Alcohol & Bipolar Disorder

Bipolar disorder is a mental illness.

In the UK, 1.3 million people are affected. [1] It’s widely acknowledged in the medical field that when people have mental health symptoms, co-occurring conditions are much more likely to develop.

This is especially the case for people who have bipolar disorder and addiction to alcohol.

The Link Between Alcohol Use Disorder & Bipolar Disorder

Alcohol addiction

Having a mental health disorder increases the likelihood of substance use disorders developing. In the case of bipolar disorder (BD), the situation is no different.

In fact, some research shows that the co-morbidity of alcohol use disorder (AUD) in bipolar disorder can reach 45%. [2] That’s a huge amount of people.

While some might refer to themselves as bipolar alcoholics, the professional term is a comorbid condition or dual diagnosis of BD and AUD.

There’s a common misconception that bipolar disorder is a condition where people have extremely happy highs and severe depressive lows. While the experience of extreme emotions is a constant push and pull, they can fluctuate between a much wider range of emotions than simply “happy and sad”.

For many people with bipolar disorder, there can be severe feelings around a loss of control. When caught up in mood episodes, turning to alcohol can feel like the only option to numb or escape extreme feelings.

While alcohol can exacerbate symptoms of BD, its immediate effects such as helping people to relax can be too much of a temptation to resist at desperate moments. This, of course, has implications which will be discussed later.

What is Bipolar Disorder?

Bipolar disorder used to be known as manic depression. It’s a condition that is characterised by manic symptoms as well as depressed affective episodes.

In manic episodes people present as and feel high and overactive. On the other hand, in depressive episodes, people are low and lethargic.

There are different types of bipolar disorder that have slightly different implications in terms of how they present. What’s common throughout all types are feelings of hopelessness, despair, numbness, anger, sadness, and of course on the “high side” happiness and excitability.

These mood swings and extremes can last for weeks.

Bipolar 1 disorder

To understand a bit more about the differences in types of conditions, it’s important to look at bipolar disorder symptoms.

BD type 1 is characterised by its highs. People will experience at least one high episode lasting at least a week.

In fact, the mania can go on for 3-6 months if a person doesn’t have access to mental health resources and professional treatment. When affected by mania people can lose their ability to accurately perceive and make sense of the world.

Some depressive episodes are also present for some people and these can also last for months at a time. Interestingly, research shows that alcohol use disorder is more likely for people with bipolar 1 disorder. [2]

Bipolar 2 disorder

BD type 2 is characterised by its lows and as such can, unfortunately, be misdiagnosed as depression.

People will experience at least one depressive episode – it’s usually more and episodes can last for months at a time if left untreated. The depressive episodes can be broken up by some hypomania episodes.

Hypomania presents as a high but is not as extreme as mania, therefore people don’t reach the highs that are apparent in bipolar 1 disorder and are still able to connect with reality.

Cyclothymia or cyclothymic disorder

Cyclothymia is milder than bipolar disorder. It’s characterised by regular episodes of hypomania and depressive episodes that present for at least two years.

This condition can actually turn into bipolar disorder.

It can be very difficult for people to get a diagnosis and can be frustrating as symptoms might not present as being “extreme enough” despite how negatively impacting it can be on life.

Rapid cycling

Rapid cycling is self-explanatory in some ways, people quickly pass from one episode to another and this tends to go in a cycle. It’s characterised by a person having at least 4 episodes in a year ranging from and between manic, hypomanic, depressive, and mixed symptoms.

People can switch between various episodes in the course of a day whereas others will experience it changing across a week or month. Stable episodes are also present.

How Bipolar is Diagnosed

At home support

As with all mental health conditions, a person needs to have their psychiatric symptoms assessed in light of a variety of factors.

A mental health professional or psychiatrist – people going through a diagnosis will meet with a variety of healthcare professionals – will assess you and talk to the professional team around you.

The professional will need to rule out any other conditions and will hold an assessment that will focus on various topics from your history, physical health, mental health, environment, etc.

