Session 14 - Psychoactive substances: risks in bipolar disorders  pp. 149-155

Psychoactive substances: risks in bipolar disorders

By Francesc Colom, Eduard Vieta and Jan Scott

Image View Previous Chapter Next Chapter


Substance abuse or dependency problems are very frequent in the bipolar population, involving about 50% of patients according to some studies. Seven out of ten bipolar men abuse alcohol during mania, thus complicating its course. The goal of this session above all is for our patients to become aware of the risk, not of hard drugs (if indeed the distinction between hard and soft drugs makes any sense), but of more everyday-drugs like coffee and alcohol. This awareness is crucial because the number of bipolar patients who use caffeine is very high and the majority of them do not even view this behavior as a problem, although its effect on sleep and on comorbid pathologies that are very common in bipolar disorders such as panic attacks is very obvious.


  • While the therapist talks informally to the group members, one of the co-therapists can write the following list on the blackboard:

– Beer.

– Wine.

– Joints (marijuana).

– Whisky, rum, and other hard liquors.

– Acid (“trips”).

– Cocaine.

– Amphetamines.

– Stimulating beverages (Red Bull).

– Cola drinks.

– Coffee.

– Ecstasy and other designer drugs.

  • Once our informal chat is over, we put the following question openly to the whole group: “Which of the substances listed on the blackboard do you think are potential dangers for a person suffering from bipolar disorder?” Most of the patients will exclude some of the substances from the list, generally coffee and cola drinks but also sometimes wine and beer, and even marijuana.