Bipolar disorder, once more commonly known as manic depression, is a mental health disorder causing “unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks,” according to the National Institute of Mental Health.
Bipolar disorder in itself is a challenging condition and, for some who struggle with this disease, difficult to manage. Bipolar disorder requires careful monitoring and compliance – a commitment from patients to take their prescribed medications daily and as described as well as, follow through with talk therapy and other treatment regimens. Substance abuse or alcohol addiction further complicates treatment.
Unfortunately, it’s quite common for people who struggle with bipolar disorder to also have an addiction to alcohol or, in some cases, other substances. In fact, alcohol addiction can make bipolar disorder difficult to diagnose and vice-versa, yet successfully managing both diseases is key to long-term recovery and well-being.
What You’ll Find in This Guide:
- Examining the Relationship Between Bipolar Disorder and Alcohol Addiction
- Strategies for Diagnosing Co-Occurring Bipolar Disorder and Alcohol Addiction
- Strategies for Successfully Treating Co-Occurring Bipolar Disorder and Alcohol Addiction
- Long-Term Recovery for People with Bipolar Disorder and Alcohol Addiction
Examining the Relationship Between Bipolar Disorder and Alcohol Addiction
The following resources offer information on the relationship between bipolar disorder and addiction, examining the theories that may explain the high incidence of comorbidity between the two conditions and providing insight into the challenges faced by people with this combination of mental health disorders.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) explains that multiple theories have been presented to explain the link between bipolar disorder and alcoholism, yet the specific link still isn’t fully understood. There is some evidence to suggest an underlying genetic component contributing to both diseases.
But perhaps more importantly, “This comorbidity also has implications for diagnosis and treatment. 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”.
The report notes that the NIMH Epidemiologic Catchment Area (ECA) study in 1990 found astonishing rates of comorbid alcohol abuse disorders among those with bipolar disorder. Specifically:
- 60.7 percent of individuals with bipolar I disorder had a substance abuse disorder – which may include alcohol or other drug abuse – at some point during their lifetime.
- 46.2 percent of individuals with bipolar I disorder had an alcohol use disorder.
- 40.7 percent of people with bipolar I disorder had a drug abuse or dependence diagnosis.
According to the American Journal of Managed Care (AJMC), people with bipolar disorder are more likely to develop an addiction to drugs or alcohol. According to statistics presented by the AJMC, 25% to 50% of people with bipolar disorder have at least one comorbid mental health disorder. Individuals with bipolar disorder are three times more likely to develop alcohol abuse or dependence.
In one study of patients diagnosed with bipolar disorder:
- 46% had comorbid alcohol abuse or dependence
- 41% had drug abuse or dependence
- 21% had panic disorder
- 21% had OCD
Other studies summarized by the AJMC find similarly high rates of co-occurrence among people who struggle with bipolar disorder. “Similarly, the NCS has reported that 6.5% of alcoholic men and 10.6% of alcoholic women have a lifetime history of mania. Among the individuals diagnosed with bipolar I disorder in the NCS study, 71% reported at least 1 lifetime substance use disorder; 61% reported alcohol dependence; 64.2% reported alcohol abuse; 40.7% reported drug dependence; and 46.1% reported drug abuse.”
The primary challenge for those with co-occurring bipolar disorder and alcohol addiction is that the emotional instability common among people with bipolar disorder can make it particularly challenging complying with the guidelines of a treatment plan or recovery program. According to DualDiagnosis.org, a treatment plan or rehabilitation program specifically designed to address the challenges of complex mental health disorders is the key to recovery, as trained specialists are able to design treatment programs that successfully address co-occurring conditions, avoiding the complications presented by symptoms of one disorder that hinder the treatment of another.
Strategies for Diagnosing Co-Occurring Bipolar Disorder and Alcohol Addiction
Diagnosing patients with comorbid bipolar disorder and alcohol addiction proves especially challenging even for skilled and experienced healthcare providers. The following section offer information on diagnostic challenges and approaches as well as information for those who may be struggling with both conditions on what to expect on the path to a diagnosis.
Separating symptom from disorder is the biggest hurdle in successfully diagnosing co-occurring bipolar disorder and alcohol addiction. The Behavioral Health Evolution explains,
Learning to differentiate among these is essential in the assessment process. For the patient, learning the difference is essential to the treatment and recovery process.
