Many teens with undiagnosed bipolar disorder report using alcohol or drugs to cope with their emotions. This behavior is called “self-medicating.” Self-medicating means using substances like alcohol, marijuana, or other drugs to try to manage feelings such as anxiety, sadness, or agitation, instead of getting support from a mental health professional.
Undiagnosed bipolar disorder often leads to self-medicating because the mood swings can feel confusing and overwhelming. Teens may not understand what is happening, and substances can seem like an easy way to feel better or avoid emotional pain. Unfortunately, this pattern can quickly become dangerous, sometimes leading to substance use disorder or worsening mental health symptoms.
At Massachusetts Center for Adolescent Wellness, the clinical team is trained to recognize and provide adolescent dual diagnosis treatment—meaning both mental health disorders like bipolar disorder and substance use issues. The center provides specialized assessments, integrated treatment, and ongoing support for adolescents and families facing these complex challenges.
Understanding Bipolar Disorder and Substance Use
Bipolar disorder is a mental health condition that causes a person to experience extreme changes in mood, energy, and behavior. These changes include periods of feeling very “up” or energized, called manic episodes, and periods of feeling very “down” or hopeless, called depressive episodes. Many teens do not recognize these shifts as a medical condition and may think this is just part of growing up.
Bipolar disorder can be difficult to identify, especially when substance use is involved, making bipolar treatment for adolescents essential. Sometimes, teens begin using alcohol or drugs to try to manage the intense highs and lows they experience. Over time, this can lead to addiction and bipolar symptoms becoming more severe or harder to treat.
The main types of episodes in bipolar disorder include:
- Manic episodes: Feeling extremely happy or irritable, having lots of energy, talking quickly, taking risks, or acting impulsively.
- Depressive episodes: Feeling very sad, tired, hopeless, losing interest in activities, or having difficulty concentrating.
- Mixed episodes: Experiencing both manic and depressive symptoms at the same time, like feeling very agitated but also hopeless and tired.
When bipolar disorder goes undiagnosed, these mood swings can feel unpredictable and hard to control. Teens may start using substances to try to “even out” these feelings, but this often creates a cycle where both addiction and bipolar disorder reinforce each other. Without the right diagnosis and support, these patterns can become deeply rooted, making recovery more complex. The Massachusetts Center for Adolescent Wellness is experienced in helping teens and families understand and address both conditions together.
Why Do People Self-Medicate with Substances?
Teens with undiagnosed bipolar disorder often self-medicate with substances because they experience intense changes in mood and emotions that feel confusing or overwhelming. Without understanding the source of these feelings, some teens turn to alcohol, cannabis, or stimulants as a way to cope. This pattern of self-medicating can result from several psychological factors related to bipolar disorder and adolescence.
Mood Regulation
Bipolar disorder can cause rapid and intense mood swings. Some teens use substances to try to “level out” these highs and lows. For example, during a manic episode, a teen may feel restless, energetic, or unable to sleep. Alcohol might be used to slow down racing thoughts or help with sleep. In contrast, during depressive episodes, a teen may feel very tired or sad and might use stimulants like prescription medications or energy drinks to feel more alert or motivated.
Quick Relief From Emotional Distress
Substances can bring fast but short-lasting relief from strong emotions. A teen who feels sudden anxiety, sadness, or agitation may use alcohol, cannabis, or other drugs to numb these feelings or to escape them for a while. Because the relief is only temporary, the emotional symptoms often return, sometimes even stronger, creating a cycle of repeated substance use.
Limited Awareness of Underlying Bipolar Disorder
Many teens do not recognize that their mood swings or intense emotions are symptoms of bipolar disorder. Instead, they may believe these changes are caused by stress, school pressures, relationships, or just normal teenage behavior.. Without a diagnosis, they may try different substances to see what helps them feel “normal” instead of seeking professional support.
Common substances teens use to self-medicate include:
- Alcohol for anxiety and sleep issues
- Cannabis for mood stabilization
- Stimulants to counter depressive episodes
These patterns can make it harder for both teens and those around them to recognize bipolar disorder as the underlying issue.