What are the Causes of Bipolar Disorder?

While a direct cause can’t be pointed at in relation to bipolar disorder, there are risk factor indications that can make it more likely.

The NHS states that BD is most likely linked to:

  • Chemical imbalances in the brain in relation to one or more neurotransmitters (serotonin, adrenalin, and dopamine).
  • Genetic factors. Where people are diagnosed with bipolar disorder, there are quite often other family members who also have it. Although there isn’t a “bipolar” gene that actually causes it, there definitely appears to be a genetic component that is linked to environmental influences that might trigger the disorder.
  • Emotional and physical triggers such as a family death, being the victim of abuse, sleep disturbances, and overwhelming daily stress. [3]

What is Alcohol Use Disorder?

Alcohol

Alcohol use disorder is a disease that impacts the mind and physical body. It’s significantly characterised by a person losing control of their alcohol intake.

They’ll develop alcohol cravings and build up a tolerance to it resulting in increased consumption.

This condition leads to negative effects on a person’s physical and mental health. It’s also very common for families to fall apart or at least experience serious trauma linked to the addiction and behaviours, and for there to be financial worries linked to alcohol use.

As addiction and dependence form, going without the substance leads to alcohol withdrawal which can be distressing and even dangerous. The treatment of alcohol dependence under a doctor is essential in order to keep a person safe, and at extreme levels, alive.

Alcohol Use & Bipolar Disorder

Research shows that of all mental health illnesses, BD is the most likely to present as a comorbid condition. The likelihood of comorbid alcohol abuse or drug use disorders along with BD is very high.

In fact, one study reported that 62.3% of people with BD were shown to also have a dual diagnosis along with AUD (23.2% with alcohol dependency). [4]

Bipolar symptoms can result in people turning to alcohol. However, despite the effects sought, drinking can make BD worse.

Alcohol is a depressant and as such can worsen depressive states. When a person is in a manic state, alcohol can exaggerate the level of mania.

As well as exacerbating symptoms of bipolar disorder, alcohol when mixed with BD medications introduces a whole other level of physical and mental health risks.

Alcohol & Manic Episodes

As is to be expected, introducing a psychoactive substance to a brain where there is already a chemical imbalance or alternative functioning can cause further implications.

Alcohol causes changes in brain chemicals and this along with an episode of mania can lead to various symptoms:

  • An extremely elevated mood where a person feels high or “buzzing”.
  • Euphoria.
  • Extremely agitated and “overactive”.
  • Incessant and rapid speech.
  • Extremely self-confident or self-grandiosity (i.e. feeling invincible or above the law).
  • Hallucinations, psychosis or psychotic symptoms.

The level of energy can increase cravings for alcohol as people try to self-medicate and bring themselves down. Alternatively, alcohol can make the above situations worse as it works as a type of “fuel” to delusional thought, speech, and behaviour.

Alcohol & Depressive Episodes

During depressive episodes people can experience the following symptoms:

  • Extreme sadness.
  • Feeling isolated and lonely.
  • Feelings of despair and hopelessness.
  • Feelings of anxiety, guilt, and shame.

Of course, this can lead to excessive alcohol consumption as a person tries to numb or dull senses and feelings. Unfortunately, alcohol worsens symptoms because of its natural effects on brain chemistry and hormones.

The Risks of Alcohol Use When a Person has Bipolar Disorder

It’s important that people with bipolar disorder understand how alcohol misuse alters their future prospects in relation to physical and mental health.

The effects of alcohol on health include:

  • High blood pressure.
  • Heart disease.
  • Increased risk of cancer.
  • Liver disease.
  • Alcohol-related dementia.
  • Stroke.
  • Digestive problems.
  • Increased risk of mood swings, anxiety, and depression.

When people have bipolar disorder along with alcohol use disorder, they’re also at an increased risk of suicide.

While many people with BD won’t have suicidal thoughts, it’s a reality that needs to be acknowledged and discussed in order to help prevent suicidal behaviours for those who are affected.

