Bipolar Disorder and Alcohol Use Disorder

Medically reviewed by Timothy J. Legg, PhD, PsyD, CRNP, ACRN, CPH on April 11, 2016Written by Elizabeth Connor on April 11, 2016

Overview

People who misuse alcohol are more likely to have bipolar disorder. Among people with bipolar disorder, the impact of drinking is staggering. About 45 percent of people with bipolar disorder also have an alcohol use disorder (AUD), according to a 2013 review.

The combination of bipolar disorder and AUD can have severe consequences. People with both conditions are likely to have more severe bipolar symptoms. They may also have a higher risk of dying by suicide.

Linking bipolar disorder and alcohol use disorder

Researchers haven’t identified a clear link between bipolar disorder and AUD, but there are some possibilities. Some theorize that when AUD appears first, it can trigger bipolar disorder. There’s no hard scientific evidence for this idea, though.

Other theories suggest that people with bipolar disorder turn to alcohol in an attempt to quiet their symptoms, especially manic symptoms.

Another explanation for the connection is that people with bipolar disorder exhibit reckless behavior, and AUD is consistent with this type of behavior.

If you have both conditions, it matters which condition appears first. People who receive a diagnosis of AUD may recover faster than people who first receive a diagnosis of bipolar disorder. On the other hand, people who receive a diagnosis of bipolar disorder first are more likely to have difficulty with the symptoms of AUD.

Understanding bipolar disorder

Bipolar disorder is marked by extreme mood swings. Drinking alcohol can often amplify these mood swings. In the United States, bipolar disorder affects about 2.8 percent of the adult population, according to the National Institute of Mental Health. A bipolar diagnosis is described as type 1 or 2, depending on the severity of symptoms.

Bipolar 1 disorder

You must have had at least one manic episode for your doctor to make a diagnosis of bipolar 1 disorder. This manic episode must be preceded or followed by a depressive episode. These episodes may be so severe that you need hospitalization.

Bipolar 2 disorder

Bipolar 2 disorder involves hypomanic episodes. You must have had at least one major depressive episode for your doctor to make a bipolar 2 disorder diagnosis. This episode must last two weeks or more.

You also must have experienced one or more hypomanic episodes lasting for at least four days. Hypomanic episodes are less intense than manic episodes. Learn more about the difference.

How these disorders are diagnosed

Bipolar disorder and AUD are similar in some ways. Both tend to occur more frequently in people who have a family member with the condition.

In people with bipolar disorder or AUD, the chemicals that regulate moods don’t work properly. Your environment as a young person can also influence whether you’re likely to develop AUD.

To diagnose bipolar disorder, your doctor will look at your health profile and discuss any symptoms you may have. Your doctor may also conduct a medical exam to rule out the possibility of other underlying conditions.

To identify AUD, your doctor will ask you a series of questions about your habits and your body’s reactions to drinking. They can also categorize AUD as mild, moderate, or severe.

Treatment for bipolar disorder and alcohol use disorder

Doctors often diagnose and treat bipolar disorder and AUD separately. Because of this, people with both conditions may not get the full treatment they need. Even when researchers study bipolar disorder or AUD, they tend to look at just one condition at a time.

Your doctor might recommend one of three strategies to treat bipolar disorder and AUD:

  1. Treat one problem first, then the other. The more pressing problem is treated first, which is usually AUD.
  2. Treat both problems separately, but at the same time.
  3. Combine treatments and address the problems together.

Many people consider the third approach to be the best method. There isn’t much research that describes how to combine treatment for bipolar disorder and AUD, though.

For bipolar disorder, medication and a mix of individual or group therapy have shown to be effective treatments.

Several options are available to treat AUD. This may include a 12-step program or cognitive behavioral therapy for relapse prevention.

What’s the outlook?

If you have bipolar disorder, you should avoid drinking. If you’re experiencing a hypomanic or manic episode, you may find it difficult to control your impulses to drink. Alcohol can also increase the sedative effects of any mood stabilizers that you may be taking. This could be dangerous.

If you want the social experience of drinking, try an alcohol-free mojito or a virgin bloody mary cocktail. Nonalcoholic beer is also an option. If you don’t see what you want at the bar or at the supermarket, ask your bartender or a clerk at the store for assistance.

If you have bipolar disorder, AUD, or both, talk to your doctor about treatment options that will work for you.

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