The Complex Relationship Between Alcohol and Bipolar Disorder

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Many people with substance use disorder (SUD) or alcohol use disorder (AUD) have complex, severe, or persistent mental health disorders, including bipolar disorder (BD). According to Substance Abuse Treatment, Prevention, and Policy, "The lifetime prevalence of SUDs is at least 40% in bipolar I patients." Alcohol abuse is one of the leading co-occurring conditions alongside BD. In addition, recent research "on the causal relationship between the two disorders suggests that a subgroup of bipolar patients may develop a relatively milder form of affective illness that is expressed only after extended exposure to alcohol abuse." Pathways Recovery Center is committed to providing high-quality treatments for individuals with co-occurring disorders

AUD and bipolar disorder have multiple potential connections. Some people use alcohol as a way to cope with the symptoms of depressive episodes, while others may misuse alcohol during manic periods when they have less impulse control. The interplay between alcohol consumption and BD is complex and unique to each person. Alcohol misuse can significantly worsen symptoms of bipolar disorder and potentially cause the development of additional mental health disorders. 

Delving Deep: Understanding Bipolar Disorder

Bipolar disorder is a mood disorder characterized by abrupt changes in energy levels, moods, and behaviors. People with BP often experience cycles of depressive episodes followed by manic episodes. The length and severity of the episodes determine the type of bipolar disorder. Both manic and depressive episodes cause significant emotional distress for clients and their loved ones. 

The symptoms and side effects of bipolar disorder have the potential to affect the following: 

  • Personal, social, and professional relationships
  • Career goals 
  • Education 
  • Performance at work 
  • Ability to manage everyday responsibilities
  • Quality of life 

All forms of BD increase the risk of AUD. However, bipolar I and bipolar II have been shown to cause more addictive behaviors. The most common forms of bipolar disorder include: 

  • Bipolar I: manic episodes with or without depressive episodes
  • Bipolar II: frequent major depressive episodes followed by hypomania
  • Cyclothymia: chronic mood disturbances accompanied by less severe depressive or manic symptoms compared to bipolar I and bipolar II
  • Rapid Cycling Bipolar: experiencing four or more episodes of mania or depression within 12 months
  • Bipolar With Mixed Features: individuals may experience depressive and manic symptoms simultaneously
  • Unspecified Bipolar: undefined bipolar disorder featuring depressive and/or manic symptoms
  • Bipolar With Seasonal Pattern: mood changes follow a seasonal pattern (i.e., people may feel more depressed during the winter and more manic during the summer) 

Bipolar disorder is one of the most common mood disorders. According to the National Institute of Mental Health (NIMH), "An estimated 2.8% of U.S. adults had bipolar disorder in the past year." The majority of individuals with BD experience one or more accompanying mental health issues. Treatment programs use a whole-person approach and integrative care to ensure clients receive access to essential services for both BD and substance abuse. The two conditions can be highly destabilizing if not treated concurrently. Side effects of SUD and bipolar disorder often overlap and cause more severe symptoms unless treated simultaneously.  

Substance abuse is a common co-occurring condition alongside BD. However, researchers are uncertain why some people develop the dual diagnosis, although age and genetics may play a role. According to the National Institute on Drug Abuse (NIDA), "One study found that adolescent-onset bipolar disorder confers a greater risk of subsequent substance use disorder compared to adult-onset bipolar disorder." Early intervention and treatment reduce the risk of young adults developing AUD. Pathways Recovery Center offers treatment to individuals 18 and older. The care team helps families navigate interventions and the transition into therapy for individuals struggling with severe manic or depressive episodes. 

Alcohol Use in Bipolar Individuals: A Common Coping Mechanism?

People abuse alcohol for many reasons. Often, individuals who become dependent or addicted to alcohol have multiple risk factors and co-occurring or underlying issues affecting their ability to abstain. Genetics, age, and gender all impact how a person physically responds to alcohol. 

Mental health disorders often have complex causes and side effects. A few common reasons people with bipolar disorder may turn to alcohol include:

  • Peer pressure 
  • Increased impulsivity 
  • As a way to cope with stressors 
  • To escape everyday life 
  • Genetic predisposition
  • Environmental factors 

Some people may also use alcohol to self-medicate and reduce symptoms of depression, mania, or hypomania. However, many are unaware of the dangers of misusing alcohol in this way. Although drinking may make people feel more in control in the short term, long-term side effects have the potential to cause severe illness, injury, or even death. Alcohol addiction is very dangerous, and most people find it hard to stop without the aid of rehabilitation programs or professional mental health treatment. 

