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Bipolar Disorder and Alcohol Abuse

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There are few mental health disorders that are as closely linked to alcohol abuse as bipolar disorder

Alcohol intensifies the symptoms of bipolar disorder through its sedative effects. Every sip of alcohol increases the risk of depression and mania severity.

Link Between Bipolar Disorder & Alcohol

While alcohol use disorder (AUD) is very common among those with mental illness, it's highest among those with bipolar disorder.

Many people with bipolar disorder turn to alcohol to self-medicate and reduce symptoms. While they may find temporary relief, alcohol increases the severity of symptoms over time.

Because the symptoms of the two conditions are similar, proper diagnosis and treatment of bipolar disorder are often delayed.

Suicide is an especially pressing concern for both bipolar disorder and AUD. Alcohol's depressive effects can amplify those already experienced with bipolar disorder.

While doctors do not fully understand the connection between the two conditions, genetics also play a role. Both AUD and bipolar disorder are inheritable conditions.

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What is Bipolar Disorder?

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

When a person experiences mania, they may feel happy, energetic, or even irritable. Manic depression causes feelings of sadness and loss of interest in most activities.

These extreme mood changes can also affect energy levels, sleep patterns, cognition, and behavior.

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

Bipolar I Disorder

Bipolar I disorder is the only one that includes manic episodes. It's the more severe form, with manic episodes that last for at least a week and depressive episodes lasting for at least 2.

It's also possible to experience episodes of depression with manic symptoms at the same time.

Bipolar II Disorder

Bipolar II disorder has episodes of depression and hypomanic episodes, but no mania. A person is more likely to seek treatment during a depressive episode than a manic episode.

Symptoms of Bipolar Disorder

Bipolar disorder 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 different. Mania is more severe and can trigger a break from reality, or psychosis.

Mania and hypomania symptoms include:

  • 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 include:

  • 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
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Can You Drink Alcohol With Bipolar Disorder?

Alcohol amplifies bipolar symptoms.

Because alcohol is a depressant, it can make depression worse for those with bipolar disorder. And because it has stimulant-like qualities (in small doses), it can lead to mania as well.

Alcohol also interacts with a variety of medications, including medications for bipolar disorder like lithium. It reduces their effectiveness and can increase their side effects, such as dizziness and nausea.

A 2006 study found a direct link between alcohol consumption and rates of depressive or manic episodes in people with bipolar disorder.9

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Bipolar Disorder & Alcohol Use Disorder (AUD)

Moderate drinking is a common way for people to unwind and de-stress. It's defined as one drink a day for women and two a day for men.

However, when alcohol consumption exceeds that amount, it becomes alcohol abuse.

Binge drinking 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 (AUD).

Also known as alcoholism, AUD 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 AUD.

Common symptoms of AUD (or alcoholism) 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

Treating Co-Occurring Bipolar Disorder & AUD

When someone is diagnosed with both a substance use disorder (SUD) and mental health disorder, this is called a dual diagnosis.

AUD has the highest co-occurrence rate with bipolar disorder. These co-occurring conditions also tend to have the most negative outcomes.

Over 46 percent of those with bipolar I and almost 40 percent of those with bipolar II have AUD.8

Alcohol can alter or enhance bipolar symptoms. For this reason, 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, leading to complications and relapse. Because alcohol can alter bipolar symptoms, it can make treatment of bipolar disorder difficult.

Treating alcoholic bipolar patients requires a multi-faceted approach. Providers must also address the symptoms of bipolar disorder that trigger alcohol use.

If you or a loved one has received a dual diagnosis, such as comorbid bipolar disorder and substance abuse disorder, seek treatment today.

Treatment in an integrated facility specializing in mental health and substance use is critical.

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Updated on April 7, 2022
9 sources cited
  1. Bipolar Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services.
  2. Bipolar Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 31 Jan. 2018.
  3. Bipolar Disorder and Alcoholism.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services.
  4. Daniel K. Hall-Flavin, M.D. “Each Can Worsen the Symptoms and Severity of the Other.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Apr. 2019.
  5. Strakowski, Stephen M. “Effects of Co-Occurring Alcohol Abuse on the Course of Bipolar Disorder Following a First Hospitalization for Mania.” Archives of General Psychiatry, American Medical Association, 1 Aug. 2005.
  6. Yasgur, Batya Swift. “Managing Comorbid Bipolar Disorder and Alcohol Use Disorder: Clinical Challenges and Conundrums.” Psychiatry Advisor, 17 Dec. 2018.
  7. Brunette, Mary, et al. “A Review of Research on Residential Programs for People with Severe Mental Illness and Co-Occurring Substance Use Disorders.” Drug and Alcohol Review, vol. 23, no. 4, Jan. 2004, pp. 471–481.
  8. Cerullo, Michael A, and Stephen M Strakowski. “The prevalence and significance of substance use disorders in bipolar type I and II disorder.” Substance abuse treatment, prevention, and policy vol. 2 29. 1 Oct. 2007.
  9. Goldstein, Benjamin I. “The Association between Moderate Alcohol Use and Illness Severity in Bipolar Disorder.” The Journal of Clinical Psychiatry, vol. 67, no. 01, 2006, pp. 102–106., https://doi.org/10.4088/jcp.v67n0114.

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