The Connection Between Bipolar and Alcohol Abuse

While the association between a mood disorder and co-occurring alcoholism is well established, the most prevalent dual diagnosis is the one involving bipolar disorder and alcohol. Although the science behind this particular comorbidity isn’t yet clear, what is known is that alcohol abuse compounds the severity of the bipolar disorder and complicates treatment.

Bipolar disorder is a complex mental health condition that features extreme mood swings that vacillate between depressive and manic states, with some intermittent normal periods between these. There are four types of bipolar disorder, with bipolar I being the most serious. Individuals who suffer with bipolar disorder may gravitate toward alcohol use in an effort to soften the effects of the mental health disorder.

Gaining a better understanding of the relationship between bipolar and alcohol abuse allows us to improve the response time for getting someone much needed treatment for either or both of these conditions. Fortunately, both bipolar disorder and alcohol use disorder can be effectively managed through medication and psychotherapy.

What is Bipolar Disorder?

Mental illness can result in deep disturbances to all aspects of daily life, and bipolar disorder is particularly difficult to endure. Bipolar disorder, formerly referred to as manic-depression, features extreme mood swings. The characteristic shifts in mood and energy levels make it hard to complete basic tasks that others can so easily accomplish. According to the National Institute of Mental Health, bipolar disorder afflicts about 2.8% of the adult population in the U.S. Among those diagnosed with bipolar disorder, 82% are classified as severe.

The 4 types of bipolar disorder include:

Bipolar I Disorder. Bipolar I is the most common and most severe form of bipolar disorder, characterized by manic episodes that last for at least seven days or with manic symptoms so severe that acute stabilization in a hospital setting is often necessary.

Bipolar II Disorder. Bipolar II is defined by a pattern of manic and depressive episodes, but not to the same severity of Bipolar I.

Cyclothymic Disorder. Cyclothymic Disorder, or cyclothymia, is features repeated periods of manic symptoms and depressive symptoms lasting at least two years, however the symptoms do not reach the diagnostic criteria for manic or depressive episodes.

Unspecified Bipolar Disorders. This category includes those who experience bipolar disorder symptoms that do not fit into the above categories.

Symptoms of bipolar vary depending on the type of the disorder, but may include:

Depressive symptoms

• Low mood that persists
• Loss of interest in everyday life activities
• Fatigue
• Sleep problems
• Inability to concentrate or make decisions
• Feelings of guilt or worthlessness
• Restlessness or slowed behaviors
• Weight loss or gain that is unintended
• Thoughts of suicide

Manic symptoms

• Racing thoughts
• Rapid speech, very talkative
• Euphoric, hyperactive behavior
• Increased activity and energy
• Reduced sleep
• Easily distracted, difficulty finishing tasks
• Engages in high risk behavior
• Poor decision-making

The Effects of Bipolar Disorder

Bipolar disorder can be dangerous to one’s physical health as well. Often the individual with bipolar will fixate on their own death, even obsessing about suicide. Also, many who struggle with bipolar disorder will engage in self-harming behaviors, such as the practice of “cutting” or other forms of self-mutilation, as an outlet for feelings of frustration and self-loathing.

Relationships are hard hit by bipolar disorder. People battling bipolar disorder often isolate themselves, withdrawing socially because they feel misunderstood. The isolating behaviors only worsen interpersonal relationships and can negatively impact employment stability.

Substance abuse is common among those with bipolar disorder, particularly alcohol abuse, further complicating the symptoms and exacerbating high-risk behaviors. Other comorbidities may include anxiety disorder, psychosis, eating disorders, and ADHD.

The Link Between Bipolar and Alcohol Use Disorder

The connection between bipolar disorder and alcohol use disorder has been the subject of research. It has been found that 46.2% of individuals with bipolar I disorder also have a comorbid alcohol use disorder, although it has yet to be discovered exactly why there is such a high prevalence of this dual diagnosis. Some of the possible causes for these comorbid disorders are posed in an article, “Bipolar Disorder and Alcoholism,” [Sonne and Brady]:

• That bipolar disorder may be a risk factor for substance use
• That symptoms of bipolar may emerge during alcohol withdrawals
• That individuals with bipolar may use alcohol to mitigate mania
• That bipolar disorder and alcoholism affect neurotransmitters the same way
• That there is a genetic component with family history of both disorders

Unfortunately, alcohol abuse only enhances the symptoms of bipolar disorder. Although someone suffering from the relentless mood swings attempts to find relief in alcohol use, this strategy only worsens the disease and can lead to alcohol dependence or addiction.