Some individuals are diagnosed only when they have begun the path to recovery from alcohol abuse. When alcohol is used as a means to self-medicate and ease the symptoms of bipolar disorder, medical professionals may mistakenly attribute behaviors and other symptoms to alcohol abuse rather than identify the mental illness that is also present. Thus, taking the first step to recover from alcohol addiction if you suspect you may have bipolar disorder can be the key to finally pinpointing the underlying cause of your mental health issues and beginning the journey to successful recovery.
Experts believe that anyone with a substance use disorder or addiction should be screened for bipolar disorder. Due to the high rate of comorbidity of bipolar disorder and alcohol or drug addiction, screening those who presently have an addiction could prove an effective way to identify these patients and initiate active treatment for both disorders simultaneously. If one disorder is treated but the other is not yet diagnosed, it’s possible that people with bipolar disorder will relapse and continue using alcohol and drugs in an attempt to mask the extreme mood swings and other symptoms of bipolar disorder.
People who are bipolar will often struggle with addiction for years and suffer through multiple relapses – finally encountering one provider who suggests screening for bipolar disorder. At Health.com, Jeffrey (name changed for confidentiality) describes his own experience of seeing multiple providers, in part due to moves to other areas. When one provider asks if he’d ever been diagnosed with bipolar disorder and shared information about the symptoms, the last 20 years of Jeffrey’s life suddenly began to make sense.
Bipolar disorder share common symptoms with alcohol addiction, making diagnosis particularly challenging. Providers who understand that every patient may present both with unique circumstances and unique symptoms are best equipped to approach each patient with an open mind. Too quickly attributing symptoms to alcohol or drug abuse could lead to a missed diagnosis and thus leave patients without adequate treatment programs.
Strategies for Successfully Treating Co-Occurring Bipolar Disorder and Alcohol Addiction
After the diagnostic hurdle is overcome, the path to recovery can begin. The following resources provide valuable information on the approach to treatment for people who struggle with bipolar disorder and alcohol addiction.
Inpatient detox and rehab is often a valuable first step in recovery. While the road to recovery may be different for each individual, people attempting recovery from alcohol or drug addiction often have to go through a detoxification period before recovery can truly begin. The National Alliance on Mental Illness (NAMI) explains that detoxification may involve withdrawal symptoms, and this process is safest when carefully monitored by medical professionals who can administer slowly-tapering amounts of the substance – or a medical alternative – to make the withdrawal process easier for the patient to endure. The inpatient setting also provides better results in many cases, as patients do not have the easy access to their substance of choice during the withdrawal period.
Treating both disorders is essential for successfully recovering from either. Sadie Long discusses her experience with co-occurring bipolar disorder and alcohol addiction in an article for The Fix, noting that for her, drinking was the only way she found to ease the pain, yet self-medicating only created an additional problem to overcome. It wasn’t until Sadie was able to achieve sobriety for a longer period of time that doctors were able to successfully identify her bipolar disorder and thus prescribe an appropriate treatment regimen for controlling the symptoms of bipolar disorder while she also continued her road to long-term sobriety.
All treatment providers should be aware of your dual diagnosis. If you’ve been diagnosed with bipolar disorder and a substance use disorder or alcohol addiction, it’s important that all of your treatment providers are aware of your dual diagnosis. Your healthcare providers may overlook important considerations if they’re not aware of the full complexity of your mental health disorders.
Careful oversight to ensure treatment compliance is key. Treatment adherence is of utmost importance for people with bipolar disorder. The nature of the illness results in many patients not being able to recognize their illness, particularly during periods of high symptom severity. During these phases, it’s not uncommon for patients to stop taking the medications that regulate their mood and emotions.
People with bipolar disorder must understand the serious dangers that alcohol use pose for them. Alcohol lowers inhibitions and can exacerbate already-altered moods, resulting in an escalation of symptoms that can easily lead to poor choices, serious injury, or worse.
Long-Term Recovery for People with Bipolar Disorder and Alcohol Addiction
Bipolar disorder is a lifelong mental health disorder requiring long-term management, as is alcohol addiction. Despite the challenges, long-term recovery is achievable and many people struggling with both disorders are able to lead normal lives and maintain long-term health. The following resources offer valuable insights on the key elements of a long-term recovery.
