Bipolar Disorder and Alcohol Use Disorder: A review PMC

The same study reports on a 1-year prevalence of 5.7% for substance abuse (except nicotine) according to DSM-IV criteria. Three percent fulfilled criteria for alcohol dependence and 1.8% for abuse (4). In a prior survey, looking at lifetime prevalence rate, the same group reports on similar numbers for BD, and 9.9 and 8.5% for alcohol abuse and dependence, respectively (5). These numbers are in a similar range as in other European countries; while prevalence rates from the US are much higher, both for BD and substance abuse/dependence (6). Whereas numbers for legal substances, e.g., alcohol, are considered as relatively robust and reproducible, many cases of illicit drug use remain undetected in patients with BD.

Recovery is possible

To diagnose AUD, a medical or mental health professional will conduct a thorough assessment, including exploring a person’s psychological and physical health history. They will also gather information about a person’s past and current behavior with alcohol and other substances. For both conditions, a healthcare provider usually performs a physical and psychological health assessment.

How these disorders are diagnosed

When a person takes their medication, they are in a better position to manage their condition. However, adhering to treatment can be difficult for some people with bipolar disorder. The researchers found a direct link between alcohol consumption and the rate of occurrence of manic or depressive episodes, even when study participants drank a relatively small amount of alcohol. In the past, researchers have noted that symptoms of bipolar disorder appear as a person withdraws from alcohol dependence.

When to see a doctor

Brown et al. reported rates of SUDs in patients with BD ranging from 14 to 65% in treatment settings (48) but only a minority has received a correct diagnosis so far. Given the high incidence of psychiatric comorbidities in AUD, the German S3 Guideline recommend in every patient with AUD to carefully screen for psychiatric comorbidities after completing treatment of acute intoxication or withdrawal (49). If you or your loved one is using substances to help with handling bipolar disorder, know that you’re not alone in this mindset. A lot of people find themselves trying to self-medicate to help cope with symptoms.

In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy). Addictive behavior and alcohol and substance abuse are common among people with bipolar disorder. A third feature of IGT is a discussion of the relationship between the two disorders.

1. Future studies are needed to examine whether abstinence (refraining from any alcohol use) vs harm-reduction methods (self-moderation and reducing frequency or amount)40 differentially alter mood, functioning, and course of illness.
2. Electroconvulsive therapy (ECT) involves brain stimulation while you are under anesthesia.
3. By conducting this delineated analysis, we provide insights into subtype-specific dynamics of alcohol use and mania or hypomania.
4. Alcohol can affect a person with bipolar disorder differently, compared with someone who does not have it.

People with bipolar II disorder often enjoy being hypomanic (due to elevated mood and inflated self-esteem) and are more likely to seek treatment during a depressive episode than a manic episode. Cyclothymia is a disorder in the bipolar spectrum that is characterized by frequent low-level mood fluctuations that range from hypomania to low-level depression, with symptoms existing for at least 2 years (American Psychiatric Association [APA] 1994). 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).

When you have this type, you have the high energy level and euphoria of mania, but you’ll also have symptoms of delirium. Those include confusion, disorientation about time and place, and an altered sense of reality. Mania is condition that produces extremes – mood, energy, activity, and behavior. Your highly elevated mood and activity are noticeable to other people and a switch from your usual demeanor.

A plan for ongoing treatment or strategies to avoid drinking after a stay in residential treatment will help you avoid relapsing. It is hard work to go through treatment for both bipolar disorder and alcohol use disorder, but if you put in the time and effort it really can be effective. Besides psychotherapy an individually tailored pharmacotherapy is essential in almost all BD patients with comorbid AUD. For BD, pharmacotherapy is an essential component to stabilize mood and prevent recurrences, whereas its role for treating AUD beyond controlling acute withdrawal symptoms is less clear. Randomized controlled studies in BD traditionally exclude patient with concurrent SUD. 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).

