This report provides an overview of the current state of knowledge about why some people tend to experience periods of extreme mood and what can help. Much has been written about the biological aspects of bipolar disorders: this report aims to redress the balance by concentrating on the psychological aspects, both in terms of how we understand the problems and also approaches to help and treatment. We hope this report will influence the way in which services are delivered, so that more people have access to psychological treatments and that services will no longer insist that users accept one particular view of their problem.

P.47 12.5 Risk through drugs and Alcohol - People with experience of bipolar disorder seem to be more likely to use drugs and alcohol than members of the general population or indeed people with experience of psychosis or depression alone. Studies have indicated that 40–50 per cent of people with experience of bipolar disorder will be dependent on, or use significant amounts of, drugs or alcohol in their lifetime (Care, 2007; Cassidy et al., 2001; Regier et al., 1990). These rates are higher than those in the general population, although it is important to note that potentially harmful levels of substance use are apparent in up to a quarter of adults in the general population if alcohol use is included (Care, 2007; Regier et al., 1990). Use of drugs and alcohol are notable across mood states so are not limited to periods of mania or depression only. The high rates of substance use are important because individuals who have problems with drugs and/or alcohol as well as experience of bipolar disorder tend to have more severe mood problems and benefit less well from available treatments than individuals who do not use substances in this way (Salloum & Thase, 2000; Strakowski et al., 1988).