If the AUD commences before the BD, then one hypothesis for the comorbidity would be that the AUD activates a predisposition towards BD in that subgroup; although there is no genetic or familial evidence for this (Maier and Merikangas, 1996). The other hypothesis, namely that patients with BD use alcohol to self-medicate their mood symptoms, or drink a result of their tendency towards impulsive behaviours, may also apply (Swann et al., 2003). It is likely, however, that within the spectrum of comorbid AUD and BD, there lies a variety of orders and associations, and that no one hypothesis explains the full spectrum of presentations. Consistent with this is the fact that when comorbid groups are studied, some patients present with BD first, some with AUD first, and some patients present with both simultaneously (Strakowski et al., 2005a). Those with AUD first tend to be older and tend to recover more quickly, whereas those with BD first tend to spend more time with affective disorder, and have more symptoms of AUD (Strakowski et al., 2005a). There are some gender differences also in that more men than women with BD tend to be alcoholic (Frye et al., 2003).
Challenges to Effective Treatment of Bipolar Disorder and Alcoholism
Alcohol, in particular, poses a significant risk for individuals with bipolar disorder. Studies indicate that alcohol consumption can destabilize mood states, increase the frequency and severity of manic and depressive episodes, and reduce the effectiveness of prescribed medications. The depressive effects of alcohol on the central nervous system can deepen depressive episodes, while its disinhibiting properties may trigger manic or hypomanic states. Furthermore, alcohol use can impair judgment and decision-making, making it harder for individuals to adhere to their treatment plans, including medication regimens and therapy sessions. This interplay between alcohol and bipolar disorder creates a vicious cycle, where substance use complicates the management of the disorder, leading to poorer outcomes and increased risk of hospitalization.
Supportive Therapies and Lifestyle Strategies
The FIRESIDE Principles for an integrated treatment of bipolar disorder and alcohol use disorder. A second key concept underlying IGT is a focus on common features in the recovery and relapse process in the two disorders. Patients are told that the same kinds of thoughts and behaviors that will facilitate their recovery from one disorder will also aid in the recovery process from their other disorder. Conversely, thoughts and behaviors that may increase the risk of relapse to one disorder will similarly elevate their chances of relapse to the other disorder.
Aftercare Support Includes:
Alternatively, symptoms of bipolar disorder may emerge during the course of chronic alcohol intoxication or withdrawal. Still other studies have suggested that people with bipolar disorder may use alcohol during manic episodes in an attempt at self-medication, either to prolong their pleasurable state or to sedate the agitation of mania. Finally, other researchers have suggested that alcohol use and withdrawal may affect the same brain chemicals (i.e., neurotransmitters) involved in bipolar illness, thereby allowing one disorder to change the clinical course of the other.
There are a number of disorders in the bipolar spectrum, including bipolar I disorder, bipolar II disorder, and cyclothymia. Bipolar I disorder is the most severe; it is characterized by manic episodes that last for at least a week and depressive episodes that last for at least 2 weeks. Patients who are fully manic often require hospitalization to decrease the risk of harming themselves or others. This mixed mania, as it is called, appears to be accompanied by a greater risk of suicide and is more difficult to treat. Patients with 4 or more mood episodes within the same 12 months are considered to have rapid cycling bipolar disorder, which is a predictor of poor response to some medications. Bipolar II disorder is characterized by episodes of hypomania, a less severe form of mania, which lasts for at least 4 days in a row and is not severe enough to require hospitalization.
Table 1 supplies an overview of double-blind, randomized pharmacological studies for comorbid bipolar affective and AUDs, based on a systematic PubMed search. Family-focused treatment (FFT) with psychoeducation is recommended and effective (99). Developing an awareness of the signs of both conditions helps inform early intervention and improves treatment outcomes.
Increased Risk of Suicide
- The precipitating factor is the death of his wife, the predisposing factor is the history of psychiatric illness in the maternal aunt, and the perpetuating factor of illness in the patient is non-compliance.
- Many medications prescribed for bipolar disorder, such as mood stabilizers and antipsychotics, can be rendered less effective when combined with alcohol.
- Cyclothymia is a disorder in the bipolar spectrum that is characterized by frequent low-level mood fluctuations that range from hypomania to low-level depression, with symptoms existing for at least 2 years (American Psychiatric Association APA 1994).
- Dual diagnosis programs, which simultaneously treat both the mental health disorder and the substance use disorder, have been shown to be effective.
