Cigarette smoking is prevalent among bipolar patients, particularly those who have frequent or severe psychotic symptoms. Some experts speculate that, as in schizophrenia, nicotine use may be a form of self-medication because of its specific effects on the brain; further research is necessary.

Up to 60% of patients with bipolar disorder abuse other substances (most commonly alcohol, followed by marijuana or cocaine) at some point in the course of their illness.

The following are risk factors for alcoholism and substance abuse in bipolar disorder patients:

  • Having mixed-state episodes rather than ones of pure mania.
  • Being a man with bipolar disorder.


In Pakistan, drug addiction is more prevalent among the lower middle and lower class than it is among the higher class. The severity of this addiction has led to the majority of the homeless people beggaring on the streets being drug users.

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