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Bipolar Disorder and Alcohol

What Is Bipolar Disorder?

Bipolar disorder is not a singular diagnosis; instead, it is a term that describes several different but related psychological/psychiatric conditions. In general, bipolar disorder is a severe psychological/psychiatric disorder that consists of very specific variations in an individual’s mood and affect.

  • Mood refers to an individual’s subjective appraisal of their emotional state, essentially how an individual describes how they feel.
  • Affect refers to behaviors that an outsider observes that are used to infer the person’s emotional state. For instance, if you see an individual who is crying, you might infer the individual is sad.
  • In bipolar disorder, the range of mood and affect alternates from feelings of depression to manic-like states.

Bipolar disorder is characterized by the presence of mania or hypomania. Mania is defined as a period of abnormally elevated, expansive, or irritable displays of mood or affect that last for at least one week.

Examples of mania may include:

  • Extreme talkativeness.
  • Grandiose behavior or extremely inflated self-esteem.
  • A significant decrease in the need for sleep.
  • Racing thoughts, often observed as very rapid and prolonged speech.
  • Being very distractible.
  • Significant hyperactivity.
  • An increase in potentially dangerous behaviors that include gambling binges, shopping binges, having multiple sexual encounters, etc.
  • A significant increase in goal-directed behavior, such as housecleaning, pacing, work-related behaviors, etc.

Mania is not necessarily equated with “feeling good,” and individuals who are extremely distractible or hyperactive, and engaging in destructive behaviors may have feelings of elation, but these individuals often report that these experiences are not overtly positive even though they were caught up in them when they occurred. In addition, manic episodes are notoriously short-lived (often lasting only for hours or a few days) whereas depressive symptoms may occur for months.

Individuals with bipolar disorder also often experience alternating episodes of clinical depression. Like mania, clinical depression is diagnosed by a set of behavioral criteria. An individual must the display at least five of 11 symptoms consistently over a two-week period, and one of the symptoms must include significant feelings of sadness or a significant loss of interest or the ability to experience pleasure.

There are two primary types of bipolar disorder.

  • Bipolar I disorder is diagnosed when an individual meets the diagnostic criteria for at least one full episode of mania. The person may, or may not, have had episodes of depression or hypomania.
  • Bipolar II disorder is diagnosed when the individual has displayed at least one episode of hypomania. No manic episodes can be documented in the individual, and they may or may not have had depression.

The Link Between Alcohol and Bipolar Disorder

Individuals with a diagnosis of bipolar disorder are very often also diagnosed with other mental health disorders (comorbidity). One of the most common dual diagnoses is a diagnosis of bipolar disorder and a Alcohol Use Disorder (AUD). According to that alcohol is the most commonly abused substance in individuals with bipolar disorder.

The research that describes the prevalence of co-occurring bipolar disorder and alcohol use disorder often combines both bipolar I and bipolar II disorders.

  • The 12-month prevalence for bipolar I disorder in the United States is reported as being 0.6 percent, with equivalent prevalence rates between males and females.
  • The 12-month prevalence for bipolar II disorder in the United States is reported as being 0.8 percent.

Research studies investigating the relationship between bipolar disorder and substance use disorders report that 33-61 percent of individuals with a diagnosis of bipolar disorder also have a co-occurring alcohol use disorder, depending on the study. In general, sources report that about 50 percent of individuals who receive a diagnosis of bipolar disorder will also qualify for a diagnosis of alcohol use disorder.

The reasons for the strong relationship between bipolar disorder and substance abuse are not well defined. Explanations range from the common “self-medication” hypothesis (people use alcohol to cope with their emotional symptoms) to more sophisticated notions of genetic contributions and environmental interactions with an individual’s genes. No explanation for this relationship has been definitively demonstrated, although the most popular notion among professional researchers and clinicians is that individuals who develop one form of psychiatric/psychological disorder are at an increased risk to develop numerous other psychological/psychiatric disorders. The increased risk is due to a combination of family history, genetics, and experiences all interacting in unique ways in different individuals.

Treatment for Alcoholism and Bipolar Disorder

When an individual has a dual diagnosis of bipolar disorder and an alcohol use disorder, both disorders need to be treated concurrently. Attempting to address only the bipolar disorder or the alcohol use disorder, and not treating the other disorder, may not be successful.

Treatment programs for individuals with co-occurring disorders are often described as integrated treatment approaches. These programs utilize a team of treatment professionals who work together to treat issues associated with both disorders. An individual with bipolar disorder and a co-occurring alcohol use disorder would be thoroughly evaluated by several physicians and therapists. They would, most likely, initially be placed on medication for bipolar disorder and may enter a physician-assisted withdrawal management program for their alcohol abuse (sometimes referred to as medical detox).

Initial treatment would most likely be performed on an inpatient basis. Once the individual has completed the withdrawal management program, they would continue on their medication for bipolar disorder and with any other medically assisted treatments for other co-occurring issues, including depression.

Medical treatment for bipolar disorder would be ongoing over the course of the person’s life. Treatment for the individual’s alcohol use disorder should also be extensive, and the individual should continue to participate in treatment-related activities, such as social support groups (e.g., Alcoholics Anonymous), for many years. Co-occurring disorders are serious and present significant challenges to your well-being and ability to function, but recovery is possible with treatment and ongoing aftercare.

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