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Bipolar and Alcohol

9 Minutes

Edited & medically reviewed by THE BALANCE Team

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CONTENTS

Extreme fluctuations in energy and mood are the hallmarks of bipolar disorder, a psychiatric illness that induces severe psychological instability. But contrary to popular belief, bipolar disorder is much more than just mood swings; it causes dramatic changes in cognitive functioning, emotional states, behaviour, and judgment. Individuals diagnosed with this disease may veer from a depressed state to a manic high in days, depending on the type and nature of their disorder. The consequential effects of bipolar disorder are broad-ranging and may cause difficulties in maintaining careers, relationships, and personal life.

Interestingly, studies have found an increased incidence of alcohol and substance use in bipolar individuals. Surveys suggest that approximately half of those diagnosed with an underlying bipolar disorder depend on alcohol to carry out the normal activities of life. When severe symptoms of bipolar and alcoholism occur together, the potential for adverse outcomes significantly increases. Fortunately, various treatment modalities, including medications, individual and group counselling, and intensive addiction treatment, are available to help such people achieve inner balance and lead more productive lives.

Bipolar disorders are usually difficult to identify, especially in people abusing alcohol. The extreme mood swings triggered by this psychiatric issue may resemble the highs and lows one may experience during alcohol intoxication or withdrawal. By the same token, alcohol abuse may intensify the highs and lows associated with bipolar disorder, making it challenging to know whether the source of these mood swings is psychological or chemical.

The changes triggered by bipolar disorder are more drastic than the mood swings that an average individual experiences in their life. While these mood fluctuations may have a particular pattern, they can sometimes strike in unpredictable ways, making one feel out of control. Similarly, the loved ones of a bipolar person may feel helpless when exposed to these dramatic changes.

The red flags raising the suspicion of a bipolar disorder in an alcohol user can be divided into two categories:

Depressive Symptoms

A sense of hopelessness
Physical fatigue
Changes in appetite
Low self-worth
Poor memory and concentration
Reduced energy levels
Suicidal thoughts or suicide attempts
Changes in sleeping habits (difficulty sleeping or sleeping too much)
Brain fog
Self-destructive behaviour

Manic Symptoms

An inflated sense of power (grandiosity)
High energy levels
Unusually high enthusiasm
Pressured speech that jumps quickly from one topic to another
Poor judgment
Impulsive behaviour, such as excessive shopping or alcohol abuse
Indulgence in risky behaviour, such as driving too fast or having unsafe sex
Racing thoughts
Loss of appetite
Edginess or irritability
Frequent anger outbursts

Some people with bipolar disorder may develop a state caused by hypomania, a less severe form of mania characterised by increased productivity, increased elevated levels, and outgoing behaviours.

Remember that the symptoms of bipolar may vary from one person to another. The use of alcohol can occur in both depressive and manic states. In manic phases, individuals may resort to alcohol to calm themselves down; in depressive phases, this depressant helps them tame the feelings of hopelessness and despair.

In an attempt to regulate the severe changes in energy and mood, many bipolar individuals commonly resort to abusing alcohol. As per the Journal of Clinical Psychiatry, up to 70 per cent of people meeting the criteria for bipolar disorder have an underlying history of substance abuse, a percentage far exceeding the general population.

However, most people are unaware of the potential outcomes of using alcohol in bipolar disorder. In reality, alcohol can alter the symptoms of bipolar disorder in several ways, including:

Longer episodes of emotional instability
Intensification of the usual symptoms (including mood swings, impulsivity, poor judgement, irritability, and hostility)

Treating bipolar and alcohol abuse together can be complex and often requires intensive attention to the symptoms of this mental illness as well as the addictive behaviours related to alcohol use. The treatment outcomes for such individuals are likely to be much better if both conditions are managed simultaneously under the same programme. For most effective care, a rehab with cross-trained staff members in substance abuse treatment and mental health care must be prioritised.

Experts believe that the physical and psychological impairment secondary to bipolar disorder can make health care an expensive behavioural health diagnosis, both in terms of cost as well as the loss of life quality. People with bipolar disorder may feel stigmatised, misunderstood, or isolated due to their underlying diagnosis. The condition can also negatively impact different aspects of their life, including occupation, relationships, and finances. Having the support of a loved one can make a significant difference in the treatment outcome.

Many individuals feel uncomfortable discussing their mental illness and underlying addiction with a loved one. However, it is essential to remind yourself that the course of bipolar disorder and addiction is unlikely to improve without seeking professional help. Expressing concern to a loved one may feel embarrassing and awkward initially, but merely having this conversation can make a genuine difference in how the disease progresses and what outcomes it brings.

