Bipolar Disorder and Alcohol: Effects, Risks, and Management

Healthcare providers should be aware of the potential for co-occurring disorders and be prepared to address both conditions simultaneously. Fortunately, there are numerous resources available for individuals dealing with both bipolar disorder and alcohol use issues. Understanding bipolar dual diagnosis is the first step towards effective treatment. Many mental health facilities now offer specialized programs for individuals with co-occurring disorders, providing integrated treatment that addresses both conditions simultaneously. Bipolar disorder, often called manic depression, is a mood disorder that is characterized by extreme fluctuations in mood from euphoria to severe depression, interspersed with periods of normal mood (i.e., euthymia). Bipolar disorder represents a significant public health problem, which often goes undiagnosed and untreated for lengthy periods.

Managing Alcohol Use with Bipolar Disorder: Strategies for Success

1. Given that bipolar disorder and substance abuse co-occur so frequently, it also makes sense to screen for substance abuse in people seeking treatment for bipolar disorder.
2. If left untreated, alcohol dependence and withdrawal are likely to worsen mood symptoms, thereby forming a vicious cycle of alcohol use and mood instability.
3. If people become disillusioned with their medications, some will stop using the drugs and consume alcohol as a form of self-medication.
4. The Collaborative Study on the Genetics of Alcoholism is a family pedigree investigation that enrolled treatment-seeking alcohol-dependent probands who met the DSM-IV criteria for alcohol dependence (70).
5. Understanding this relationship is crucial for both individuals with bipolar disorder and their loved ones.
6. Therefore, healthcare providers should conduct a thorough evaluation to determine how to treat each person based on their diagnosis and symptoms.

Criteria for a diagnosis of alcohol abuse, on the other hand, do not include the craving and lack of control over drinking that are characteristic of alcoholism. The lifetime prevalence of alcohol abuse is approximately 10 percent (Kessler et al. 1997). Alcohol abuse often occurs in early adulthood and is usually a precursor to alcohol dependence (APA 1994). Moreover, the high prevalence of alcohol abuse among individuals with bipolar disorder underscores the need for comprehensive screening and integrated treatment approaches.

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.

Symptoms of Alcohol Use Disorder

Many inpatient and outpatient programs help deal with both disorders, ideally eliminating the cravings for alcohol and stabilizing bipolar disorder. Contact a treatment provider today for more information on treatment plans and options for dealing with this co-occurring disorder. Although alcohol can provide temporary relief from bipolar disorder, it also endangers an individual with the illness, intensifying the effects of the disorder and increasing risks over time. It is not recommended to drink when you suffer from bipolar disorder, as uncomfortable and unwanted episodes can occur from any amount you may drink. The higher the high alcohol would bring, the lower the low a bipolar individuals mood would project onto daily life, yet for some it is all worth it. Alcohol eases the anxiety between the crazy feelings and the ups and downs bipolar disorder brings about.

Subsequently, the same group conducted a double-blind, placebo-controlled study (119) symptoms of lsd overdose 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). No controlled data for other aAP or antidepressants have, so far, been generated (see Table 1).

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.

Valproate

All that’s needed for a diagnosis of bipolar I disorder is the development of a manic episode. These episodes may be so severe that they require hospitalization in order to stabilize. People who receive a diagnosis of AUD may recover faster than people who first receive a diagnosis of bipolar disorder.

E-Mental Health Approaches

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 drinking out of boredom open or retrospective studies and expert opinion.

Several studies have demonstrated success with cognitive behavioral therapy in treating alcoholism (Project MATCH Research Group 1998). Many of the principles of cognitive behavioral therapy are commonly applied in the treatment of both mood disorders and alcoholism. Weiss and colleagues (1999) have developed a relapse prevention group therapy using cognitive behavioral therapy techniques for treating patients with comorbid bipolar disorder and substance use disorder. This therapy uses an integrated approach; participants discuss topics that are relevant to both disorders, such as insomnia, emphasizing common aspects of recovery and relapse. 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).

During a bipolar blackout, a person may engage in behavior that is impulsive or risky. The relationship between bipolar disorder and alcohol use is complex and multifaceted. While alcohol can provide temporary relief from bipolar symptoms, its long-term effects are overwhelmingly negative, often exacerbating the very symptoms individuals are trying to alleviate. Bipolar disorder, characterized by extreme mood swings ranging from manic highs to depressive lows, affects millions of people worldwide.

Both tend to occur more frequently in people who have a family member with the condition. You also must have experienced one or more hypomanic episodes lasting for at least 4 days. Medications for anxiety, antidepressants, anticonvulsants used as mood stabilizers, mood stabilizers, and antipsychotics may interact with alcohol.

However, recent preliminary evidence suggests that liver enzymes do not dramatically increase in alcoholic patients who are receiving valproate, even if they are actively drinking (Sonne and Brady 1999a). Thus, valproate appears to be a safe and effective medication for alcoholic bipolar patients. As a general rule, it seems appropriate to diagnose bipolar disorder if the symptoms clearly occur before the onset of the alcoholism or if they persist during periods of sustained abstinence. The adequate amount of abstinence for diagnostic purposes has not been clearly defined. Family history and severity of symptoms should also factor into diagnostic considerations. Given that bipolar disorder and substance abuse co-occur so frequently, it also makes sense to screen for substance abuse in people seeking treatment for bipolar disorder.

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). In conclusion, it appears that alcoholism may adversely affect the course and prognosis of bipolar disorder, leading to more frequent hospitalizations.

The family and loved ones of a person with the condition can help by encouraging healthful behaviors that discourage the consumption of alcohol. If people become disillusioned with their medications, some will stop using the drugs and consume alcohol as a form of self-medication. Some people use alcohol alongside their prescription xanax vs ambien drugs, adding to the risk. Combining alcohol with psychosis increases the risk of mental and physical complications.