How Self-Medication Masks Undiagnosed Bipolar Disorder
Self-medicating with substances can make it very hard to recognize bipolar disorder in teens. Alcohol, cannabis, and stimulants can change mood and behavior in ways that look similar to bipolar symptoms. This overlap can cause confusion for both teens and healthcare providers during evaluation.
For example, alcohol use can lead to feelings of sadness, low energy, and trouble concentrating. These symptoms are also common in bipolar depression, so it can be difficult to tell if alcohol is causing the depression or if the depression is part of bipolar disorder. Stimulants, such as ADHD medications or certain drugs, can cause bursts of energy, racing thoughts, talkativeness, and impulsive decisions. These symptoms can look like a manic episode, but they may be the direct result of the stimulant and not actually mania.
Withdrawal from substances can also mimic bipolar symptoms. When a person stops using alcohol, cannabis, or other drugs, they might feel anxious, irritable, tired, or emotionally unstable. These feelings can be mistaken for either depression or a mixed episode of bipolar disorder. Because substance effects can come and go quickly, it is difficult to track clear patterns of mood episodes.
The following table shows how bipolar disorder symptoms and substance-induced symptoms can be similar but have key differences:
| Bipolar Symptoms | Substance-Induced Symptoms
|
| Mood episodes last days/weeks | Symptoms tied to substance use/withdrawal |
| Pattern of episodes over time | Symptoms fluctuate with substance availability |
| Family history often present | Symptoms began after substance use started |
Understanding these differences is important because it can help with accurate diagnosis and appropriate treatment planning. When substance use is involved, careful observation over time is required to separate the effects of drugs or alcohol from the underlying mood disorder.
Dangers of Co-occurring Addiction and Bipolar Disorder
When bipolar disorder and substance use happen at the same time, the risks increase for both health and safety. This combination is often called “dual diagnosis” or “co-occurring disorders.” The interaction between addiction and bipolar disorder can make each condition worse and harder to treat.
1. Increased Risk of Severe Mood Episodes
Substance use can make mood swings in bipolar disorder more intense and unpredictable. Alcohol, cannabis, and stimulants can trigger stronger manic episodes—periods of high energy, impulsive decisions, and risky behavior. These substances can also deepen depressive episodes, causing longer or more severe periods of sadness, hopelessness, or lack of energy, which may necessitate depression and addiction treatment for teens.
People with both addiction and bipolar disorder may experience more frequent mood shifts. Substances can disrupt the brain’s natural balance, leading to rapid cycling between highs and lows. This makes it difficult to find stability and increases the risk of making unsafe choices.
2. Higher Suicidality
Research shows that the risk of suicide is higher when bipolar disorder and substance use occur together, compared to either condition alone. Teens with both conditions are especially vulnerable. Studies have found that up to half of young people with this dual diagnosis have considered or attempted suicide at some point.
Substance use lowers inhibitions and makes it harder to think clearly during mood episodes. This can increase the likelihood of acting on suicidal thoughts or engaging in self-harm. The presence of both addiction and bipolar disorder is considered a major risk factor for suicide, making early identification and support important.
3. Complicated Treatment Outcomes
Treating both addiction and bipolar disorder at the same time is complex. Substances can interfere with mood-stabilizing medications, and mood changes can make it difficult to follow treatment plans. Relapses in substance use or episodes of mania or depression can disrupt progress in therapy.
Integrated approaches are used to address both conditions together. This means that mental health and addiction specialists work as a team. Treatment plans are adjusted based on how the two conditions interact in each person.
Common warning signs in teens with both addiction and bipolar disorder include:
- Rapid escalation in substance use during mood episodes
- Dangerous behaviors during intoxication and mood episodes
- Resistance to treatment or frequent treatment failures
These signs can help families and professionals recognize when a dual diagnosis is making recovery more challenging.
Signs of Undiagnosed Bipolar Disorder in Teens
1. Rapid Shifts in Mood
- Mood changes in bipolar disorder usually last for several days or even weeks, not just a few hours.
- Examples include periods of feeling unusually happy, overly energetic, or irritable, followed by deep sadness, hopelessness, or withdrawal.
- These moods are more intense and disruptive than typical teenage mood swings, which tend to be shorter and less severe.