However, recent preliminary evidence suggests that liver enzymes do not dramatically increase in alcoholic patients who are receiving valproate, even if they are actively drinking (Sonne and Brady 1999a). Thus, valproate appears to be a safe and effective medication for alcoholic bipolar patients. In a 5-year followup study, Winokur and colleagues (1995) evaluated a group of bipolar patients with and without alcoholism. In the alcoholic patients, bipolar illness and alcoholism were categorized as being either primary or secondary. The patients with primary alcoholism had significantly fewer episodes of mood disorder at followup, which may suggest that these patients had a less severe form of bipolar illness.

The other hypothesis, namely that patients with BD use alcohol to self-medicate their mood symptoms, or drink a result of their tendency towards impulsive behaviours, may also apply (Swann et al., 2003). It is likely, however, that within the spectrum of comorbid AUD and BD, there lies a variety of orders and associations, and that no one hypothesis explains the full spectrum of presentations. Consistent https://rehabliving.net/what-is-to-sponsor-definition-and-meaning/ with this is the fact that when comorbid groups are studied, some patients present with BD first, some with AUD first, and some patients present with both simultaneously (Strakowski et al., 2005a). Those with AUD first tend to be older and tend to recover more quickly, whereas those with BD first tend to spend more time with affective disorder, and have more symptoms of AUD (Strakowski et al., 2005a).

There were more suicide attempts and psychiatric hospitalizations among the cohort with drug abuse. Aripiprazole is an antipsychotic that partially agonizes dopamine receptors. Aripiprazole was used as an adjunctive intervention in a randomized trial of 35 patients with comorbid alcohol dependence and depression.37 There was less depression in both the aripiprazole plus escitalopram group and the escitalopram group. Imaging showed a change in activity in the left cingulate gyrus in the patients with comorbid alcohol dependence and MDD.

Bipolar disorder used to be called manic depression, but healthcare professionals don’t use this term anymore. People must have at least five of the above symptoms, including a persistent depressed mood, to have a depression diagnosis. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the lifetime prevalence of co-occurring depression and AUD is 27% to 40%, and the 12-month prevalence is up to 22%. “The reasons behind our findings likely have more to do with what alcohol and social situations involving alcohol do to a person’s circadian rhythms and brain-based reward circuits, not just the action of the substance in the brain,” says Sperry. Randomized controlled studies on pharmacological treatments of comorbid BD and AUD. Addiction is a disease that rewires the brain to increasingly seek out a substance for its pleasurable effects.

Many of the principles of cognitive behavioral therapy are commonly applied in the treatment of both mood disorders and alcoholism. Weiss and colleagues (1999) have developed a relapse prevention group therapy using cognitive behavioral therapy techniques for treating patients with comorbid bipolar disorder and substance use disorder. This therapy uses an integrated approach; participants discuss topics that are relevant to both disorders, such as insomnia, emphasizing common aspects of recovery and relapse. People with DSM-IV alcohol dependence are 3.7 times more likely to also have major depressive disorder, and 2.8 times more likely to have dysthymia, in the previous year.

Finally, other researchers have suggested that alcohol use and withdrawal may affect the same brain chemicals (i.e., neurotransmitters) involved in bipolar illness, thereby allowing one disorder to change the clinical course of the other. In other words, alcohol use or withdrawal may “prompt” bipolar disorder symptoms (Tohen et al. 1998). It remains unclear which if any of these potential mechanisms is responsible for the strong association between alcoholism and bipolar disorder. It is very likely that this relationship is not simply a reflection of cause and effect but rather that it is complex and bidirectional.

For comparison, a recent US household survey reports a 12-month prevalence of DSM-5 AUD of 13.9% (9). A doctor may also diagnose bipolar I disorder if a person’s past behavior includes symptoms that meet the criteria, or in other words, if a person has previously had an episode that meets the criteria. The symptoms of both depression and mania must indicate a shift in the person’s behavior or mood. There should also be no other reasons that can explain the extreme changes in mood, such as drug use or a hormone imbalance. Bipolar I features manic episodes that last at least 1 week or are so severe that the person needs urgent hospital care. In some cases, it can be life threatening, as there is a higher risk of suicide and risky behavior than in the general population.

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