Consequences of Combining Alcohol and Bipolar Disorder

Alcohol is a depressant that disrupts neurotransmitters and affects multiple body systems, including heart, kidney, and liver health. Individuals trying to manage their bipolar disorder with medications may experience severe side effects if they mix prescription drugs with alcohol. For example, valproate is a medication commonly used to treat bipolar disorder. According to Alcohol Research and Health, "Both valproate and alcohol consumption are known to cause temporary elevations in liver function tests, and in rare cases, fatal liver failure." People with BD may also stop responding to valproate and other medications if they consume excessive amounts of alcohol. 

Research shows alcohol abuse may trigger bipolar disorder or significantly worsen symptoms in some individuals. According to the previously mentioned article by Alcohol Research and Health, "[R]esearchers have suggested that alcohol use and withdrawal may affect the same brain chemicals (i.e., neurotransmitters) involved in bipolar illness, thereby allowing one disorder to change the clinical course of the other." AUD exacerbates the symptoms and phases of bipolar disorder. Often, clients require new medication to manage symptoms after becoming addicted to alcohol. 

In addition to causing more severe symptoms and potentially deadly health complications, the combination of BD and AUD also causes emotional distress and relationship issues. People with BD are more likely to take unnecessary risks, act impulsively, and react inappropriately to various situations. Alcohol intensifies the emotional instability experienced by people with BD. 

AUD often worsens the following potential side effects of severe or unmanaged BD:

  • Job loss or financial distress 
  • Housing difficulties 
  • Relationship issues, including divorce or separation 
  • Legal problems caused by impulsive or risk-taking behaviors 
  • Social isolation 
  • Reduced productivity at work or school 
  • Hospitalization 
  • Reduced quality of life 

The potential for rapid mood swings, adverse medication interactions, and heightened impulsivity make alcohol and BD a dangerous combination. Individuals with BD may be more likely to misuse alcohol when experiencing severe symptoms of depression or mania, which is precisely when the effects of alcohol may cause the most damage. Pathways Recovery Center uses relapse prevention education and skill development to help people recover from AUD and find healthy ways to manage severe symptoms during manic or depressive cycles. Clinicians help clients recognize the connections between various emotions and behavioral responses. Managing AUD reduces the risk of people experiencing severe side effects of BD. 

Treatment Considerations for Co-Existing Alcohol Abuse and Bipolar Disorder

The treatment for co-occurring BD and AUD requires a nuanced approach to address challenges related to both conditions. Symptoms for BD and AUD exist along a spectrum. No two people have the same recovery experience. Treatments must be tailored to the needs and preferences of clients to ensure positive outcomes. According to Frontiers in Psychiatry, "Alcohol use disorder and bipolarity significantly influence each other's severity and prognosis with a more complicated course of both disorders." 

Clients in treatment collaborate with their care team to determine what services and therapies will help them manage both conditions. Individuals are often treated with a combination of prescription medications, psychotherapy, and alternative holistic therapies. Many evidence-based therapies have proven effective in treating bipolar disorder and AUD. 

Some of the most common methods used to treat co-occurring BD and AUD include:

  • Prescription medications to manage symptoms of withdrawal or BD episodes
  • Cognitive-behavioral therapy (CBT)
  • Mindfulness-based techniques
  • Group therapy and support groups 

Lifestyle changes are often necessary to ensure long-term recovery from AUD. Establishing healthier patterns of behavior and improving coping skills also helps people manage BD. Pathways Recovery Center has multiple levels of care. Each program is structured to provide the highest quality support for individuals in recovery. Clinicians help clients learn how to identify potential problems and find healthy ways to cope, reducing the risk of relapse. 

Prevention and Management Strategies

A person's lifestyle directly impacts their physical and mental health. In some cases, making minor lifestyle changes mitigates the risks associated with BD and co-occurring AUD. According to the Journal of Psychiatric Research, "Lifestyle interventions in BD targeting nutrition, exercise, wellbeing alongside beliefs, coping strategies and attitudes towards health show promise in reducing the risk of comorbid ailments in BD." Clients can take control of their recovery and reduce the severity of symptoms by making meaningful lifestyle changes under the guidance of a mental health professional. Treatment programs give clients the time and space to create new routines and reinforce healthier behaviors. 

Rewriting old patterns of behavior takes time and dedication to change. Individual therapy is one of the most effective ways to remain motivated while making necessary lifestyle changes. Therapists help clients navigate their recovery from substance abuse while developing healthy habits to reduce the symptoms and side effects of BD. Many people attend community-based or private support groups in addition to individual therapy. Being able to discuss challenges with peers who share similar life experiences validates the struggles and successes clients experience during recovery from BD and AUD. 

Psychoeducation is another essential part of treatment and long-term recovery for individuals with dual diagnosis. People are more likely to make practical lifestyle changes if they clearly understand how their diagnosis impacts behaviors. During treatment, clinicians educate clients on the details of their condition and potential treatment options to ensure they make informed choices. 

