Bipolar Disorder and Alcohol Use Disorder: A Review Current Psychiatry Reports

Those with both bipolar and a substance use disorder are more likely to commit suicide. In someone who has bipolar disorder, drinking can increase symptoms of mood shifts. However, it may also be difficult to control the impulse to drink during shifts in mood. To receive a bipolar 2 disorder diagnosis, you must have had at least one major depressive episode.

Challenges with taking medication for bipolar disorder

Sperry notes that previous studies have shown that more than half of people who have a bipolar disorder diagnosis also experience alcohol use disorders sometime in their lives, and that many report using alcohol to help them get to sleep. Bipolar disorder and alcohol problems seem to go hand-in-hand, leading to a widespread belief that drinking acts as a kind of “self medication” to ease bipolar’s life-altering symptoms of mania, depression, anxiety, sleep disturbances and more. People who have a diagnosis of both bipolar disorder and alcohol dependence will need a special treatment plan.

Data used were extracted from February 2006 to April 2022, and follow-up ranged from 5 to 16 years. Research published in 2017 showed treatment with valproate and naltrexone can help people manage bipolar disorder and alcohol addiction. Citicoline is another adjunct treatment option that research suggests is effective for bipolar disorder and cocaine addiction and can also help with improving cognition.

Research on Integrated Group Therapy

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). There are a number of pharmacotherapy trials, and psychotherapy trials that can aid programme development. 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. In conclusion, the combination of bipolar disorder and alcohol use presents significant challenges, but with proper understanding, treatment, and support, these challenges can be overcome.

Study volunteers’ data makes a big difference

Thus, patients are told that drinking will negatively affect the course of their BD, and that non-adherence to their BD medication will increase their risk of relapse to drinking. Again, the focus on the intersection between the two disorders is consistent with the single-disorder What Are the Early Signs of Addiction paradigm. Because of this, people with both conditions may not get the full treatment they need at first. Even when researchers study bipolar disorder or AUD, they tend to look at just one condition at a time. There’s been a recent trend to consider treating both conditions simultaneously, using medications and other therapies that treat each condition.

Lithium has been the standard treatment for bipolar disorder for several decades. Unfortunately, several studies have reported that substance abuse is a predictor of poor response of bipolar disorder to lithium. More specifically, as stated previously, compared to non-substance abusers, alcoholics appear to be at greater risk for developing mixed mania and rapid cycling. 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). This suggests that lithium may not be the best choice for a substance-abusing bipolar patient.

1. By Sarah Bence, OTR/LBence is an occupational therapist with a range of work experience in mental healthcare settings.
2. Still, alcoholic patients going through alcohol withdrawal may appear to have depression.
3. The role of genetic factors in psychiatric disorders has received much attention recently.
4. Bipolar disorder (BD) and alcohol use disorder (AUD) are independently a common cause of significant psychopathology in the general population.

Eighty-two percent of patients stayed on naltrexone for at least 8 weeks, 11 percent discontinued the medication because of side effects, and the remaining 7 percent discontinued for other reasons. The authors concluded that naltrexone was useful in treating patients with comorbid psychiatric and alcohol problems. However, Sonne and Brady (2000) reported on two cases of bipolar women (both actively hypomanic) who received naltrexone for alcohol cravings, and both had significant side effects similar to those of opiate withdrawal. Given that there is only preliminary data on the use of naltrexone in bipolar alcoholics to date, naltrexone should be used with caution in patients who have been actively hypomanic. Multiple explanations for the relationship between these conditions have been proposed, but this relationship remains poorly understood. Alcohol use may worsen the clinical course of bipolar disorder, making it harder to treat.

There has been little research on the appropriate treatment for comorbid patients. Some studies have evaluated the effects of valproate, lithium, and naltrexone, as well as psychosocial interventions, in treating alcoholic bipolar patients, but further research is needed. Psychosocial interventions have often been considered the mainstays of treatment for alcoholism and other substance use disorders. Several studies have demonstrated success with cognitive behavioral therapy in treating alcoholism (Project MATCH Research Group 1998). Many of the principles of cognitive behavioral therapy are commonly applied in the treatment of both mood disorders and alcoholism.