For example, a representative household survey in Iran found a 12-month prevalence of alcohol use disorders of 1% according to DSM-IV criteria and 1.3% according to DSM-5, with higher prevalence rates in urban vs. rural areas (8). For comparison, a recent US household survey reports a 12-month prevalence of DSM-5 AUD of 13.9% (9). If alcohol consumption exacerbates bipolar symptoms or interferes with daily functioning, professional help is essential. Early intervention increases the likelihood of a successful treatment outcome and long-term well-being. It is generally not recommended, as alcohol can interfere with medications, destabilize mood, and increase the likelihood of relapse or severe symptoms. Treating co-occurring alcohol use disorder and bipolar disorder requires specialized approaches.
For AUD, however, a recent meta-analysis of 22 studies showed no difference between BD-I (OR 3.78) and BD-II (OR 3.81) (28). A recent catchment area study in Northeast England found a 40% lifetime comorbidity between BD II and AUD, surprisingly with little difference between female (38%) and male (43%) subjects (36). Alcohol consumption can induce significant neurochemical changes in the brain, which may exacerbate or trigger symptoms in bipolar disorder and alcoholism relation individuals predisposed to bipolar disorder. One of the primary mechanisms involves the modulation of neurotransmitter systems, particularly gamma-aminobutyric acid (GABA) and glutamate.
Psychological and psychosocial interventions
CBT and IGT have the best, but still insufficient evidence- base as psychosocial treatments. Figure 1 depicts a proposed therapy algorithm based on the evidence presented in this article. Supportive pharmacotherapy should be mainly centered around BD, with mood stabilizer, e.g., lithium and valproate, still the treatment of choice. However, there is clearly more research needed to develop reliable treatment algorithms for comorbid BD and AUD. Ondansetron is a 5-HT3 receptor antagonist used to prevent nausea and vomiting caused by chemo- or radiation therapy. A controlled study suggested a reduction of alcohol consumption with ondansetron (126).
Stress and Trauma as Triggers
In conclusion, the connection between bipolar disorder and substance abuse, particularly alcohol, is profound and multifaceted. While alcohol does not directly cause bipolar disorder, it can worsen symptoms, trigger episodes, and complicate treatment. Understanding this link is essential for effective management and prevention strategies. For individuals with bipolar disorder, avoiding or minimizing alcohol consumption is strongly recommended, as it can significantly impact their mental health trajectory. Healthcare providers must remain vigilant in screening for substance use in patients with bipolar disorder and offer comprehensive, integrated care to address both conditions effectively.
- It is generally not recommended, as alcohol can interfere with medications, destabilize mood, and increase the likelihood of relapse or severe symptoms.
- This creates constantly changing drinking patterns that make both conditions more challenging to treat.
- The use of alcohol or drugs can also influence the onset and trajectory of bipolar disorder.
- Specific numbers for AUD and BD are not available, but for affective disorders (AD) in general and SUD, criminal behavior has been observed twice as frequent in AD with SUD compared to AD without (63).
- The Guidance on community mental health services and person-centred and rights-based approaches describes what person-centred and human rights-based approaches look like in mental health, and give examples of good practice services.
Prevalence of Co-occurrence
- Alcohol dependence, also known as alcoholism, is characterized by a craving for alcohol, possible physical dependence on alcohol, an inability to control one’s drinking on any given occasion, and an increasing tolerance to alcohol’s effects (APA 1994).
- Your doctor or counselor may recommend behavioral therapy, medication, or a combination of both to treat alcohol use disorder.
- Another significant concern is the interaction between alcohol and bipolar medications.
- Diagnosis is alcohol dependence syndrome with bipolar affective disorder, and the current episode is hypomanic without psychotic symptoms.
- However, chronic alcohol use disrupts the balance between these systems, leading to neuroadaptation.
If not feasible, a close coordination of therapies, e.g., by means of a case manager, should be established. Bipolar people can also isolate themselves when they experience depressive episodes, social anxiety or shame over impulsive behaviours during manic episodes. People with bipolar disorder are more susceptible to alcoholism due to self-medication, genetic predisposition and their inability to cope with mood swings.
Support groups such as Alcoholics Anonymous, as well as bipolar-specific support groups can provide a more stable atmosphere with better accountability in many ways. Alcohol initially appears to stabilise mood but soon overturns neurotransmitter function and tends to lead to deeper emotional instability. Participate in both one-on-one sessions and group therapy, fostering community support and personal insights. Alcohol use increases impulsivity, which is a tendency to act without thinking about the risks or consequences first. If you do drink, it’s important to limit the amount of alcohol you consume and avoid combining it with other substances, such as cannabis.