- During a manic phase, a teen may seem overly confident, talk quickly, or have racing thoughts, even if there is no clear reason.
- In a depressive phase, the same teen may lose interest in friends, hobbies, or activities and have trouble getting out of bed or completing assignments.
- Bipolar mood cycles are often unpredictable and may not have an obvious trigger, unlike mood changes caused by stress or conflict.
2. Impulsive Behavior and Substance Use
- Bipolar disorder often involves impulsive actions, especially during manic episodes. This can include spending sprees, reckless driving, risky sexual behavior, or sudden decisions to skip school.
- Impulsivity related to bipolar disorder is usually more extreme and frequent than typical teenage risk-taking, which is often limited to experimentation or peer pressure.
- Substance use in bipolar disorder can happen as part of these impulsive behaviors. For example, a teen may suddenly start drinking heavily or using drugs during a manic episode.
- These behaviors are usually out of character for the teen and may occur with little planning or regard for consequences.
- Unlike typical experimentation, impulsive actions in bipolar disorder often come in clusters and may result in significant problems at school, at home, or with the law.
3. Changes in Sleep and Energy Levels
- Bipolar disorder can cause dramatic changes in sleep patterns that last for days or weeks.
- During manic phases, a teen may sleep very little (sometimes just a few hours a night) and still feel full of energy.
- In depressive phases, the same teen may sleep much more than usual or have trouble falling or staying asleep, and feel tired during the day.
- These sleep changes are more extreme and long-lasting than those caused by normal teenage schedules or the effects of substance use, which tend to be temporary.
- Fluctuations in energy often match the mood state and are not directly tied to changes in activity or substance use, making them different from staying up late for social reasons or being tired after using alcohol or drugs.
Integrated Treatment for Bipolar and Substance Use
Treating bipolar disorder and substance use together is called integrated or dual diagnosis treatment. Integrated treatment addresses both conditions at the same time, rather than focusing on just one and waiting to treat the other. Research shows that when bipolar disorder and substance use are treated separately, symptoms often return or become more difficult to manage. Treating both conditions at once can help stabilize mood, reduce the risk of relapse, and improve overall functioning.
1. Dual Diagnosis Approaches
Dual diagnosis treatment is an approach designed for people who have both a mental health condition, such as bipolar disorder, and a substance use disorder. This type of treatment involves a team of professionals—such as psychiatrists, therapists, and addiction specialists—who work together. The team coordinates care plans, monitors progress, and adjusts treatments as symptoms change.
Dual diagnosis treatment uses screenings and assessments to identify the specific ways bipolar disorder and addiction interact. Treatment is tailored to the individual, taking into account mood symptoms, substance use patterns, and environmental factors. Evidence shows that dual diagnosis treatment is more effective than treating each condition separately because it recognizes how the two conditions can influence each other.
2. Combining Therapy and Medication
Therapy and medication are both used in integrated treatment for bipolar disorder and substance use. Cognitive-behavioral therapy (CBT) helps people understand patterns in their thoughts, feelings, and behaviors. CBT teaches coping skills for managing mood swings and avoiding triggers for substance use. Dialectical behavior therapy (DBT) focuses on emotion regulation, distress tolerance, and healthy relationships.
Mood stabilizers, such as lithium or certain anticonvulsants, help manage the highs and lows of bipolar disorder. Bipolar disorder medication may also include antidepressants, but these are prescribed with caution due to the risk of triggering manic episodes. Medications for substance use disorders, such as naltrexone or buprenorphine, may be included in treatment plans if appropriate.
Therapy and medication work together. Medication can reduce symptoms and make it easier to participate in therapy. Therapy helps develop skills to stay healthy and avoid relapse.
3. Family Engagement in Recovery
Family involvement is a key part of integrated treatment for teens with both bipolar disorder and substance use issues. Families learn about the conditions, how to support recovery, and how to create a stable home environment. Family therapy sessions provide a place to discuss challenges, improve communication, and develop problem-solving strategies.
Families are included in education sessions, where they learn about warning signs, relapse prevention, and healthy boundaries. Support from family members can help teens stay on track with their treatment plan. Involving families in care also helps professionals understand the teen’s daily environment and adjust treatment as needed.
