For BD, pharmacotherapy is an essential component to stabilize mood and prevent recurrences, whereas its role for treating AUD beyond controlling acute withdrawal symptoms is less clear. Randomized controlled studies in BD traditionally exclude patient with concurrent SUD. Thus, the evidence for choosing a mood stabilizer in BD with comorbid AUD is rather weak; strictly speaking, high levels evidence consists of altogether three placebo-controlled studies in this patient group (104–106). To make any suggestion (not even recommendations) about best available treatments we therefore rely on additional low-level evidence from open or retrospective studies and expert opinion.
Ongoing Support:
No statistically significant treatment differences were detected in drinking or mood outcomes. 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). IGT (Weiss & Connery, 2011), based primarily on cognitive-behavioral therapy principles, is designed to serve as an adjunct to BD pharmacotherapy by focusing on the two disorders simultaneously, with a particular emphasis on their relationship. The first is the “single-disorder paradigm,” in which patients are encouraged to think of themselves as having a single disorder, i.e., “bipolar substance abuse,” rather than trying to tackle two discrete disorders at once.
Retrospective data suggested that, similar to aripiprazole (117), quetiapine might relieve alcohol graving in patients with BD and concomitant cocaine use (118). Subsequently, the same group conducted a double-blind, placebo-controlled study (119) in patients with BD + AUD. Quetiapine add-on to treatment as usual (TAU) had no effect on any alcohol-related outcomes, but produced a faster and significantly greater decrease of depressive symptoms. This finding is of note as many antidepressant treatment modalities are less effective in BD patients with comorbid AUD. The lack of efficacy of quetiapine against AUD was also confirmed in another placebo- controlled study (120).
Bipolar Disorder and Alcohol Use Disorder: A review
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. The detrimental impact of substance use and BD has been well-established, both for the individual and for society (54, 55). Numerous investigations demonstrated that comorbid AUD influences the clinical course of BDs unfavorably for a review, see (50). Especially in younger people BD as well as SUD results in severe and lasting impairment and a loss of healthy years lived (56, 57).
- They are also recruiting more participants for their research to gain a clearer understanding of the connections between alcohol and bipolar disorder.
- Those experiencing multiple episodes of mania and depression will usually require longer-term treatment to minimize relapses.
- Research indicates that alcohol acts as a central nervous system depressant, which can disrupt the delicate balance of neurotransmitters in the brain.
- In the alcoholic patients, bipolar illness and alcoholism were categorized as being either primary or secondary.
Long-Term Effects of Alcohol on Bipolar Disorder
Alcohol disrupts neurotransmitter balance, lowers inhibitions, and interferes with medication efficacy, creating a fertile ground for mood instability. Manic episodes fueled by alcohol can lead to dangerous behaviors, while depressive episodes can deepen emotional pain and increase suicidal risk. Recognizing the harmful interplay between alcohol and bipolar disorder is the first step toward effective management.
Analyzing SUD and bipolar comorbidity in clinical settings, the same group reports the highest prevalence for AUD (42%) followed by cannabis use (20%) and any other illicit drug use (17%) (21). Cannabis ranking second after AUD has also been confirmed in other studies (7, 27, 29). Similar rates of SUD were also reported in the Systematic Treatment Enhancement Program Bipolar Disorders (STEP BD) study including 3,750 Bipolar I or II patients (30).
Symptoms
Unipolar depressed patients had high retest reliability, while bipolar patients had more varied responses indicating mood fluctuations 10. We need prospective validation, which we plan to achieve through the completion of our study’s prospective part 11. In younger patients, it appears that alcohol use and bipolar symptoms are more likely to increase or decrease in unison (64).
- Several factors explain the high rate of co-occurrence between alcohol use disorder and bipolar disorder, including genetic vulnerability, self-medication, impaired judgment during mania, and brain chemistry similarities.
- Alcohol, in particular, poses a significant risk for individuals with bipolar disorder.
- 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).
- While alcohol does not directly cause bipolar disorder, it can worsen symptoms, trigger episodes, and complicate treatment.
