While there is a difference between CU and use disorders, CU in BD was associated with hypomanic and manic episodes, but not depression [8,18,19]. Individuals with BD and CU displayed increased severities of mania [20], hallucinations, delusions and overall illness [21]. Several studies reported higher rates of complications and more severe bipolar symptoms, including more time in manic and mixed episodes [9], more frequent affective episodes [10], and mixed states [22]. Psychotic symptoms [23] were also more prevalent in BD with CUD.