Common components of integrated treatment include:
- Individual therapy sessions
- Group therapy with peers
- Family therapy and education
- Medication management
- Relapse prevention planning
These components work together to provide coordinated care for both bipolar disorder and substance use.
Empowering Teens and Families to Seek Lasting Help
When a teen has both undiagnosed bipolar disorder and substance use, the path to recovery can be challenging. Many young people and families feel uncertain or isolated when facing these issues, but effective help is available. Research indicates that with a clear diagnosis and a plan designed for both conditions, teens can achieve stability in their mood and reduce or stop substance use.
Integrated treatment, which addresses both bipolar disorder and substance use at the same time, is an approach supported by national guidelines and medical organizations. This treatment typically involves a team of mental health and addiction specialists who coordinate care, using evidence-based therapies and medication when appropriate.
Massachusetts Center for Adolescent Wellness provides specialized dual diagnosis care for adolescents. The clinical team is experienced in recognizing the signs of both bipolar disorder and substance use, even when symptoms overlap. Family involvement is included in the treatment process, so caregivers and siblings learn how to support recovery at home and in daily life.
Recovery for teens with addiction and bipolar disorder is possible, but it often requires ongoing support and adjustments to treatment as needs change. Professional help can assist in finding the right therapies, monitoring progress, and managing any setbacks along the way. Trying to handle these conditions without guidance can result in missed warning signs or unsafe situations.
Professional teams are trained to help young people regain control over their lives and improve their relationships, school performance, and mental health. Many families have seen their teens build resilience and move forward with a sense of hope after receiving comprehensive care. Early intervention and specialized support contribute to safer, more stable outcomes for both teens and their families.
FAQs About Self-Medicating and Undiagnosed Bipolar Disorder
Can bipolar disorder be diagnosed in teens who are currently using substances?
Bipolar disorder can often be diagnosed in teens who are using substances, but the process is more complex. Experienced clinicians look for patterns of mood changes that are not directly related to substance use or withdrawal. They may use interviews, observation, and standardized assessment tools over weeks or months to see if mood episodes persist even when substance effects are not present. Diagnosis may take longer, but it is possible when both substance use and mood symptoms are carefully evaluated together.
How can parents tell the difference between typical teenage behavior and bipolar disorder symptoms?
Bipolar disorder symptoms usually last longer and are more intense than normal teenage ups and downs. Mood episodes in bipolar disorder can continue for days or weeks, not just a few hours. These episodes often cause noticeable changes in sleep, energy, and behavior that disrupt daily life or cause problems at school and home. Typical teenage behavior is less extreme, does not last as long, and usually does not affect functioning as deeply.
What should families do if they suspect both bipolar disorder and substance use in their teen?
Families who suspect both bipolar disorder and substance use in a teen can seek professional evaluation at a facility with expertise in dual diagnosis for adolescents. Specialists may use detailed assessments to understand how mood symptoms and substance use interact. Early evaluation helps guide appropriate treatment planning for both conditions.
Moving Forward Together
Recovery from both bipolar disorder and substance use is possible with the right support and treatment. Many teens and families have experienced challenges with mood swings and substance use, and these issues can feel isolating or confusing. Specialized care is available for teens who have both conditions, and treatment can address both at the same time.
The Massachusetts Center for Adolescent Wellness provides expertise in working with teens facing dual diagnosis conditions. Clinicians use evidence-based therapies and involve families throughout the process, creating a supportive environment for everyone involved. Ongoing care is tailored to each teen’s unique needs, and progress is monitored at every step.
Families are not alone in this journey. Expert help is available from professionals who understand the complexity of dual diagnosis in adolescence. Contact us to start your teen’s journey to wellness.
References Section
- National Institute of Mental Health. (2023). Bipolar Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder
- Substance Abuse and Mental Health Services Administration. (2016). Substance Use Disorders and Co-Occurring Mental Disorders. Retrieved from https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4960.pdf
- University of Michigan Medicine. (2024). Bipolar disorder and alcohol: It’s not as simple as ‘self-medication’. Retrieved from https://www.michiganmedicine.org/health-lab/bipolar-disorder-and-alcohol-its-not-simple-self-medication