Bipolar Disorder and Alcoholism: Key Links and Management

Seeing a mental health professional right away is very important if you also have symptoms of bipolar disorder or another mental health condition. Sperry notes that previous studies have shown that more than half of people who have a bipolar disorder diagnosis also experience alcohol use disorders sometime in their lives, and that many report using alcohol to help them get to sleep. This study doesn’t mean that self-medicating doesn’t happen on a case-by-case basis.

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Post-hoc analysis showed that acamprosate treatment resulted in lower Clinical Global Impression scores of substance abuse severity in the last two weeks of the trial (Tolliver et al., 2012). As a result of this process, a number of evidence-based psychotherapies have been developed for BD and for alcohol dependence. Similarly, motivational enhancement therapy, twelve-step facilitation therapy, and cognitive-behavioral relapse prevention therapy have all been shown to be effective in the treatment of alcohol dependence (Project MATCH Research Group, 1997). As a result, little psychotherapy research has focused on patients with co-occurring BD and alcohol dependence. It is worth noting that individual experiences may vary and not all individuals with bipolar disorder will develop alcohol use disorders.

Over time, these strained relationships can become harder to repair, especially if alcohol is used as a way to cope with emotional pain. It can also lead to poor performance at work or school, as alcohol impairs focus, productivity, and decision-making. A total of 584 individuals (386 females (66.1%); mean SD age, 40 13.6 years) were included. These participants had a BDI (445 76.2%) or BDII (139 23.8%) diagnosis, with or without a lifetime diagnosis of AUD, and a median (IQR) follow-up of 9 (0-16) years. The findings were seen even in people who were not engaging in binge drinking, drinking with high intensity or frequency, or experiencing impairment related to their alcohol use. If you have depression and drink too much alcohol, then you may be wondering if there are any treatments or lifestyle changes for someone in your situation.

• In conclusion, it is crucial to recognize the effects that alcohol has on mental health, particularly in individuals with bipolar disorder.
• This chapter deals with the intermediate and long-term treatment of comorbid BD and AUD.
• It’s usefulness in BD patients comorbid with AUD, however, still needs to be further investigated.
• Some people use alcohol alongside their prescription drugs, adding to the risk.
• As described by the National Institute of Mental Health, bipolar disorder causes unusual shifts in mood, energy, activity levels, and concentration.

They can help you understand the risks of alcohol use and how to manage them. Alcohol use can cause symptoms of depression, mania, or hypomania to worsen if you have bipolar disorder. Your doctor or pharmacist can help you learn about the potential side effects and drug interactions of any medications you take. Your doctor may prescribe more than one medication to treat bipolar disorder. It’s possible that alcohol use might increase impulsivity in people with bipolar disorder, but more research is needed. A 2020 research review found that most studies on impulsivity and bipolar disorder have not included information about alcohol use.

Symptoms

We’ll work with you to find the combination of medication and therapy that works for you. We’ll work as a team, empowering you to develop the skills to get a handle on your bipolar symptoms and manage your AUD. Many individuals with bipolar disorder turn to alcohol as a form of self-medication or as a way to escape emotional pain and distress. Alcohol can temporarily alleviate feelings of sadness or anxiety and induce a sense of relaxation. However, this relief is short-lived, and the long-term consequences can be detrimental.

The authors concluded that naltrexone was useful in treating patients with comorbid psychiatric and alcohol problems. However, Sonne and Brady (2000) reported on two cases of bipolar women (both actively hypomanic) who received naltrexone for alcohol cravings, and both had significant side effects similar to those of opiate withdrawal. Given that there is only preliminary data on the use of naltrexone in bipolar alcoholics to date, naltrexone should be used with caution in patients who have been actively hypomanic.

Treatment Strategies in Comorbid BD and AUD—General Principles of Treatment

As relapses and recurrences are rather the rule than the exception, regular outpatient contacts, emergency numbers to call in case of an imminent relapse and a timely and easy access to inpatient treatment for either one of the disorders are crucial. The German S3 Guidelines for AUD recommend that both disorders, BD and AUD, should be treated in one setting and by the same therapeutic team (49, 81). If not feasible, a close coordination of therapies, e.g., by means of a case manager, should be established.