Alcohol can also interact with bipolar medications. Although many people with BD have psychological therapies as part of treatment, medications are a key part of managing mental health.

Often, patients have been prescribed antidepressants, antipsychotics, and mood stabilisers, all of which can have adverse and dangerous effects when combined with alcohol.

In fact, lithium (a common medication in the treatment of BD) can quickly reach toxic levels if you drink alcohol with it in your system.

Mixing medications with alcohol

Pills

When you mix alcohol with bipolar drugs, there are many serious risks including:

  • Drowsiness and sedation
  • Increased risk of drug toxicity.
  • Increased risk of suicide.

Treatment for both mild and heavy alcohol use is important for people with BD. For those who have developed a dependency, an alcohol detox is critical for general health as well as in relation to health implications where BD medications are involved.

What Treatments are there for Bipolar Disorder & Alcohol Use Disorder?

Therapy

It’s really important to find effective treatments to manage comorbid bipolar and alcohol use disorder. The most successful approaches include a combination of medications, psychological therapies, and psychosocial treatments.

In healthcare settings, different teams address different conditions. It can therefore feel tricky to find a way to navigate seeing both a mental health team who addresses BD and a substance abuse team who addresses alcohol use.

People tend to focus on one condition before the other.

In relation to bipolar disorder, people are treated by a mental health professional who will identify appropriate medications and therapies to treat the BD.

It’s imperative to get on top of alcohol use, however, in order for this to be effective. This might feel easier said than done, especially as it can take a little while for BD medications to kick in and to see the results of whether they work for the individual.

It’s possible to live a well-managed life with positive well-being as a focus if a person is equipped with professionals in how to do so.

In relation to alcohol use, there are a few options that offer recovery support including:

  • NHS community treatment programmes through your local drug and alcohol service.
  • Self-help groups such as Alcoholics Anonymous and SMART recovery groups.

Private Rehab Treatment

It has to be pointed out that inpatient treatment programmes at private clinics offer the best approach to achieving sobriety.

They provide all the necessary resources and techniques to manage addiction through alcoholism treatments that include the following:

Going to a private clinic gives each person the space and time to become alcohol-free while in a safe environment. It actually provides a brilliant opportunity because the time can also be used – while under 24-hour care – to stabilise BD medications.

Mental health care professionals can liaise with rehab staff to manage your treatment through a joint approach.

Alcohol detox at rehab

In private clinical settings, people can have an alcohol detox. This is used to wean people off alcohol who have become dependent. The detox usually lasts around ten days and is overseen by a doctor.

In most cases, Librium is prescribed to manage withdrawal symptoms. However, this is discussed on an individual basis according to your health needs.

After the detox period, attention focuses on psychological and holistic therapies which are used to tackle the psychological aspect of alcohol addiction.

Final Thoughts

It can feel overwhelming to consider the effects of both bipolar disorder and alcohol use disorder simultaneously. However, long-term recovery is possible.

It’s really important to focus on what you stand to gain from recovery (i.e. more stable periods) rather than what you lose (i.e. alcohol).

Mental health and substance addiction staff can work together to form a care package for your recovery in both areas. While the journey can feel daunting at the start, a stay at a private clinic can make this easier as you’ll be supported by specialist staff who provide 24-hour support.

Get Help Today

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To find out more, contact Rehab 4 Alcoholism for a conversation about your options.

References

[1] https://www.bipolaruk.org/faqs/bipolar-the-facts#:~:text=Bipolar%20is%20a%20severe%20mental,is%20one%20in%20fifty%20people.

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730445/#:~:text=Bipolar%20disorder%20and%20alcohol%20use%20disorder%20represent%20a%20significant%20comorbid,and%20poor%20response%20to%20treatment.

[3] https://www.nhs.uk/mental-health/conditions/bipolar-disorder/causes/

[4] https://www.frontiersin.org/articles/10.3389/fpsyt.2021.660432/full