This narrative review tries to summarize current knowledge about the incidence, influence and treatment of illicit drug abuse in people with BD. However, these subjects may also suffer from cyclothymic or bipolar II disorders (BD II). Treating SUD in bipolar disorder requires a comprehensive and multidisciplinary approach. Incidence and management of illicit drug use differ from alcohol use disorders, nicotine use of behavioral addictions. It is only through demonstration of the effectiveness of treatment integration that there will be extensive therapeutic efforts to bridge psychiatric treatment programmes and services, and substance abuse treatment programmes and services.

Since alcohol can alter or enhance bipolar symptoms, treatment typically begins with detox. For many with bipolar disorder, regular drinking as a form of self-medication dramatically increases the risk of AUD. The two main types of bipolar disorders are bipolar I and II. While alcohol use disorder (AUD) is common among those with mental illness, it’s highest among those with bipolar disorder.

The Best Drug Abuse Treatment Centers for Unique Needs

Results of an open study suggested a reduction of both craving and stabilization of mood with naltrexone in patients with BD + AUD (125). Randomized controlled studies on pharmacological treatments of comorbid BD and AUD. This finding is of note as many antidepressant treatment modalities are less effective in BD patients with comorbid AUD. Carbamazepine has been traditionally used in acute alcohol withdrawal to reduce the risk of seizures and ameliorate physical symptoms. In general, treatment-refractory patients are over-represented in the group of BD patients with comorbid SUD (107). Thus, the evidence for choosing a mood stabilizer in BD with comorbid AUD is rather weak; strictly speaking, high levels evidence consists of altogether three placebo-controlled studies in this patient group (104–106).

Alcohol consumption can significantly interfere with the effectiveness of medications prescribed Blues drugs to manage bipolar disorder, creating a dangerous scenario for individuals trying to stabilize their condition. The disinhibiting effects of alcohol may also lead to poor decision-making, such as spending sprees, risky sexual behavior, or aggressive outbursts, which are hallmark symptoms of manic phases. During manic phases, alcohol may intensify impulsivity, aggression, and risky behaviors, while in depressive phases, it can deepen feelings of sadness, hopelessness, and suicidal ideation. Are you or a loved one struggling with addiction to alcohol and bipolar disorder?

Post-hoc analysis showed that acamprosate treatment resulted in lower Clinical Global Impression scores of substance abuse severity in the last two weeks of the trial (Tolliver et al., 2012). Brown et al. (2009) followed up with a randomized, double-blind, placebo controlled study of naltrexone added-on to pharmacotherapeutic regimens to treat participants with BD and alcohol dependence. In a sixteen-week, open-label, pilot study of naltrexone added on to existing regimens for 34 participants with BD and alcohol dependence, significant improvement was observed on both the HAM-D and YMRS, and days of alcohol use and craving decreased significantly (Brown et al., 2006).

Bipolar Disorder & Alcohol Use Disorder (AUD)

Drinking on bipolar medication can turn one drink into several, especially drinking on an empty stomach. Alcohol also greatly increases the severity of mania, which many who suffer from bipolar find extremely pleasurable. These patterns do not fit into specific labels of the illness, lacking a more efficient way to classify a similar disorder.

Why do people with bipolar disorder drink alcohol?

This cycle acceleration is particularly dangerous because it reduces the time between episodes, leaving little room for recovery and increasing the overall emotional and physical toll on the individual. One of the primary mechanisms through which this occurs is alcohol’s disruptive effect on sleep patterns. Understanding this relationship is essential for both individuals and their support systems to make informed decisions about managing the condition effectively. The resulting fatigue and emotional instability further deepen feelings of hopelessness, creating a feedback loop where depression and alcohol use reinforce each other.

Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. A 6-month, double-blind, maintenance trial of lithium monotherapy versus the combination of lithium and divalproex for rapid-cycling bipolar disorder and co-occurring substance abuse or dependence. Family treatment for bipolar disorder and substance abuse in late adolescence. A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence. Depression precipitated by alcohol use in patients with co-occurring bipolar and substance use disorders.

