Alcohol Addiction and Bipolar Disorder

Bipolar disorder is a mental health disorder characterized by significant and unusual changes to a person’s mood, functioning, and energy levels.^{1, 2} Formerly known as manic-depression or manic-depressive disorder, the three types of bipolar disorders, known as bipolar I, bipolar II, and cyclothymic disorder, involve similar symptoms on different levels of severity.^{1, 2}

People with bipolar disorder commonly struggle with substance misuse and co-occurring substance use disorders, including alcohol use disorder (AUD).³  The combination of bipolar disorders and alcohol use disorder can worsen the outcome of each disorder, which is why receiving integrated treatment for co-occurring disorders, also known as dual diagnosis treatment, can be so important.⁴

If you or a loved one are concerned about bipolar disorder and compulsive drinking or are struggling with bipolar disorder and alcohol use disorder, you may benefit from seeking treatment. Understanding how bipolar disorder interacts with alcohol misuse and addiction can be an important first step towards achieving recovery.

What is Bipolar Disorder?

The term bipolar disorder is used to describe a category of disorders that affect a person’s mood, energy, and activity levels.² According to the National Institute of Mental Health, around 4.4% of adults in the U.S. are believed to have bipolar disorder at some point in their lives.⁵

There are three different types of bipolar disorder, including:

Bipolar I.  The main feature of bipolar I is manic episodes, which involves abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, and, in many cases, depressive or hypomanic episodes as well.^{1, 2} According to the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), manic episodes involve at least three of the following:⁶

• Inflated self-esteem or grandiosity.
• Decreased need for sleep (such as feeling rested after just a few hours of sleep).
• Being more talkative than usual or feeling pressure to keep talking.
• Flight of ideas, meaning jumping between ideas quickly, or feeling that thoughts are racing.
• Distractibility (such as being easily drawn to unimportant or irrelevant external stimuli).
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (such as purposeless, non-goal-directed activity).
• Excessive involvement in activities that have a high potential for painful consequences (such as engaging in uncontrolled buying sprees).

Manic episodes can also involve psychotic features, which means hallucinations, false thinking, or disorganized thoughts.¹

People commonly also experience major depressive episodes. They need to have at least five of the following (and at least one of the first two) over a period of two weeks, including:¹

• Intense sadness or despair.
• Loss of interest in activities they once enjoyed.
• Feelings of worthlessness or guilt.
• Fatigue.
• Increased or decreased sleep.
• Increased or decreased appetite.
• Restlessness or slowed speech or movement.
• Difficulty concentrating.
• Frequent thoughts of death or suicide.

Hypomanic episodes can also occur; this refers to less severe manic symptoms that only last up to 4 days in a row. They generally do not affect a person’s functioning as severely as a manic episode.¹

Rapid cycling, which refers to four or more episodes of mania or depression within a year, can be a feature of bipolar I.²

Bipolar II. This is a less extreme form of bipolar disorder that occurs when a person has at least one major depressive episode and at least one hypomanic episode that lasts at least 4 consecutive days a week.^{1, 6} People can usually function between these episodes.¹

Cyclothymic disorder. This is a milder form of bipolar that involves mood swings that are less severe in the form of recurrent hypomanic and depressive symptoms that do not meet the criteria for full manic or depressive episodes.² People need to have these symptoms for at least 2 years to receive a diagnosis.⁶

The DSM-5 indicates that the 12-month prevalence estimate for bipolar disorder is 0.6% in the U.S.⁶ The 12-month prevalence for bipolar II was 0.8%.⁶ The lifetime prevalence of cyclothymic disorder is between 0.4%-1%.⁶

Experts agree that there isn’t just one cause for bipolar disorder, rather, it involves a combination of risk factors, including genetics, differences in brain structure and functioning, changes in brain chemicals, and environmental factors.^{1, 2}

The APA indicates that 80-90% of people with bipolar disorder have a relative with bipolar disorder or depression.¹ Certain influences may impact or trigger manic or depressive episodes, such as stress, sleep problems, or drug or alcohol use.¹

The Relationship Between Bipolar Disorder & Alcohol Misuse

Research indicates that somewhere between 30-50% of people with bipolar disorder will develop a substance use disorder sometime during their lives.³ Rates of comorbid bipolar disorder and alcohol use disorder are estimated to be up to 45%, according to one study.^{4 intro} A review indicates that rates of lifetime comorbidity of bipolar disorder and alcohol use disorder range from 40–70%, and affect males more often than females.⁷

People can develop either disorder first.⁴ The reasons for the bidirectional nature of bipolar disorder and alcoholism are complex and aren’t fully understood, but can involve the following considerations:

• There may be a shared genetic predisposition between bipolar disorder and alcohol use disorder.⁷
• Bipolar and drinking behavior may be related in that depressive episodes could increase alcohol craving in people with bipolar and alcohol use disorder.⁷
• Alcohol use may trigger new episodes of bipolar disorder.⁷
• Bipolar disorder may involve “self-medicating” with alcohol (which isn’t medication at all), where people drink to numb their symptoms of bipolar, which could, over time, cause them to develop AUD, which could then exacerbate symptoms of bipolar disorder.⁴
• People with bipolar may drink due to their tendency toward impulsive behaviors.⁴
• Bipolar disorder and alcohol may involve overlapping problems in the areas of the brain responsible for impulsivity, motivation, and the feeling of reward.³

Dangers of Untreated Alcohol Addiction & Bipolar Disorder

Untreated AUD and bipolar disorder can lead to different and dangerous long-term health impacts, such as:⁴

• More severe impairments because of either disorder.
• Increased risk of suicide.
• Increased risk of other mental health disorders, such as anxiety or social phobia.
• Worse outcomes for either bipolar disorder or AUD.
• Increased risk for criminal behaviors.

Treatment for Bipolar Disorder & Alcohol Addiction

Dual diagnosis treatment for alcohol use disorder and bipolar disorder can help people start the path to recovery from both disorders.⁷ Integrated treatment means people receive treatment for both disorders at the same time. ⁴

People may participate in different therapies and interventions, such as:

• Pharmacotherapy using mood stabilizers (such as lithium) and atypical antipsychotics (such as quetiapine) to help manage symptoms of bipolar disorder⁴ People may receive medication to alleviate symptoms of alcohol withdrawal and also to reduce drinking in people with AUD.⁴
• Psychoeducation to help people understand each disorder and how they interact.⁴
• Participation in self-help or mutual-help groups, such as Alcoholics Anonymous (AA), Dual Recovery Anonymous, or SMART Recovery.⁴
• Integrated Group Therapy (IGT), which is based on principles of cognitive-behavioral therapy (CBT) to help people make changes to the thoughts and behaviors that contribute to both bipolar disorders and substance use disorders. People are encouraged to think of having one disorder (such as bipolar substance misuse) instead of two disorders at the same time.⁴

Finding Treatment for Bipolar Disorder and Alcohol Addiction

If you or a loved one are struggling, you should know that treatment is available to help you take back control and begin a healthier and more productive life. If you suspect that you or your loved one have bipolar disorder, you may consider reaching out to your doctor. They can conduct a thorough evaluation and refer you to mental health providers and/or rehab facilities.

You can also use the Substance Abuse and Mental Health Services Administration’s online Behavioral Health Treatment Services Locator to search for facilities that provide dual diagnosis/co-occurring disorders treatment.

Addiction helplines, like the one owned and operated by American Addiction Centers, are available to answer questions about co-occurring bipolar and alcohol use disorder and can help you understand the treatment process. Please call to speak to a caring admissions navigator who can help connect you to treatment centers that may be appropriate for your needs.