Increased medication compliance with valproate may be an important factor in selecting a mood stabilizer for alcoholic bipolar patients. This is the first study that examines and shows differences in alcohol use between bipolar disorder subtypes BD I and BD II. Liquid courage meets mental mayhem as we dive into the perilous dance between alcohol and bipolar disorder, where every sip can tip the scales of an already delicate emotional balance.

Causes & Risk Factors

There are a number of pharmacotherapy trials, and psychotherapy trials that can aid programme development. Post-treatment prognosis can be influenced by a number of factors including early abstinence, baseline low anxiety, engagement with an aftercare programme and female gender. The future development of novel therapies relies upon increased psychiatric and medical awareness of the co-morbidity, and further research into novel therapies for the comorbid group. Integrated treatment programs aim to provide coordinated and simultaneous interventions for both alcohol use disorder and bipolar disorder. This approach involves a multidisciplinary team of healthcare professionals who collaborate to develop an individualized treatment plan.

• This allows medical providers to manage care during withdrawal, evaluate bipolar symptoms, and begin treatment.
• Specific numbers for AUD and BD are not available, but for affective disorders (AD) in general and SUD, criminal behavior has been observed twice as frequent in AD with SUD compared to AD without (63).
• It might provide temporary relief from the intense emotional highs and lows that are characteristic of bipolar disorder.
• Chronic alcohol consumption impairs the effectiveness of medication and reduces the ability to control depressive symptoms.
• People with bipolar II disorder often enjoy being hypomanic (due to elevated mood and inflated self-esteem) and are more likely to seek treatment during a depressive episode than a manic episode.

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Excessive alcohol drinking can also cause problems socially, such as issues with family, school, employment, bipolar disorder and alcohol and friends. This could have a carryover effect on depression since loneliness and lack of social support are linked to depression. Over time, your brain’s reward pathway builds tolerance and requires more and more dopamine (via alcohol) to feel pleasure.

There are neurochemical abnormalities in both disorders in the serotonin/dopamine pathways, which could suggest a similar pathology in both disorders (Yasseen et al., 2010). Involving the family in recovery can provide emotional support and stability that contribute to a more effective recovery. Education and counselling processes for family members improve proper communication and reduce the likelihood of relapse. “The reasons behind our findings likely have more to do with what alcohol and social situations involving alcohol do to a person’s circadian rhythms and brain-based reward circuits”. The Brain & Behavior Research Foundation is committed to alleviating the suffering caused by mental illness by awarding grants that will lead to advances and breakthroughs in scientific research.

How to Support Someone Facing Both Bipolar Disorder and Alcohol Abuse

Besides cannabis, alcohol is the most frequent substance of abuse as it is societally accepted and can be purchased and consumed legally. Estimates for lifetime comorbidity of bipolar disorder and alcohol use disorder are substantial and in the range of 40–70%, both for Bipolar I and II disorder, and with male preponderance. Alcohol use disorder and bipolarity significantly influence each other’s severity and prognosis with a more complicated course of both disorders. Modern treatment concepts acknowledge the interplay between these disorders using an integrated therapy approach where both disorders are tackled in the same setting by a multi-professional team. Adding valproate to lithium may reduce alcohol consumption whereas studies with antipsychotics or naltrexone and acamprosate did not affect mood fluctuations or drinking patterns. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.

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A controlled study with topiramate in BD + AUD failed due to slow recruitment (114). Many people live with anxiety, fear, or addiction without realizing how much it’s affecting their daily lives. Whether you’re feeling overwhelmed, unsure about your symptoms, or just looking for answers — we’re here to listen, without judgment. A person who is avoiding or cutting down on alcohol may find it helpful to replace the habit with an alternative feel-good solution . A person may need to work with their doctor for some time before they find a suitable medication and dose.