For those with bipolar disorder, alcohol is a depressant that can disrupt the delicate balance of mood regulation, potentially triggering manic or depressive episodes. 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 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 and alcohol dependence often experience intensified manic and depressive symptoms, increased impulsivity, and worsened medication side effects. Many people with bipolar disorder and alcohol abuse experience more frequent mood swings and rapid cycling, increasing the risk of hospitalization and long-term instability. While alcohol does not directly cause bipolar disorder, excessive drinking can trigger manic or depressive episodes in individuals who are already genetically predisposed to the condition.

Such instability can undermine treatment progress, reduce medication efficacy, and lead to a worsening of the overall condition. For someone already vulnerable to depression, this can prolong and intensify symptoms, making it harder to find motivation or seek help. As the initial stimulant effects wear off, alcohol suppresses brain activity, leading to feelings of sadness, fatigue, and hopelessness. This interference can disrupt the equilibrium that medications and therapy aim to maintain, making mood swings more frequent and severe.

For someone with bipolar disorder, even small changes in sleep patterns can act as a trigger for manic or depressive episodes. The destabilization of sleep caused by alcohol can directly contribute to rapid cycling, a severe form of bipolar disorder characterized by four or more mood episodes within a year. For those with bipolar disorder, avoiding alcohol is not just a recommendation but a critical component of maintaining emotional stability and preventing severe depressive episodes. In summary, alcohol’s role as a depressant poses a significant risk to individuals with bipolar disorder by intensifying feelings of sadness, hopelessness, and suicidal thoughts. This combination of medication interference and alcohol’s depressant effects can make depressive episodes more frequent and intense, hindering long-term management of bipolar disorder.

Alcoholism and bipolar disorder often interact with each other. A considerable amount of alcohol also intensifies mania, which many bipolar patients find quite pleasurable. It increases the chance of depressive symptoms with each sip, much like many substances do. Additionally, substance abuse disrupts the treatment process, resulting in persons losing or forgetting abilities or insights gained during treatment. Medication is crucial in the case of bipolar disorder. Most substances that increase energy or mood also make people feel anxious and depressed, and tired afterward.

Motivations and Consequences of Comorbid SUD in People with Bipolar Disorder

In integrated treatment, a clinician or group of clinicians treats both disorders simultaneously. Although the patients receive expert care for each disorder, they may hear potentially conflicting advice regarding the overlap between the two disorders. Parallel treatment, which ordinarily takes place on an outpatient basis, consists of treating the two disorders in separate settings. As a result, little psychotherapy research has focused on patients with co-occurring BD and alcohol dependence. Similarly, motivational enhancement therapy, twelve-step facilitation therapy, and cognitive-behavioral relapse prevention therapy have all been shown to be effective in the treatment of alcohol dependence (Project MATCH Research Group, 1997). In early to mid-adolescence, initiation of alcohol use may be an environmental effect (with social and peer influences being predominant and changeable)(Smyth et al., 2011), but development most used drug by teens of the alcohol abuse/dependence pattern in late adolescence or in early adulthood, may be subject to genetic influences (Kendler et al., 2009).

During manic phases, alcohol can heighten dopamine levels, intensifying euphoria and impulsivity, while during depressive phases, it can further deplete serotonin, deepening feelings of hopelessness and lethargy. Alcohol affects neurotransmitters such as dopamine and serotonin, which are already dysregulated in bipolar john joseph kelly and amy carter disorder. When medication efficacy is compromised, individuals may experience more severe depressive symptoms, including prolonged periods of sadness and anhedonia (inability to feel pleasure).