Too often, a diagnosis of bipolar disorder is established years after individual first experiences the symptoms. Experts state that most people with this disorder do not receive any treatment at least until six years from their first episode. This delay in treatment often makes the symptoms more extreme and increases the likelihood of relapse. Intervening on behalf of a loved one exhibiting signs of bipolar disorder and simultaneous alcohol use may prevent these unnecessary delays while expediting recovery.

Bipolar disorder is a complex mental illness, especially when it is combined with alcohol abuse. Treatment often draws from multiple disciplines and modalities to address the physical, psychological, psychosocial, and neurological needs. In addition to intense individual therapy, patients with this dual diagnosis are offered the following evidence-based interventions:

Motivational Interviewing

This therapy is a collaborative approach in which the client and the therapist work as partners to help the former define their sources of motivation and use them to achieve self-defined goals. The process is highly patient-centred and helps treat bipolar individuals to recover from the effects of alcohol addiction.

Cognitive Behavioural Therapy

This therapy addresses the destructive behaviours and thought patterns contributing to alcohol addiction, anxiety, and depression. As a part of this therapy, clients learn to recognise and manage self-defeating thoughts through self-affirming coping strategies.

Solution-Focused Therapy

This client-centred approach helps them set and achieve specific goals of bipolar disorder and alcohol addiction management. It focuses more on measurable outcomes instead of diving deeply into the origin of their mental health issues.

Trauma Therapies

A history of violence, childhood abuse, trauma, or chaotic living environments often triggers the bipolar disorder. Trauma therapies such as Eye Movement Desensitisation and Reprocessing (EMDR) are added to the treatment programs to manage such cases. Once the symptoms of bipolar disorder are under control, the addictive behaviours related to alcohol use are likely to reduce.

Medications

Medication therapy has proven to be highly beneficial for many people with bipolar disorder. By restoring the balance in their energy levels and mood, these medications can also curb the impulse to abuse alcohol. An expert carefully determines the choice of medication by evaluating each case individually. Some common medicines used to treat bipolar disorder include mood stabilisers, antidepressants, and antipsychotics.

For more comprehensive care for a client with this dual diagnosis, a good rehab centre often provides a single treatment programme for managing alcohol abuse and bipolar disorder simultaneously. These programmes are offered at different levels of care, including:

Medical detox centres (inpatient or outpatient)
Inpatient treatment
Residential rehabilitation
Partial hospitalisation programmes
Outpatient programmes
Intensive outpatient programmes

In the early stages of rehabilitation, many clients benefit more from inpatient and residential treatment programmes. However, once the foundation for recovery is established through intensive residential treatment, they may transition to outpatient services for more autonomy and flexibility.

FAQs

Why do people with bipolar disorder drink alcohol?

Bipolar disorder is characterised by significant changes in mood that may vary in intensity and length. These symptoms often give rise to manic or depressive states, lasting for weeks at a time. Using alcohol temporarily diminishes these effects by changing the user’s energy level and mood.

For instance, if a bipolar person suffers from a depressive episode, they may resort to alcohol to increase their self-confidence and happiness. Similarly, consumption of alcohol and bipolar mania also go hand in hand, as the former helps a person combat insomnia and go to sleep much quicker.

What is substance-induced bipolar disorder?

Frequent use of drugs often causes physical changes in the brain’s structure and functions. The most obvious change that occurs secondary to prolonged drug use is in the brain’s reward system, which makes the whole experience more pleasurable. At the same time, drugs are also notorious for rewiring other parts of the brain that regulate behaviour and mood. Consistent changes in these parts can sometimes lead to substance-induced bipolar disorder in a previously stable addict.

As a bipolar alcoholic, is it safe to continue using alcohol?

There are multiple reasons to avoid drinking if you have been diagnosed with bipolar disorder. One of the most important reasons is the possible interactions between alcohol and bipolar disorder medications. While therapy and other modalities hold importance in the management of the bipolar disorder, medication forms an integral part of the treatment that cannot be ignored. Most people with this disorder use a combination of mood stabilisers, antidepressants, and antipsychotics to combat the symptoms and manage their severity.

Depending on the type of drugs you take for bipolar disorder, alcohol may affect your ability to work accurately. For example, if you are taking lithium to stabilise your mood, combining it with alcohol may increase its effects, leading to toxicity.

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