People with mental health conditions often use alcohol or drugs to self-medicate and relieve adverse mental states such as depression and anxiety. Research suggests the relationship between alcoholism and bipolar disorder is especially close and complex. According to the National Institutes of Health, among patients with bipolar type I disorder, 46% have a lifetime history of an alcohol use disorder (AUD), and 39% with bipolar type II. (1) Furthermore, the three mental health disorders most commonly co-occurring with alcoholism are major depression, bipolar disorder, and anxiety disorder. (2)
People with bipolar disorder frequently report feeling they are not in control of their life. They are often unsure how to feel or what to do when they experience an episode. For those inadequately treated for their condition, drinking can seem like a reasonable solution. Alcohol is a depressant that sometimes produces feelings of calmness, like many medications prescribed for bipolar disorder. As a result, it may initially provide some relief from emotional turmoil. Nevertheless, this effect is temporary—chronic alcohol use will not help treat this condition and is more likely to worsen it.
Although many symptoms of bipolar and AUDs overlap and underlying causes tend to be thoroughly entangled, these conditions can be effectively treated and managed. Guardian Recovery offers comprehensive, long-term treatment consisting of various therapeutic, evidence-based approaches to address these issues and promote psychological wellness.
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What Is Bipolar Disorder?
Bipolar disorder is a relatively common psychiatric condition characterized by extreme mood shifts and noticeable changes in thoughts, behaviors, energy, and activity levels. (3) Moods vary from manic episodes of elated, energized, or irritable behavior to depressive episodes of hopelessness, apathy, and lethargy. The National Institute for Mental Health estimates nearly 3% of U.S. adults had past-year bipolar disorder, representing approximately 6.78 million individuals. (4)
This condition typically onsets in late adolescence but can start earlier or later in life. It affects women and men equally and is found among people of all ages, races, and ethnic groups. Some researchers have suggested bipolar disorder has a genetic link, as it tends to run in families. (5)
The Diagnostic & Statistical Manual of Mental Disorders 5 has established a set of criteria for bipolar disorders. (6)
Manic Symptoms Include:
- Extreme aggression and irritability.
- Elevated mood and exaggerated optimism.
- Reduced need for sleep without fatigue.
- Grandiosity, excessive sense of self-importance, and self-confidence.
- Racing speech, thoughts, and flight of ideas.
- Impulsivity, poor judgment, distractibility.
- Recklessness.
- In severe cases, delusions and hallucinations.
Depressive Symptoms Include:
- Notable changes in appetite and sleep patterns.
- Protracted sadness or unexplained crying episodes.
- Irritability, anger, agitation, anxiety, and feer.
- Pessimism and apathy.
- Loss of energy and prolonged periods of lethargy.
- Feelings of guilt or worthlessness.
- Inability to concentrate or make decisions.
- Loss of enjoyment in former interests, social isolation.
- Aches and pains without an identifiable cause.
- Repeated thoughts of death or suicide.
Three Main Types of Bipolar Include:
Bipolar I
Bipolar I is characterized by manic or mixed episodes that last at least seven days or are so severe they require immediate hospitalization. It is also marked by depressive episodes lasting at least two weeks. In either case, symptoms must significantly change from their normal behavior. (7)
Bipolar II
Bipolar II is hallmarked by bouts of severe depressive states alternating back and forth with hypomania, a milder form of mania. As a result, manic and mixed episodes are usually less severe. (8)
Cyclothymia
Cyclothymia is marked by brief hypomanic episodes that alternate back and forth with short bouts of depression. These symptoms are not as long-lasting or extensive as experienced in full-blown depressive or hypomanic episodes. The symptoms of this subtype do not meet the criteria for other forms of the disorder. (9)
The Interrelationship Between Bipolar & Alcohol Use Disorder
According to research, AUD and bipolar co-occur at higher rates than would be expected by mere chance. Likewise, AUD co-occurs more often with bipolar than unipolar depression. (10) Comorbidity rates of bipolar disorder—especially comorbid substance misuse—are the highest among major mental health disorders. Comorbid AUD and bipolar “significantly influence each other’s severity and prognosis with a more complicated course of both disorders.” (11)
On the one hand, alcohol can worsen depressive states due to its sedating effects. On the other hand, alcohol can also intensify manic symptoms because it initially increases dopamine levels (12). In general, alcohol increases the severity and volatility of bipolar symptoms. Alcohol destabilizes mood, and individuals predisposed to mania or depression can experience more dramatic extremes than their usual episodes. (13)
Individuals with mental health conditions commonly resort to drug and alcohol misuse because they erroneously believe it is a legitimate and practical form of self-medication. This is especially true in the case of alcohol; it is legal, widely available, and portrayed as acceptable in the media. Because alcohol misuse and bipolar disorder share similar underlying factors, their co-existence often heralds the onset of a vicious cycle that is challenging to break.