• For many with bipolar disorder, regular drinking as a form of self-medication dramatically increases the risk of AUD.
• Post-treatment prognosis can be influenced by a number of factors including early abstinence, baseline low anxiety, engagement with an aftercare programme and female gender.
• When medication efficacy is compromised, individuals may experience more severe depressive symptoms, including prolonged periods of sadness and anhedonia (inability to feel pleasure).
• The evidence for Assertive community treatment (AST) that has been examined in two RCTs is inconclusive, with one study showing a reduction of alcohol use, the other not when compared to standard clinical case management.
• Treatment is a crucial success element for addressing any condition, even though there is finite proof of simultaneously treating both disorders.
• This chapter deals with the intermediate and long-term treatment of comorbid BD and AUD.
• Drinking alcohol can also negatively impact sleep, a key trigger for bipolar mood swings, leading to further emotional instability.

Mental Health               →

• Sequential treatment involves focusing on the more acute disorder first, then treating the other disorder when the acute problem has been stabilized; this approach is most commonly utilized in a hospital setting.
• A person with bipolar disorder experiences mood swings and other symptoms.
• The fact that bipolar subjects with a history of SUD are usually excluded from clinical trials significantly limits the generalizability of RCT findings to the ‘real life’ patient with BD.
• If you suspect that you or your loved one have bipolar disorder, you may consider reaching out to your doctor.
• The program also included psychoeducation on both disorders.
• This uncertainty can delay appropriate adjustments to the treatment plan, further destabilizing the individual’s condition.

The presence of bipolar subtypes was not addressed in this study, so it is not clear if these adolescents had the subtypes of bipolar illness that are more difficult to treat. This suggests that lithium may not be the best choice for a substance-abusing bipolar patient. Researchers have found that patients with mixed mania respond less well to lithium than patients with the nonmixed form of the disorder (Prien et al. 1988). Available research on the use of lithium, valproate, and naltrexone for comorbid patients is reviewed below. Bipolar II disorder and cyclothymia are even more difficult to reliably diagnose because of the more subtle nature of the psychiatric symptoms. Still, alcoholic patients going through alcohol withdrawal may appear to have depression.

O’Sullivan and colleagues (1988) found that alcoholics with bipolar disorder functioned better during a 2-year followup period than did primary alcoholics (i.e., those without comorbid mood disorders) or alcoholics with unipolar depression. A growing number of studies have shown that substance abuse, including alcoholism, may worsen the clinical course of bipolar disorder. Several epidemiological and clinical studies have consistently found high rates of comorbid AUD (i.e., alcohol abuse or dependence) among BD patients (Merikangas et al., 2007; Mitchell et al., 2007; Oquendo et al., 2010). Research published in 2017 showed treatment with valproate and naltrexone can help people manage bipolar disorder and alcohol addiction. A 2018 review looked at epidemiological data to evaluate the likelihood of people diagnosed with mood and anxiety disorders to self-medicate with alcohol or drugs to cope with challenging symptoms.

Alcohol Help does not endorse any treatment facility or guarantee the quality of care provided, or the results to be achieved, by any treatment facility. Alcohol Help is not a medical provider or treatment facility and does not provide medical advice. Make a free, confidential call to a treatment provider today. Medicine can be prescribed to reduce the uncontrollable state experienced, reducing the motivation to drink alcohol as a coping mechanism.

In summary, both epidemiological and clinical studies confirm the high co-incidence of drug use disorders in bipolar patients. In comparison, rates for unipolar depression are 40.3% for AUD (21% for alcohol dependence) and 17.2% for other substance use disorders. Improving mood symptoms by specific pharmacotherapy for BD may be the initial step to get a grip on drug use and use disorders, but in case of excessive drug consumption, acute detoxification treatment need to be first before specific BD treatments can be started. The FIRESIDE Principles for an integrated treatment of bipolar disorder and alcohol use disorder. In the programmatic level, as exemplified by the work of Farren et al. (Farren and McElroy, 2008, 2010; Farren et al., 2010), patients enter a comprehensive integrated treatment programme that focuses on both psychiatric illness and substance use disorders. Addressing alcohol use is therefore critical in breaking this cycle and restoring stability for individuals with bipolar disorder.