The Warning Signs of Alcohol Use Disorder

The telltale signs and symptoms of alcohol use disorder (AUD) include behavioral, physical, and psychological elements. The DSM-5 established a list of criteria that helps to diagnose the severity of an alcohol problem. The more symptoms that are present, the higher the severity of the AUD. Mild AUD is indicated when 2-3 criteria are present, moderate AUD when 4-5 criteria are met, and severe AUD is diagnosed when 6 or more criteria are met.

The diagnostic criteria include:

• Higher levels of alcohol consumption or drinking over a longer period of time than was intended
• Persistent unsuccessful attempts to cut down or control alcohol use
• Significant time spent obtaining, drinking, and recovering from the effects of alcohol.
• Alcohol cravings
• Recurrent alcohol use leading to failure to fulfill major role obligations at work, school, or home
• Recurrent use of alcohol, despite having mounting interpersonal problems caused or worsened by alcohol
• Giving up or missing important social, occupational, or recreational activities due to alcohol use
• Recurrent alcohol use in high risk situations
• Increased tolerance markedly increases levels of alcohol consumption to get desired effect
• Withdrawal symptoms when alcohol is withheld

Dual Diagnosis Treatment for Bipolar and Alcoholism

According to statistics provided by the National Alliance on Mental Illness, approximately 9.2 million Americans struggle with a dual diagnosis, such as bipolar and alcohol addiction. When layering alcoholism over an existing mental health disorder, the individual’s condition becomes more serious. The resulting co-occurring disorders leaves individuals with mounting negative life consequences and deteriorating mental and physical health.

It is essential to seek help for comorbid disorders at a residential recovery program that specializes in treating a dual diagnosis. These programs are staffed appropriately with the psychiatric expertise necessary to prescribe medication, design a customized treatment plan for co-occurring disorders, and to effectively manage the unique mental health challenges that may emerge in the treatment setting.

It is essential that someone with both bipolar disorder and an AUD obtain treatment for both disorders simultaneously. Treatment will be multi-pronged, including medication, psychotherapy, holistic elements, and recovery support. These treatment elements include:

Detox and withdrawal.  Initially the individual must first eliminate the chemical toxins from the body through an alcohol detoxification process. This typically takes 5-7 days and is best undergone in an inpatient medically supervised detox program that is trained to identify dangerous withdrawal symptoms.

Medication: Mood stabilizing medications, such as antipsychotics and antidepressants, are the most commonly prescribed drugs for treating bipolar disorder. The specific type of bipolar disorder will dictate the medications. Lithium is the predominant medication prescribed for controlling bipolar disorder, in addition to anticonvulsants and SSRIs. Some may benefit from medication-assisted treatment for the alcoholism. Naltrexone is a non-narcotic drug that can help individuals maintain sobriety by reducing the cravings that lead to relapse.

Psychotherapy: Thoughts can influence behaviors, and negative thoughts can lead to self-destructive behaviors. Cognitive behavioral therapy (CBT) is the most commonly used form of psychotherapy for treating bipolar disorder. CBT therapists will guide the individual to identify thought distortions or triggers that lead to the disruptive behaviors, and help them change these destructive thought patterns. CBT is also effective for individuals in addiction recovery, providing them with essential coping skills.

Interpersonal and social rhythm therapy.  IPSRT provide life skills that helps the patient learn how to better predict and manage the bipolar episodes. This therapy focuses on the importance of maintaining a consistent daily routine, in addition to improving interpersonal relations and stress management.

Holistic: Experiential and holistic therapies can aid in regulating bipolar symptoms and promote overall wellness. These activities might include massage therapy, yoga, deep-breathing techniques, mindfulness meditation, art therapy, guided imagery, and aromatherapy.

Lifestyle: Because establishing a healthy routine is essential in managing bipolar disorder, residential programs will counsel patients on nutrition and exercise. Improving sleep quality, getting regular exercise, eating a nutritious diet, and managing stress are all intrinsic to achieving emotional stability and reducing the probability of a relapse.

Recovery support groups.  Success in recovery does not end with completion of a dual diagnosis program. Aftercare is an important aspect of recovery and should be included in the comprehensive dual diagnosis treatment planning. Aftercare includes regular participation in a recovery community, such as a 12-step or non 12-step program, ongoing outpatient group and individual counseling, and possibly transitional housing for a few months in sober living.

Elevation Behavioral Health Provides Dual Diagnosis Treatment

Elevation Behavioral Health is an upscale private residential mental health program in Los Angeles. Elevation is committed to providing leading dual diagnosis treatment for individuals who struggle with both bipolar disorder and alcohol use disorder. Our expert staff ensures that each individual in our care receives compassionate and respectful care, along with the most up to date evidence-based treatment measures. Our beautiful, serene setting provides a soothing and supportive environment for healing and new beginnings. For more information, please reach out to the Elevation team at (888) 561-0868.