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 of Comorbid Bipolar Disorder and Alcoholism
It can reduce their effectiveness or increase the likelihood of severe adverse outcomes. People who drink while taking bipolar medications often experience more frequent mood episodes and less stable mental health overall. Unfortunately, the field is marred by a paucity of well-conceived, conducted, and published studies informing the clinician about how to manage a comorbidly diagnosed patient. Despite some ongoing studies, the research field still reflects the current therapeutic field; namely there are few integrated treatment programmes in existence, and even fewer leading to therapeutic guidelines. It is only through demonstration of the effectiveness of treatment integration that there will be extensive therapeutic efforts to bridge psychiatric treatment programmes and services, and substance abuse treatment programmes and services. That treatment integration is still a long way off, despite the accumulating research demonstrating the benefits of integration.
Bipolar Disorder and Alcohol Use Disorder: A review
- Treating co-occurring alcohol use disorder and bipolar disorder requires specialized approaches.
- In conclusion, it appears that alcoholism may adversely affect the course and prognosis of bipolar disorder, leading to more frequent hospitalizations.
- In a 5-year followup study, Winokur and colleagues (1995) evaluated a group of bipolar patients with and without alcoholism.
- Alcohol use can cause symptoms of depression, mania, or hypomania to worsen if you have bipolar disorder.
- Although researchers have proposed explanations for the strong association between alcoholism and bipolar disorder, the exact relationship between these disorders is not well understood.
While alcohol use does not directly cause bipolar disorder, it can unmask or precipitate symptoms in individuals who are genetically predisposed or already in the early stages of the condition. This phenomenon is often referred to as “kindling,” where repeated exposure to substances like alcohol lowers the threshold for mood episodes, making them more likely to occur with less provocation over time. For those with a family history of bipolar disorder, alcohol use may act as a catalyst, accelerating the onset of the disorder. This highlights the importance of early intervention and screening for substance use in individuals at risk for bipolar disorder.
Research suggests that alcohol use is common among individuals with bipolar disorder, often as a form of self-medication to cope with emotional distress. However, alcohol can disrupt mood stability, interfere with medication effectiveness, and increase the risk of manic or depressive episodes. Additionally, chronic alcohol use may worsen the course of bipolar disorder, leading to more frequent and severe mood episodes. Understanding this interplay is crucial for developing effective treatment strategies and promoting better outcomes for those affected by both conditions. Other mental health conditions can make bipolar illness more severe and develop earlier.
These are hallmarks of bipolar alcoholic traits, often requiring psychiatric evaluation. In addition, imbalances in neurotransmitters such as dopamine and serotonin are also thought to contribute to the development of both disorders. Alcohol does not directly cause bipolar disorder, but it can worsen symptoms and trigger mood episodes in individuals already diagnosed with the condition. Sleep hygiene is central to treating co-occurring bipolar and alcoholism since sleep disruption triggers both mood episodes and alcohol cravings. DBT (dialectical behavior therapy) teaches emotional regulation skills, which are beneficial for managing intense feelings during mood episodes without resorting to alcohol abuse.
Risk of Relapse in Bipolar Patients
- The relationship between alcohol and bipolar disorder is complex and multifaceted, raising questions about whether alcohol can trigger or exacerbate bipolar symptoms.
- Although they are still rare, pharmacological and integrated psychotherapy methods that give equal weight to both illnesses are advised.
- We need prospective validation, which we plan to achieve through the completion of our study’s prospective part 11.
- Most epidemiological and treatment studies were conducted according to DSM-IV or ICD-10 criteria that distinguishes between substance abuse and dependence as diagnostic entities on its own.
- Approximately 14 percent of people experience alcohol dependence at some time during their lives (Kessler et al. 1997).
BD and SUD are afflicted with high rates of suicide attempts and suicide that are even topped in case of coexistence of both disorders (24). A Brazilian study reports of at least one suicide attempt in 68% of BD patients with AUD compared to 35% in BD without AUD, with virtually no difference between BD patients with DSM-IV alcohol abuse and dependence (23). Alcohol-induced manic episodes are particularly concerning due to their potential to lead to risky behaviors. During a manic state, individuals may experience an inflated sense bipolar disorder and alcoholism relation of self-esteem, engage in reckless spending, or participate in dangerous activities without considering the consequences.