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Why Do People Drink to Cope With Bipolar Symptoms?
People with bipolar disorder initially misuse alcohol for many of the same reasons anyone else does. Alcohol is a popular recreational substance due to its tranquilizing and intoxicating effects. It lessens anxiety, increases sociability, and temporarily reduces pain and discomfort. However, a drinking habit initially intended to promote short-term reprieve from bipolar symptoms can progress into a chronic pattern of heavy misuse.
The person may eventually discover the cons of drinking have begun to outweigh the benefits associated with relief from their condition. At this point, they may try to cut back on their alcohol use or quit altogether. If they fail after multiple attempts, there’s a reasonable chance they’ve developed a physical and psychological dependence on alcohol. This would be evidenced by powerful cravings and unpleasant withdrawal symptoms undermining opportunities to achieve abstinence. (14)
One inherent problem in these cases is that alcohol is habit-forming and addictive. Medications approved to treat bipolar disorder, including mood stabilizers and antipsychotics, generally have much less potential for misuse. However, these also come with side effects and may be minimally-moderately effective in severe cases. For this reason, drinking could also appeal to those who are undertreated or prescribed medications that aren’t working effectively.
As with many mental health conditions, alcohol will ultimately fail to produce the effects perceived as a respite by people with bipolar disorder. Reasons for this include increased tolerance, alcohol-related mood instabilities, and a progressive worsening of bipolar symptoms that encourages further alcohol use.
Alcohol Misuse & Bipolar Disorder Treatment
Historically, medical, mental health, and addiction professionals treated bipolar and alcohol use disorders independently, or one condition was left unaddressed. Still, modern research has found that substance misuse and psychiatric issues have many shared biological and social factors predisposing individuals to experience both. (15)
It can be difficult for people with a mood disorder to manage their symptoms when treatment providers neglect to address them. In addition, the associated stress can contribute to a reoccurrence of alcohol use. Similarly, treating a mood disorder may not do much to curb alcoholism, especially when dependence has developed.
Integrated addiction treatment that includes behavioral therapy and other evidence-based approaches is currently the go-to mental health remedy to address co-occurring disorders. Behavioral therapy teaches individuals how to alter their once-favored dysfunctional thoughts, feelings, and behaviors and replace them with healthier, more productive means of coping with life and its stresses. For example, learning how to cope with bipolar disorder appropriately can improve decision-making skills, including finding ways to abstain from alcohol and prevent relapse.
Individual therapies are often accompanied by medication-assisted treatment. Medications regularly prescribed for bipolar disorder include mood stabilizers, such as lithium, and antipsychotics, such as quetiapine. (16)
Mood Stabilizers for Bipolar Disorder Include:
- Carbamazepine
- Divalproex sodium
- Lamotrigine
- Lithium
- Valproic acid
- Benzodiazepines
Other Medications Used for Bipolar Disorder Include:
- Tricyclic antidepressants
- Atypical antidepressants
- Selective-serotonin reuptake inhibitors
- Serotonin-norepinephrine reuptake inhibitors
- Antipsychotics
Important: Some of the medications mentioned above have the potential for misuse and severe adverse side effects. Extreme sedation may be more like to occur when combined with alcohol, possibly leading to an overdose. As noted, drinking with bipolar medications is not recommended as it can cause adverse interactions, reduce their effectiveness, and promote further mood instability.
Alcohol dependence can be treated with naltrexone, acamprosate, and disulfiram, which help to reduce alcohol cravings and make drinking less desirable.
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Guardian Recovery Offers Comprehensive Treatment for Alcoholism & Bipolar Disorder
Bipolar and alcohol use disorders are most effectively managed when addressed simultaneously with a focus on the complex dynamics of their relationship. Comprehensive programs aimed at addiction recovery and treatment for mood disorders have been shown to positively impact the lives of individuals who seek professional help and support.
Guardian Recovery offers dual-diagnosis programs for substance use disorders and mental health conditions. We believe those suffering from these conditions deserve effective, concurrent treatment to fully recover from alcoholism and learn to manage bipolar symptoms. If you are ready to begin your recovery journey, contact us today to speak with an experienced Treatment Advisor for a free, no-obligation health benefits check.
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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.
(1)(5)(7-10)https://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm
(2)https://pubs.niaaa.nih.gov/publications/arh26-2/90-98.htm
(3)https://www.nimh.nih.gov/health/topics/bipolar-disorder
(4)https://www.nimh.nih.gov/health/statistics/bipolar-disorder
(6)https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t8/
(11)https://www.frontiersin.org/articles/10.3389/fpsyt.2021.660432/full
(12)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826820/
(13)https://pubmed.ncbi.nlm.nih.gov/22858208/
(14)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860472/
(15)https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/why-there-comorbidity-between-substance-use-disorders-mental-illnesses
(16)https://www.drugs.com/condition/bipolar-disorder.html
