sadness or anxiety, feeling slowed down, trouble concentrating, sleep disturbances, loss of interest, and hopelessness, sometimes with thoughts of suicide. Alcohol is a depressant, and heavy drinking can blur into those depressive symptoms until it is hard to tell which is driving which.
The Frontiers review links co-occurring alcohol use disorder with more severe depression and more suicidal ideation. A drink taken to get through a low evening tends to add weight to the mood it was meant to lift.
Why Drinking Makes Bipolar Symptoms Harder to Treat
Alcohol use disorder and periods of increased drinking are associated with a less stable course of bipolar disorder. Research links the combination with slower recovery, more mood instability, poorer treatment adherence, and worse functioning in some people.
Longer Episodes and Faster Cycling
The Frontiers review describes what co-occurring alcohol use disorder does over time: earlier onset, delayed recovery from episodes, more frequent mood switches, rapid cycling, mixed states (manic and depressive symptoms at the same time), and a greater need for hospitalization early in the illness. Mood instability like that makes it much harder to manage bipolar disorder.
The same review names alcohol or drug use as the most important predictor that a person with bipolar disorder will stop taking medication as prescribed.
What the Prechter Study Found
In July 2024, researchers at the Heinz C. Prechter Bipolar Research Program at Michigan Medicine published a JAMA Network Open study that followed 584 people with bipolar disorder for 10 years [4]. Volunteers in the Prechter Longitudinal Study, a detailed longitudinal study helping scientists identify biological, genetic, psychological, and environmental causes of the illness, reported mood, life functioning, and alcohol use every two months.
Using that intensive longitudinal data, the team found that drinking more than was typical for a person predicted rising depressive and manic symptoms over the next six months. That held even without an alcohol use disorder, and even among people who drink fewer drinks than experts consider problematic. Drinking more than usual was also tied to problems at work.
Is Drinking a Form of Self-Medication?
The reverse did not hold in the Prechter data: having increased mood symptoms did not predict more drinking, which cuts against the self-medication hypothesis.
Previous studies show that more than half of people with a bipolar disorder diagnosis develop alcohol use disorder at some point, and many with bipolar disorder turn to alcohol to sleep or calm anxiety.
Study author Sarah Sperry points to what alcohol and social situations involving alcohol do to a person’s circadian rhythms and brain-based reward circuits, “not just the action of the substance in the brain.” Her team is working to identify psychological and neurophysiological factors behind the link, using mobile and wearable technologies to measure real-world behaviors.
Drinking to get to sleep also shows up in men dealing with nightmares after trauma.
Suicide Risk
NIAAA states that untreated bipolar disorder has the highest rate of suicide of all psychiatric disorders. The Frontiers review cites a Brazilian study in which 68 percent of people with bipolar disorder and alcohol use disorder had made at least one suicide attempt, compared with 35 percent of those without it.
If a man is talking about suicide or seems in danger, call or text 988 to reach the 988 Suicide and Crisis Lifeline. In an emergency, call 911.
Bipolar Medications and Alcohol
NIMH lists mood stabilizers such as lithium and valproate, along with atypical antipsychotics, as common bipolar medications, and advises against stopping medication without talking to a health care provider first. Any question about drinking on a specific prescription belongs with the prescriber.
Lithium and Alcohol
Lithium is used to treat and prevent episodes of mania. The Frontiers review reports that co-occurring alcohol use disorder predicts a weaker response to lithium, on top of the missed doses that often come with drinking. It also notes that in adolescents, gaining mood stability on lithium was linked to lower alcohol or drug use.
A man taking lithium who drinks should tell his prescriber how much and how often. Leaving it out leaves the prescriber working with half the facts.
Valproate, Antipsychotics, and Antidepressants
MedlinePlus notes that alcohol can add to the drowsiness caused by valproic acid, and that the drug can cause serious liver damage, most likely in the first 6 months of therapy [5]. Heavy drinking strains the liver too. The Frontiers review raises a similar caution for carbamazepine.
NIMH notes that antidepressants are not used alone in bipolar disorder because they can trigger mania or rapid cycling, and each carries its own alcohol warnings. The chapter on Zoloft with alcohol walks through one example.
Bipolar Disorder or Substance-Induced Mood Swings?