The Dangers of Relapsing With Alcohol

Clinicians are responsible for ensuring clients understand the dangers of misusing alcohol while taking medications to manage bipolar disorder. In some cases, the combination makes the medication ineffective. However, some medications may have severe complications if mixed with excessive alcohol. Pathways Recovery Center educates clients on the potential effects of combining various BD medications with alcohol and provides clients with the skills they need to avoid relapsing. 

Some potential side effects of combining alcohol and medication for bipolar disorder include: 

  • Dizziness 
  • Memory issues 
  • Confusion 
  • Impulsivity and poor judgment 
  • Increased risk of severe accidents or injuries 

People taking BD medications have a higher risk of experiencing a traffic accident, fall, or other serious injury while under the influence of alcohol. Clients are encouraged to abstain entirely from drinking alcohol and use relapse-prevention strategies to stay sober. 

Real-Life Examples: Overcoming Alcohol and Bipolar Challenges

Everyone has a different experience navigating the complexities of alcohol abuse and bipolar disorder. Below are notes from a case study involving a man in treatment for BD and AUD. People can use his example to better understand how these two conditions may affect a person's life and recovery. 

#1. Establishing the Case Study

The following case study notes were taken from the Treatment Improvement Protocol (TIP) Series

“John W. is a 30-year-old man with bipolar I disorder and AUD. He has a history of hospitalizations, both psychiatric and substance related; after the most recent extended psychiatric hospitalization, he was referred for SUD treatment. He told the counselor he used alcohol to facilitate social contact, as well as deal with boredom, because he had not been able to work for some time. The counselor learned that during his early 20s, John W. achieved full-time employment and established an intimate relationship with a nondrinking woman; however, his drinking led to the loss of both.”

#2. The Effects of Treatment on John W.'s Recovery

Despite weekly meetings with a therapist and prescription medication to manage BD symptoms, John W. still struggled to maintain sobriety during more severe manic and depressive episodes until he encountered a peer in group therapy. 

“In a group for clients with CODs at the SUD treatment agency, John W. is introduced to another client in recovery with a bipolar disorder, who tells his personal story and how he discovered that both of his problems need primary attention. This client agrees to be John W.'s temporary sponsor and calls John W.'s case manager, who works at the mental health center where John W. gets his medication, and describes the treatment plan. She then makes arrangements for a monthly meeting involving the counselor, case manager, and John W.”

By taking part in integrative treatment, John W. was able to treat his BD and AUD simultaneously. In the end, dual treatment allowed John W. to achieve long-term sobriety. 

#3. What Support Structures Improved John W.'s Outcomes?

John W. was able to successfully make lifestyle changes to support long-term sobriety by doing the following: 

  • Attending weekly individual therapy sessions 
  • Engaging with peers
  • Taking prescription medication as prescribed 
  • Gaining a sponsor

Relying on these support structures and actively working to overcome challenges in recovery helped John W. build a sober life. 

Pathways Recovery Center - Dual Diagnosis Treatment

Fully understanding the intricate relationship between alcohol abuse and bipolar disorder helps clients and clinicians make more informed decisions about treatment and aftercare. According to Current Psychiatry Reports, "AUD with BD produces a significant increased risk of associated psychopathology including longer duration of withdrawal from alcohol, increased severity of manic and depressive symptoms, increased associated psychopathology, increased suicide risk, poorer prognosis, higher cost, increased morbidity and overall decreased degree of function." The compassionate clinicians at Pathways Recovery Center have decades of combined experience helping clients and their loved ones heal from the effects of complex dual diagnosis. 

Untreated BD and AUD have the potential to cause severe and life-threatening health issues. Clinicians at Pathways Recovery Center encourage clients to seek professional addiction recovery and mental health services if they struggle with co-occurring BD and AUD. 

Alcohol abuse and bipolar disorder have complex connections and overlapping risk factors. Alcohol misuse has the potential to worsen bipolar symptoms and vice versa. Individuals diagnosed with BD often have a much higher risk of developing addictive behaviors, including alcohol use disorder. Early treatment and interventions for either bipolar disorder or alcohol abuse have the potential to limit the risk of a person developing the other condition. Clients diagnosed with dual AUD and BD benefit from integrative care and personalized treatment. Pathways Recovery Center treats all active and underlying issues simultaneously to reduce the risk of relapse or severe health complications. To learn more about our programs and services, call us today at (888) 771-0966.

Clinically reviewed by 

Moses Nasser
Dr. Moses Nasser, a double board-certified physician in Family Medicine and Addiction Medicine, with expertise in holistic healing, addiction medicine, and psychiatric care, holds an X-waiver to prescribe buprenorphine and has extensive experience in mindfulness-based customer service and medication-assisted treatment.

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