Depression and bipolar disorder come with a high incidence of substance abuse. It is important to realize that there are now good medicines to treat the addictions as well as the primary mood disorders they accompany. At the 2015 meeting of the American Psychiatric Association, Nora Volkow, director of the National Institute of Drug Abuse, encouraged psychiatrists to think of addiction as a “disease of the brain that disrupts the systems that allow people to exert self-control,” saying that this would help reduce stigma both for insurance companies and for the wider public.
Most treatment of substance abuse in bipolar disorder is off-label. Doctors must infer indirect evidence of the possible efficacy of each drug in bipolar disorder from studies in those with only the primary addiction, for example, cocaine abuse without bipolar disorder.
The table at right is a preliminary rating of 1) the strength of the evidence for the efficacy of each drug in the primary addiction and 2) the likely utility of the drug for the treatment of addictions in people with bipolar disorder. For example, the drug baclofen has excellent evidence of efficacy in cocaine addiction, but gets a D for utility in bipolar disorder because baclofen can exacerbate depression.
This list is provisional, and the subjective grades for each drug are likely to change as more research is collected on these treatments. Consult a doctor if you are seeking treatment for bipolar disorder and/or substance abuse.