Consequences of Comorbidity
Limiting or avoiding alcohol can also prevent alcohol use disorder, which is a pattern of alcohol use that can impair your mental and physical health, day-to-day activities, and relationships. In neuroimaging studies, there are a number of areas of interest in BD and indeed in AUD that have emerged in different studies in different populations. Have identified areas including the pre-frontal cortex, the corpus striatum and the amygdala as being abnormal in early BD, potentially predating illness (Chang et al., 2004, Strakowski et al., 2005b). Abnormalities in the cerebellar vermis, lateral ventricles, and some prefrontal areas may develop with repeated affective episodes, and may represent the effects of illness progression (Strakowski et al., 2005b).
As with most treatments, concurrent SUD including AUD is thus a predictor for inferior response to lithium. However, as shown in adolescents, achieving more mood stability with lithium can result in lower levels of alcohol or drug consumption (108). Positive effects of lithium on SUD apart from indirect effects via mood stabilization could not be substantiated so far (109). Individuals who have bipolar disorder and AUD at the same time have a higher relapse rate. Individuals with bipolar alcohol abuse require continuous monitoring, and structured support programmes are necessary to maintain recovery.
A few studies have looked at the impact of medications like valproate, lithium, and naltrexone, as well as psychosocial interventions, in treating patients with bipolar disorder and alcoholism. The relationship between alcohol and bipolar disorder is complex and multifaceted, raising questions about whether alcohol can trigger or exacerbate bipolar symptoms. Bipolar disorder is a mental health condition characterized by extreme mood swings, including manic highs and depressive lows, while alcohol is a central nervous system depressant that can alter brain chemistry.
Alcohol’s Impact on Mood Stability
Medical supervision is also provided to ensure safe pharmacological treatment especially when dealing with bipolar alcohol abuse. The successful treatment of people diagnosed with bipolar disorder who also struggle from alcoholism requires an integrative approach to both disorders. Alcohol-induced mood swings can make it difficult to distinguish between substance-induced mood swings and bipolar episodes. Alcohol disrupts neurotransmitter function and can trigger mood swings in people prone to bipolar disorder. If you or someone you care about is battling these disruptive conditions, reach out to Laguna Beach Recovery for coordinated dual diagnosis treatment that addresses these co-occurring disorders simultaneously in a serene and supportive environment. Building solid support systems and learning effective coping strategies takes time, but leads to superior outcomes and reduced rates of relapse.
In BD, there is an equal incidence of men and women, emphasising the genetic origin of the disorder. In AUD, while there is a higher incidence in men, the genetic component may be more prominent in women (Kendler et al., 1992). There are neurochemical abnormalities in both disorders in the serotonin/dopamine pathways, which could suggest a similar pathology in both disorders (Yasseen et al., 2010). Regarding birth and early development (history of abuse), no reliable informant was available. He worked in Japan, as a truck driver and exporter of goods, in a bookstore, and taught meditation. The patient got married in 2001 and his wife passed away in 2011 due to breast cancer as per the sex and marital history.
Typically, specialised treatment is offered to individuals with co-occurring disorders that integrates medical, psychiatric and behavioural interventions for holistic healing. Long-term alcohol abuse accelerates cognitive decline and leads to memory impairment, reduced problem-solving ability and a poor ability to control emotions. Chronic alcohol consumption promotes neurodegenerative effects and makes it even more difficult to gain control over moods and maintain recovery. You might also find it helpful to join a support group for people with alcohol use disorder. Some people need to participate in a medically supervised detox program to manage alcohol withdrawal symptoms, which can be potentially life threatening in cases of long-term heavy alcohol use. They can also help you recognize the signs of alcohol use disorder and get help when needed.
Cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) teach you how to deal with mood swings, how to manage them and how to resist drinking. Alcohol dependence and bipolar disorder create a cycle of addiction in which it is very difficult for those affected to maintain stability. Such behaviour reinforces dangerous situations and poor decisions towards the law, leading to further complications in restoring mental stability. Alcohol lowers inhibitions and leads to irresponsible financial, social and professional decisions that can be regretted for years.
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Alcohol is a depressant that can deepen feelings of sadness, hopelessness, and lethargy in individuals with bipolar disorder. Those experiencing a depressive episode may turn to alcohol as a form of self-medication to numb emotional pain, but this only exacerbates the depression over time. The sedative effects of alcohol can also worsen symptoms like fatigue and social withdrawal, making it harder for individuals to engage in therapeutic activities or maintain relationships.
That is, they co-occur more often than would be expected by chance and they co-occur more often than do alcoholism and unipolar depression. Diagnosis is alcohol dependence syndrome with bipolar affective disorder, and the current episode is hypomanic without psychotic symptoms. Classically, the prognosis in mood disorders is generally described as better than in schizophrenia.