Through a literature review and case examples we will explore the process of diagnosing and treating women who have both bipolar disorder (BD) and substance use disorders (SUDs) including alcohol, marijuana, and various other drugs of abuse. Women with bipolar disorder, who use psychoactive drug substances, are at increased risk for social stigma and negative consequences, including suicide and risk of arrest. Due to the major risks that this combination of disorders presents for women, health care providers must assess for co-occurring bipolar disorder in any woman presenting with substance abuse, and assess for substance abuse or risk for substance abuse in any woman presenting with bipolar disorder. The outcomes of treatment for these women will improve when both disorders are addressed together. Prevention of substance abuse and dependency may be possible for many women if accurate diagnosis of bipolar disorder is made and adequate mood stabilizing medications and psychosocial treatments are initiated.