- This suggests that valproate, an anticonvulsant mood stabilizer, could have practical use in treating bipolar disorder and alcohol dependence simultaneously 7.
Let your doctor or mental health counselor know if you think you might have alcohol use disorder or have any questions or concerns about alcohol use. Limiting or avoiding alcohol may help reduce symptoms of bipolar disorder and support your health. People with bipolar disorder can benefit from lifestyle changes involving regular sleep, physical activity, a healthy diet, reduction of stressors, and mood monitoring. Some medicines for bipolar disorder can make people feel sleepy, have involuntary muscle spasms or tremors, or experience metabolic changes (e.g. involving weight gain). These side effects can affect adherence to treatment and should bipolar disorder and alcoholism relation be monitored and managed.
It often goes undiagnosed and untreated for long periods, with some patients waiting up to 10 years to receive treatment 2. Alcoholism is a strong desire for alcohol, leading to physical dependence and loss of control. Alcohol abuse neglects responsibilities, occurs in dangerous situations, and causes legal and relationship problems.
During depressive episodes, drinking might temporarily lift mood or provide emotional numbing. Alcohol disrupts brain chemistry and interferes with mood stabilizers, making bipolar symptoms more severe and unpredictable, while doing nothing to address the underlying issue. Unfortunately, several studies have reported that substance abuse is a predictor of poor response of bipolar disorder to lithium. More specifically, as stated previously, compared to non-substance abusers, alcoholics appear to be at greater risk for developing mixed mania and rapid cycling. 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). This suggests that lithium may not be the best choice for a substance-abusing bipolar patient.
There is already an increased risk of suicide, and alcohol consumption contributes to this by lowering inhibitions and increasing depressive episodes. Alcohol abuse can lead to increased aggression, irritability and unpredictable behaviour in people with bipolar disorder. Alcohol-induced mania is characterised by extreme impulsivity, risky behaviour and increased emotional instability. Reckless spending, dangerous activities and volatile relationships can also be observed in such individuals.
Comorbidity rates in Bipolar disorder rank highest among major mental disorders, especially comorbid substance use. 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.
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The use or digital media and “blended care” is likely to increase in the future across treatment settings and will facilitate diagnosis and treatment of mental disorders including comorbid conditions. It’s usefulness in BD patients comorbid with AUD, however, still needs to be further investigated. In the meantime, DSM-5 (11) abolished the distinction between substance use, abuse and dependency by defining threshold numbers of criteria for different grades of severity of substance use. Of the 11 criteria, 2–3 should be fulfilled to diagnose mild alcohol use disorder (AUD) (12). Also, BD criteria experienced some adaptions with yet speculative consequences for epidemiological figures. Whereas, criteria for a manic episode were tightened (13, 14) preceding substance use per se is no more an exclusion criterion for a genuine BD diagnosis as long as the mental alterations exceed well the physiological effect of the substance.
To create trustworthy treatment strategies for comorbid alcohol use disorder and bipolar disorder, further studies are necessary. Addressing the link between bipolar disorder and substance abuse requires an integrated treatment approach. Dual diagnosis programs, which simultaneously treat both the mental health disorder and the substance use disorder, have been shown to be effective. These programs often include a combination of medication management, psychotherapy (such as cognitive-behavioral therapy or dialectical behavior therapy), and support groups like Alcoholics Anonymous or Dual Recovery Anonymous.
If commonalities in the recovery and relapse process in the two disorders can be seen as parallels between the two disorders, the focus on the relationship between the two disorders can be viewed as the intersection between BD and alcohol dependence. Thus, patients are told that drinking will negatively affect the course of their BD, and that non-adherence to their BD medication will increase their risk of relapse to drinking. Again, the focus on the intersection between the two disorders is consistent with the single-disorder paradigm. Alcohol dependence is also highly genetic (Mayfield et al., 2008), and a wide range of studies confirm that association (Kendler et al., 2009). Besides psychotherapy an individually tailored pharmacotherapy is essential in almost all BD patients with comorbid AUD.