Heavy drinking can produce low moods, irritability, and extreme mood swings that look like bipolar symptoms. NIMH notes that some prescribed, recreational, or illicit drugs can mimic or worsen mood symptoms, and that misdiagnosis can happen because some bipolar symptoms resemble other illnesses.
Clinicians sort this out by timeline. Did the mood episodes show up before the drinking, or during sober stretches? Or only during heavy use and withdrawal? A wife’s memory of a manic stretch during a dry year can matter as much as his own account. When mood symptoms appear only with the substance, the diagnosis may be a substance-induced mood disorder rather than bipolar disorder.
Integrated Treatment for Co-Occurring Bipolar Disorder and Alcohol Use
NIAAA notes that people with bipolar disorder may need a combination of medications prescribed by a psychiatrist with expertise in dual diagnosis, and the Frontiers review recommends treating both disorders in one setting by the same team. Integrated bipolar disorder care often includes:
- Medication management, with drinking discussed at each visit
- Cognitive behavioral therapy, family-focused therapy, or interpersonal and social rhythm therapy, all listed by NIMH
- Group therapy to build coping strategies for cravings and intense emotions
- A standardized measurement tool such as the Alcohol Use Disorder Identification Test (AUDIT), which the Michigan researchers recommend for tracking alcohol use patterns and how they impact mood symptoms
The safest alcohol goal depends on the man’s symptoms, alcohol use disorder severity, medications, and treatment history. NIMH advises people with bipolar disorder to avoid alcohol and drugs [2]. The 2024 Prechter researchers note that more research is still needed to determine whether abstinence or harm-reduction approaches produce better mood and functioning outcomes for people with bipolar disorder [4].
What their study does support is paying attention to changes in drinking over time. Even increases that did not meet criteria for alcohol use disorder were associated with later mood instability, so alcohol use should be discussed openly and tracked as part of bipolar treatment rather than treated as a separate issue.
Bipolar and Alcohol Frequently Asked Questions
Can You Drink Alcohol While on Bipolar Medication?
That depends on the medication and the man, and only his prescriber can answer it for his situation. MedlinePlus warns that alcohol adds to the drowsiness caused by valproic acid, and co-occurring alcohol use disorder predicts a weaker response to lithium. NIMH’s general advice for people with bipolar disorder is to avoid alcohol and drugs.
Does Alcohol Help Calm Bipolar Mood Swings?
It can feel that way for an evening, but the research points the other way. In the Michigan Medicine study, drinking more than usual predicted worse manic and depressive symptoms over the following six months, while worsening mood did not predict more drinking. Over time, drinking makes symptoms worse rather than better.
Is “Bipolar Alcoholism” a Diagnosis?
No. Clinicians diagnose two separate conditions: bipolar disorder and alcohol use disorder. When both are present, they are co-occurring disorders, and each needs its own treatment within one plan. Person-first language, such as a man with bipolar disorder and alcohol use disorder, keeps the focus on the person and on what can be treated.
If drinking and mood swings are running together in your life, or in your son’s or husband’s, an evaluation that looks at both is the next step. Into Action Arizona provides residential addiction treatment in Phoenix for men, with the structure and accountability to treat alcohol use and mental health together.
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
Sources
- National Institute on Alcohol Abuse and Alcoholism. Mental Health Issues: Alcohol Use Disorder and Common Co-occurring Conditions. Core Resource on Alcohol. Last updated May 8, 2025. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/mental-health-issues-alcohol-use-disorder-and-common-co-occurring-conditions
- National Institute of Mental Health. Bipolar Disorder. NIH Publication No. 25-MH-8088. Revised 2025. https://www.nimh.nih.gov/health/publications/bipolar-disorder
- Grunze H, Schaefer M, Scherk H, Born C, Preuss UW. Comorbid Bipolar and Alcohol Use Disorder: A Therapeutic Challenge. Frontiers in Psychiatry. 2021;12:660432. Published March 23, 2021. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.660432/full
- Gavin K. Bipolar Disorder and Alcohol: It’s Not as Simple as “Self-Medication.” Michigan Medicine Health Lab. July 23, 2024 (reporting Sperry SH, Stromberg AR, et al., JAMA Network Open, 2024). https://www.michiganmedicine.org/health-lab/bipolar-disorder-and-alcohol-its-not-simple-self-medication
- MedlinePlus, National Library of Medicine. Valproic Acid. Last revised April 15, 2026. https://medlineplus.gov/druginfo/meds/a682412.html
