One of the major mental health problems with an increased rate of medication failures and treatment resistance arises with the combination of substance use and mood disorders. The purpose of this report is to discuss the off-label use of fluphenazine in managing bipolar disorder in patients with a history of substance abuse, its efficacy, and the importance of having community resources such as assertive community treatment in monitoring treatment progress and improving overall health outcomes. First-generation antipsychotics, like fluphenazine, should be used cautiously with the risks and benefits weighed against possible side effects. This report shows how fluphenazine can successfully be used as an off-label maintenance option in challenging cases.