Psychological interventions (e.g. cognitive behavioural therapy, interpersonal therapy, psychoeducation) can effectively reduce depressive symptoms and the possibility of them coming back. The researchers used data from the Prechter Longitudinal Study of Bipolar Disorder, which has been collecting information from over 1,500 participants with and without bipolar disorder. 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.
Treatment
Your treatment plan may or may not include an antidepressant, depending on your specific symptoms and needs. Medicines and psychological or psychosocial interventions should be tailored to the needs of the person and combined for best outcomes. Mood stabilizers (such as lithium, valproate) and antipsychotics are proven to help manage acute mania. Girls and women who are pregnant, breastfeeding or have childbearing potential should not use valproate. Lithium and carbamazepine also need to be avoided during pregnancy and breastfeeding whenever possible.
Bipolar disorder is a mental health condition characterized by mood swings from one extreme to another. Stigma and discrimination against people with bipolar disorder are widespread, both in communities and health services. It also fuels social exclusion and can limit opportunities for education, employment and housing. In 2021, an estimated 37 million people (or 0.5% of the global population), including approximately 34 million adults, were living with bipolar disorder (1). While the prevalence of bipolar disorder among men and women is approximately equal, available data indicate that women are more often diagnosed. Dr. Sperry advises that patients avoid using alcohol as a sleep aid or as a way to calm anxiety.
Dr. Sperry’s team is now looking deeper into why drinking has such a strong impact on people with bipolar disorder. They suspect it might be related to changes in the brain’s reward system and disruptions in circadian rhythms—the body’s natural clock that regulates sleep and mood. Except from few specialized long-term inpatient settings for comorbid patients (89) the emphasis of all treatment concepts is on outpatient settings as behavioral changes and building up resilience is a long process in both disorders. 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).
In bipolar and alcoholism, several factors explain this association, including self-medication, genetic influences and environmental stressors. CBT (cognitive behavioral therapy) helps people identify triggers for both drinking and mood episodes. Individuals learn health coping strategies to replace alcohol use during difficult emotional periods. Alcohol creates many problems for people with bipolar disorder, from mood destabilization and medication interference to an increased risk of suicide and cognitive impairment. Still, alcoholic patients going through alcohol withdrawal may appear to have depression. Depression is a key symptom of withdrawal from several substances of abuse, and studies have demonstrated that symptoms of withdrawal-related depression may persist for 2 to 4 weeks (Brown and Schuckit 1988).
Of the 228 Bipolar probands, 75.4% (74% in bipolar I patients and 77% in bipolar II patients) fulfilled criteria for DSM-IV life time alcohol dependence. Yes, alcohol can disrupt mood stability and increase the risk of manic or depressive episodes in people with bipolar disorder due to its effects on the brain. Another significant concern is the interaction between alcohol and bipolar medications.
Genetic and Neurological Links
Research continues to explore the effects of these comorbidities on prognosis and treatment outcomes 18. Alcohol use may have been a coping mechanism for stress and anxiety in the alcohol use disorder – bipolar disorder group, while stimulant use may have triggered mania in the bipolar disorder – alcohol use disorder group 19. Alcohol abuse can cause symptoms like depression, anxiety, and antisocial behavior that can resemble genuine psychiatric illnesses. It’s important for clinicians to accurately diagnose alcohol-induced psychiatric disorders and rule out independent disorders 20. When a person suffers from both alcoholism and psychiatric disorders, they may find it challenging to stay sober, may have suicidal tendencies, and may require mental health assistance.
For individuals without a pre-existing bipolar diagnosis, alcohol misuse can still contribute to mood instability and increase the risk of developing bipolar disorder or other mood disorders. Chronic alcohol consumption alters brain chemistry and structure, potentially leading to long-term changes in emotional regulation. This is particularly concerning for those with a genetic predisposition to bipolar disorder, as alcohol can act as an environmental trigger, accelerating the onset of symptoms. Even in the absence of bipolar disorder, alcohol-induced mood swings can mimic bipolar-like symptoms, complicating diagnosis and treatment.