The role of genetic factors in psychiatric disorders has received much attention recently. Some evidence is available to support the possibility of familial transmission of both bipolar disorder and alcoholism (Merikangas and Gelernter 1990; Berrettini et al. 1997). Common genetic factors may play a role in the development of this comorbidity, but this relationship is complex (Tohen et al. 1998). Preisig and colleagues (2001) conducted a family study of mood disorders and alcoholism by evaluating 226 people with alcoholism with and without a mood disorder as well as family members of those people. The researchers found that there was a greater familial association between alcoholism and bipolar disorder (odds ratio of 14.5) than between alcoholism and unipolar depression (odds ratio of 1.7). A positive family history of bipolar disorder or alcoholism is an important risk factor for offspring.
Bipolar disorder affects chemicals like serotonin, dopamine, and norepinephrine that regulate mood. Alcohol also alters these same neurotransmitter systems, prompting a cycle of chemical imbalance. Alcohol use can cause symptoms of depression, mania, or hypomania to worsen if you have bipolar disorder.
Why Do These Conditions Occur Together?
In summary, only few psychotherapeutic interventions have been studied in a randomized study design and mostly only by one research group. Professional intervention is needed when alcohol use exacerbates the symptoms of bipolar disorder or interferes with daily functioning. Early intervention, therefore, offers a greater chance of a positive treatment outcome and long-term recovery.
Gender differences have a significant influence on treatment outcomes in BD (58) but not as much on outcomes in alcohol dependence (59). Especially a history of verbal abuse and rates of social phobia and depression are higher in female than male BD patients with AUD (32). Whereas, AUD in female BD patients fosters rather self-destructive consequences, males appear more likely to externalize anger and impulsivity, and stand out by a history of criminal actions (62). Specific numbers for AUD and BD are not available, but for affective disorders (AD) in general and SUD, criminal bipolar disorder and alcoholism relation behavior has been observed twice as frequent in AD with SUD compared to AD without (63).
She also suggests that those with bipolar disorder avoid social situations where there is pressure to drink heavily. To understand this better, they are using advanced technologies like EEG and wearable devices to study brain activity and real-world behavior. They are also recruiting more participants for their research to gain a clearer understanding of the connections between alcohol and bipolar disorder. One of the study’s key recommendations is that mental health clinics should regularly ask patients about their drinking habits. The researchers suggest using standardized tools like the Alcohol Use Disorder Identification Test (AUDIT) to measure alcohol use consistently.
Genetic and Neurological Links
Although employment can be a source of stress for people living with bipolar disorder, it can also be protective. Under good working conditions, and when supported at their workplace with reasonable adjustments, employment can promote recovery by improving functioning, reducing symptoms and leading to a higher quality of life and improved self-esteem. Adverse circumstances or life-altering events can trigger or exacerbate the symptoms of bipolar disorder. The use of alcohol or drugs can also influence the onset and trajectory of bipolar disorder. Hypomanic episodes involve similar symptoms to manic episodes, but the symptoms are less intense and do not typically disrupt the person’s ability to function to the same extent.
- It can reduce their effectiveness or increase the likelihood of severe adverse outcomes.
- Alcohol’s impact on mood stability is a critical concern, especially for individuals with bipolar disorder or those at risk of developing it.
- Comorbid substance use disorder and particularly alcohol use disorder are more the norm than the exception in bipolar disorder.
- For more information about health, please see recent studies about drug for mental health that may harm the brain, and results showing this therapy more effective than ketamine in treating severe depression.
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- Additionally, chronic alcohol use may worsen the course of bipolar disorder, leading to more frequent and severe mood episodes.
- Bipolar disorder affects approximately 1 to 2 percent of the population and often starts in early adulthood.
- Researchers have found that patients with mixed mania respond less well to lithium than patients with the nonmixed form of the disorder (Prien et al. 1988).
The World Health Organization World Mental Health Survey Initiative (2) conducted across eleven countries reported a 4.8% lifetime prevalence of all manifestations of bipolarity, including subthreshold and spectrum disorder. Prolonged alcohol consumption increases the risk of liver disease, cardiovascular problems and a weakened immune system. For people with bipolar disorder, the risks are even greater due to interactions between medication and lifestyle factors. Although alcohol may provide temporary relief, it exacerbates symptoms and leads to an increased need for professional treatment. Finally, alcohol disrupts neuroplasticity, the brain’s ability to form and reorganize synaptic connections.
