Bipolar Disorder and Alcohol Abuse

Bipolar disorder is a mental health condition characterized by extreme mood swings. These mood swings include emotional highs (mania or hypomania) and extreme lows (depression). 

When an individual is diagnosed with both a substance use disorder (SUD) and mental health disorder, it is called a dual diagnosis. Alcohol abuse and alcohol use disorder are common with mental health conditions, but AUD has the highest rate of co-occurrence with bipolar disorder. These co-occurring conditions also tend to have the most negative outcomes. 

Those with bipolar disorder often turn to alcohol to self-medicate and reduce their symptoms. While this can provide temporary relief, the combination of bipolar disorder and alcohol can worsen the symptoms and severity of the other, creating a vicious cycle. This cycle of symptoms makes it difficult for professionals to diagnose as it is hard to distinguish between the two.

Over 46 percent of those with bipolar I disorder and almost 40 percent of those with bipolar II disorder have an alcohol use disorder.

What is Alcohol Abuse and Alcohol Use Disorder?

Moderate drinking (one drink a day for women and two for men) is a common way for people to unwind and destress at the end of the day. However, when alcohol consumption exceeds that amount, it can approach alcohol abuse. Binge drinking, for example, is more than four drinks for women and five drinks for men. If this level of drinking occurs more than five times in a month, it constitutes heavy alcohol use. When you reach this level of alcohol abuse, you put yourself at a greater risk of alcohol use disorder.

Formally known as alcoholism, alcohol use disorder occurs when alcohol consumption becomes a problem. You are no longer able to control your drinking and it affects your daily life. For many with bipolar disorder, regular drinking as a form of self-medication greatly increases the risk of alcohol use disorder. Common symptoms associated with alcohol use disorder include:

• Spending a lot of time drinking or recovering from alcohol consumption
• Unable to limit the amount of alcohol you drink
• Extreme cravings for alcohol
• Developing a tolerance that requires more alcohol to achieve the desired results
• Unable to meet work or school obligations
• Losing interest in favorite activities or social gatherings
• Continuing to drink even when it causes physical, social, or emotional problems
• Experiencing withdrawal symptoms when alcohol is not available

What is Bipolar Disorder?

Characterized by extreme mood swings, bipolar disorder includes periods of emotional highs (mania or hypomania) and lows (depression). When a person experiences periods of mania, they may feel happy, energetic, or even irritable. Periods of manic depression cause feelings of sadness and often the loss of interest in most activities. In addition, these extreme changes in mood can affect energy levels, sleep patterns, ability to think clearly, and behavior.

There are three main types of bipolar disorders: bipolar I, bipolar II, and cyclothymic disorder. While bipolar disorder can occur at any age, diagnosis typically occurs in the teenage years to early 20s.

Symptoms vary depending on whether it is during a mania or hypomania episode or a depressive episode. Mania and hypomania share the same symptoms but are two very different episodes. For example, mania is more severe and can often trigger a break from reality, or psychosis. Symptoms can include:

Mania and Hypomania Symptoms:

• Abnormally upbeat or wired and jumpy
• Increased energy levels
• Increased irritation and agitation
• High level of self-confidence
• High level of euphoria
• Decreased need for sleep
• Racing thoughts and easily distracted
• Unusually talkative
• Poor decision making
• Increased appetite

Depression Symptoms:

• Feelings of sadness and hopelessness
• Loss of interest
• Decreased appetite and weight loss
• Changes in sleep – insomnia or sleeping too much
• Fatigue
• Feelings of worthlessness
• Decreased ability to think and concentrate
• Thoughts of death or suicide

Bipolar I Disorder

Bipolar I disorder is the only one that includes manic episodes. Bipolar I disorder is the most severe; it is characterized by manic episodes that last for at least a week and depressive episodes that last for at least 2 weeks. It is also possible to experience episodes of depression with manic symptoms at the same time.

Over 14 percent of people with bipolar I suffer from alcohol abuse, while over 31 percent suffer from alcohol use disorder.

Bipolar II Disorder

Bipolar II disorder has episodes of depression and hypomanic episodes, but a person does not experience mania. A person is more likely to seek treatment during a depressive episode than a manic episode.

Over 18 percent of people with bipolar II suffer from alcohol abuse, while almost 21 percent suffer from alcohol use disorder.

Cyclothymic Disorder

Cyclothymic disorder is like bipolar II in that people experience symptoms of depression and hypomania for at least two years. However, these symptoms do not meet the diagnostic criteria for full hypomanic and depressive episodes.

The Link Between Bipolar Disorder and Alcohol

Bipolar disorder and alcohol use disorder commonly occur together, often with negative outcomes. While alcohol use is very common in those with mental illness, alcohol use disorder is highest among those with bipolar disorder. 

Many people with bipolar disorder turn to alcohol to self-medicate and reduce symptoms. Alcohol use increases the severity of symptoms over time. Moreover, because symptoms of alcohol use disorder and bipolar can be similar, this can delay the diagnosis and treatment of bipolar disorder.

There is a high risk of suicide associated with bipolar disorders. Similarly, alcohol use can contribute to higher suicide risk. When a person suffers from bipolar and alcohol use disorder, the increased suicide risk is extremely dangerous.

While doctors do not clearly understand the connection between bipolar disorder and alcohol use disorder, various factors can play a role. For example, specific genetic traits affect brain chemistry in bipolar disorder. In the same way, these genetic differences also affect how the brain responds to alcohol. This increases a person’s risk of alcohol use disorder.

Treating Co-Occurring Conditions

Bipolar disorder accompanied by alcohol use disorder increases the risk of more mania episodes, need for hospitalization, and more suicidal thoughts. For this reason, it is necessary to treat both conditions at the same time and under specialized care. Because alcohol can alter or enhance bipolar symptoms, treatment typically begins with detox. This allows medical providers to manage care during withdrawal, evaluate bipolar symptoms, and begin treatment.

Treating only one condition is likely to be ineffective and lead to possible complications and relapse. Because alcohol can alter bipolar symptoms, treating bipolar disorder alone is difficult when a patient is under the effects of alcohol. If the treatment only focuses on alcohol use disorder, the chances of relapse are high. 

Providers must also address the symptoms of bipolar disorder that triggered alcohol use. If you or a loved one has received a dual diagnosis, treatment in an integrated facility specializing in mental health and substance abuse is critical.