Support groups are important for long-term recovery. As the Depression and Bipolar Support Alliance (DBSA) points out, some organizations promote the idea that to be truly “clean,” you must not use any substances, including those prescribed by a physician for a legitimate mental health disorder. In the case of bipolar disorder, long-term medication therapy is often essential for continued recovery. A support group that recognizes these needs or even focuses on those with dual diagnoses may be a more appropriate choice, depending on your unique circumstances.
Long-term recovery from alcohol addiction coupled with successful management of bipolar disorder requires an integrated approach. Recovery must encompass relapse prevention, help for family members, and other elements. A truly integrated approach addressing not only the person with bipolar disorder and addiction but also their loved ones provides both patient and family with coping mechanisms and knowledge to identify warning signs of relapse or recurrence of bipolar episodes.
Develop coping strategies for overcoming stress and leading a healthier lifestyle. Habits such as regular exercise, for instance, can provide stress relief and promote emotional well-being. A healthy diet, a support network, hobbies or volunteer activities, and ongoing treatment are all important components of a long-term recovery.
Involve family members or other caregivers in recovery. When people you trust understand your illness and know how to recognize symptoms of drug or alcohol use, this support network can intervene. When signs of trouble arise, your personal support system can help you avoid relapse or encourage you to discuss your symptoms with your healthcare providers. In some cases, a simple adjustment to medications or dosage can put you back on the path to health again – and your loved ones can play a key role in helping you maintain long-term well-being. It’s also helpful to have someone you trust to turn to when you’re experiencing normal emotional upheavals and someone to encourage you to adopt healthy habits.
Above all, get involved in your own treatment. Commit to following the key recovery concepts including hope, perspective, personal responsibility, self-advocacy, education, and support. When you take ownership of your mental health and commit to long-term wellness, you gain greater control over your own well-being. This sense of ownership empowers many people who struggle with comorbid bipolar disorder and alcohol addiction to comply with treatment regimens and seek help when they feel as though their symptoms are escaping their control. Even when your disease does escape your grasp, having this sense of ownership will help you to work with treatment providers to work towards regaining your sense of control over your emotions, actions, and your life as a whole.
Struggling with both bipolar disorder and alcohol addiction is not an easy path to take, yet those who suffer from both don’t have a choice in the matter. That said, while the road to recovery may seem long, windy, and rife with obstacles, recovery and long-term well-being is achievable. Long-term disease management requires a commitment to compliance with treatment for both disorders and other key elements, but even those who at first feel there is no hope may achieve long-term health with the proper, integrated, and customized approach to treatment and long-term management of their mental health.
- National Institute on Alcohol Abuse and Alcoholism — Bipolar Disorder and Alcoholism
- DualDiagnosis.org — Bipolar Disorder and Addiction
- American Journal of Managed Care (AJMC) — Bipolar Disorder"Costs and Comorbidity
- Behavioral Health Evolution — Separating Symptom from Disorder in Screening for Co-occurring Disorders
- Brain Blogger — When Bipolar Patients Abuse Drugs – The Dual Diagnosis Dilemma
- Everyday Health — Bipolar and Addiction: The Dual Diagnosis
- Health.com — I'm Bipolar and Struggle With Addiction
- TIME — Addict or Bipolar? Examining the ‘Passion’ of Charlie Sheen
- National Alliance on Mental Illness (NAMI) — Dual Diagnosis
- The Fix — Double Trouble: Bipolar Disorder and Alcoholism
- MD Edge — Bipolar disorder and substance abuse: Overcome the challenges of ‘dual diagnosis’ patients
- Psychology Today — Alcohol, Drugs and Bipolar Disorder: A Bad Combination
- Depression and Bipolar Support Alliance (DBSA) — Dual Diagnosis and Recovery
- Help Guide — Overcoming Alcohol Addiction: How to Stop Drinking and Start Recovery
- Help Guide — Living with Bipolar Disorder: Self-Help Tips for Managing Your Symptoms and Staying Balanced
- Bipolar Care Givers.org — Ways to support the person with bipolar disorder