These acute treatments are symptom-orientated, rarely different in comorbid vs. non-comorbid patients and depend on the predominant symptomatology (affective vs. addictive) that needs attention first. For intermediate and long-term treatment, the dogma persisted for a long time that AUD needs to be treated first and sufficiently before attention should be paid to the mental health disorder. Today, strategies that promote concomitant therapy of dual disorders are the established treatment of choice (80) and recommended in major guidelines (81). However, treatment adherence and compliance remain a challenge in this special group, since medications are often not taken as prescribed (61) and psychotherapy appointments are often missed. Studies support that the most important predictor of non-adherence in BD is comorbid alcohol and/or drug abuse (82, 83). Thus, effective psychosocial (84), psychoeducational (85, 86) or psychotherapeutic (87, 88) intervention for AUD and BD can also positively impact on medication adherence and, by this, ameliorate the course especially of BD (84).
Epidemiology of Bipolar Disorder and Substance Use Disorder
The researchers found that patients in the complicated group had a significantly earlier age of onset of bipolar disorder than the other groups. They also found that the complicated and secondary groups had higher rates of suicide attempts than did the primary group. Preisig and colleagues (2001) also reported that the onset of bipolar disorder tended to precede that of alcoholism. They concluded that this finding is in accordance with results of clinical studies that suggest alcoholism is often a complication of bipolar disorder rather than a risk factor for it.
Comorbid Bipolar and Alcohol Use Disorder—A Therapeutic Challenge
The euphoric feelings and inflated self-confidence that occur during mania can lead to dangerous drinking patterns that develop into full-blown alcohol use disorder. People may drink to calm racing thoughts during mania or numb emotional pain during depression. People with bipolar disorder have an increased risk of alcohol use disorder, which is a serious condition that can negatively affect their physical, mental, and social well-being. They may recommend behavioral therapy, medication, or a combination of both to treat alcohol use disorder.
Through abstinence, therapy, and a structured treatment plan, individuals can mitigate the risks and achieve greater stability in their mental health journey. This chapter deals with the intermediate and long-term treatment of comorbid BD and AUD. We do not recap acute treatments for detoxification or delirium on one side, and mania or severe depression on the other side.
E-Mental Health Approaches
This is important because more than half of people with bipolar disorder develop alcohol use disorders at some point in their lives. Yet, this study suggests that even small increases in alcohol use can disrupt their recovery and worsen their symptoms over time. Results of an open study suggested a reduction of both craving and stabilization of mood with naltrexone in patients with BD + AUD (125). However, improvement of mood was not confirmed in a double-blind study with naltrexone add-on to cognitive behavioral therapy, and there was only a trend toward less alcohol consumption (121). Similar disappointing results have been reported from a controlled study with acamprosate in BD + AUD (122). Another critical factor is alcohol’s impact on medication efficacy and sleep patterns, both of which are essential for mood stability.
Alcohol And Bipolar Disorder: Unraveling The Trigger Connection
Thus, this study was carried out to investigate a case of alcohol dependence with bipolar disorder. A 49-year-old male visited the psychiatry outpatient department and then was admitted. The patient’s chief complaints were alcohol consumption, cigarette smoking, daily drinking for 35 years, irritability/aggressiveness, boastful talk, overspending, and decreased need for sleep from the last 20 days. According to the literature, self-medicating with alcohol is not an effective treatment for alcoholism, unless it is being used to alleviate the psychological and neurochemical effects caused by alcohol. However, there has been limited research on how to treat individuals who have both alcoholism and another medical condition.
More research is needed on how substance abuse affects the progression of bipolar disorder, especially since many bipolar patients also struggle with substance abuse. Differentiating between bipolar disorder before and after substance abuse begins is important in understanding the overall course of the illness 1. Bipolar disorder causes extreme mood swings from euphoria to severe depression and affects 1-2% of the population.