- The adequate amount of abstinence for diagnostic purposes has not been clearly defined.
Family history and severity of symptoms should also factor into diagnostic considerations. Given that bipolar disorder and substance abuse co-occur so frequently, it also makes sense to screen for substance abuse in people seeking treatment for bipolar disorder. There are a range of effective treatment options, typically a mix of medicines and psychological and psychosocial interventions. Medicines are considered essential for treatment, but themselves are usually insufficient to achieve full recovery. Pharmacological and integrated psychotherapeutic approaches that give equal weight to both disorders, while still scarce, are recommended.
Alcohol can lead to substance use disorder
Bipolar disorder often co-occurs with alcohol abuse, complicating diagnosis and treatment. People with bipolar disorder are known to use alcohol as a substance to self-medicate. When these two elements are combined, they can extremely exacerbate mood swings, increase impulsivity and make recovery more difficult. Recognising bipolar alcoholic traits can help guide more effective treatment approaches and improve patient outcomes.
This dual burden of alcohol-induced depression and bipolar disorder can increase the risk of suicidal ideation, highlighting the importance of addressing alcohol use in treatment. Looking at specific countries, a representative survey applying the Composite International Diagnostic Interview CIDI (3) for ICD 10 and DSM-IV criteria reports a 1-year prevalence rate of 1% for BD -I and 0.6% for BD-II disorder for Germany (4). The same study reports on a 1-year prevalence of 5.7% for substance abuse (except nicotine) according to DSM-IV criteria. In a prior survey, looking at lifetime prevalence rate, the same group reports on similar numbers for BD, and 9.9 and 8.5% for alcohol abuse and dependence, respectively (5).
In spite of the significant prevalence of comorbid alcoholism and bipolar disorder, bipolar disorder and alcoholism relation there is little published data on specific pharmacologic and psychotherapeutic treatments for bipolar disorder in the presence of alcoholism. The medications most frequently used for treating bipolar disorder are the mood stabilizers lithium and valproate. As stated previously, preliminary evidence suggests that alcoholic bipolar patients may have more rapid cycling and more mixed mania than other bipolar patients. There is also evidence to suggest that these subtypes of bipolar disorder have different responses to medications (Prien et al. 1988), which would help provide a rationale for the choice of agents in the alcoholic bipolar patient.
Recovery from co-occurring alcohol use disorder and bipolar disorder is possible with proper treatment and support. Both conditions require professional medical and psychological treatment, ideally delivered at the same time. People experiencing mania often engage in risky behaviors they would typically avoid, including excessive drinking or experimenting with drugs.
What You Need to Know About Alcohol Dependence Treatment?
- Educating individuals with bipolar disorder about the risks of substance use and providing them with healthier coping strategies is also crucial.
- However, this self-medication approach is counterproductive, as it worsens symptoms over time.
- Another critical neurochemical change relates to dopamine, a neurotransmitter central to reward and motivation pathways.
- With proper dual diagnosis treatment, people with both conditions can achieve stable mood and sustained sobriety.
- Medical supervision is also provided to ensure safe pharmacological treatment especially when dealing with bipolar alcohol abuse.
Manic episodes may manifest as heightened energy, impulsivity, and reduced need for sleep, while depressive episodes can bring about profound sadness, fatigue, and loss of interest in activities. The interplay between alcohol and bipolar disorder is complex, as alcohol may temporarily alleviate symptoms but ultimately worsens the condition by interfering with medication efficacy and destabilizing mood regulation. One of the most concerning aspects of alcohol consumption in the context of bipolar disorder is its ability to trigger manic or depressive episodes. Alcohol lowers inhibitions and impairs judgment, which can lead to impulsive behaviors—a hallmark of manic episodes.
Educating individuals with bipolar disorder about the risks of substance use and providing them with healthier coping strategies is also crucial. By breaking the cycle of self-medication and addressing both conditions holistically, individuals can achieve better symptom management and improved quality of life. Multiple explanations for the relationship between these conditions have been proposed, but this relationship remains poorly understood.
Among mental health disorders, BD has probably the highest risk of having a second, comorbid DSM -IV axis I disorder (26). The already cited WHO census across 11 countries showed a mean SUD life time comorbidity with BD of 36.6% with a large variation between countries (2). A meta-analysis including nine national surveys conducted between 1990 and 2015 revealed a mean prevalence of 24% for AUD and of 33% for any SUD except nicotine (28).
