Bipolar disorder, once known as manic depression, is a serious mental disorder characterized by sudden and intense changes in mood, energy levels, and behavior. While the disorder itself is a hardship to bear, those afflicted with it also have a higher risk of developing alcohol addiction. This only complicates the situation and leads to what’s known as a dual diagnosis – a co-occurring disorder that can make recovery more challenging. In this blog, we will go over bipolar disorder and the different types, as well as how bipolar disorder and alcohol abuse go hand in hand.
Understanding Bipolar Disorder
We all experience times of happiness, despair, anger, or sadness, but for an individual suffering from bipolar disorder, these emotional episodes are uncontrollable and all-consuming. There are five types of mood episodes that characterize bipolar disorder, each with a unique set of symptoms. The four types are:
- Mixed Episodes
Also known as Bipolar I disorder, mania occurs when someone has manic episodes that last at least seven days and are accompanied by psychotic features. In extreme cases, mania might result in the person needing to be hospitalized in order to prevent them from doing harm to either themselves or others. During a manic episode, someone might feel very “up”, elated, or jumpy with tons of energy. They might also have trouble sleeping and feel irritable or be prone to risky or reckless behavior. A manic episode can last up to two weeks.
Depression is a common symptom of Bipolar II. While mania isn’t typically involved in this type of bipolar disorder, a milder form called hypomania can occur. Those who suffer from this type of bipolar disorder have experienced major depression and hypomania, either at the same time or at separate times. Those who suffer from Bipolar II may find themselves severely fatigued, crying uncontrollably and for no real reason, having recurring thoughts of death or suicide, and even suffering from insomnia or hypersomnia.
Also known as cyclothymia, hypomania is a milder form of bipolar disorder. Like the more extreme versions of bipolar disorder, those suffering from hypomania might find themselves experiencing cyclical mood swings. A person might feel great, be highly productive, and function well at times, only to feel depressed and lethargic later for no discernable reason. What separates this type of bipolar disorder from the others is that the highs and lows that are felt are not extreme enough to qualify as either mania or depression. Hypomania is commonly found in adolescence and typically goes untreated as it is chalked up to the adolescent being either moody or difficult.
Some people might find themselves suffering from multiple types of bipolar disorder, sometimes simultaneously. When that occurs, it is called mixed episodes. Those suffering from mixed episodes have high energy while at the same time suffering from sleeplessness and racing thoughts. They may also feel hopeless, despairing, irritable, and suicidal.
Rapid-cycling occurs when someone has four or more mood episodes within a 12-month period. Each episode has to last at least a few days in order to qualify. Some people can experience this within a single week or even a single day. This type of bipolar disorder can increase the risk of severe depression and suicide. Rapid-cycling is more common in women than in men.
Double Trouble: The Link Between Bipolar Disorder and Alcohol Use
In the United States, bipolar disorder affects about 2.6 percent of the population, and about 45 percent of those affected also have an alcohol use disorder. Although researchers have proposed explanations for the high rate of alcohol abuse among bipolar individuals, the exact relationship between these disorders is not well understood. Researchers point to a variety of possibilities, including the following:
It is widely believed that those suffering from bipolar disorder turn to the bottle in an attempt to self-medicate and numb the painful symptoms of their disorder. These symptoms, including depression, pain, anxiety, and insomnia, are so disruptive that many individuals drink alcohol to excess as a means of offsetting the discomfort, if only for a while.
Clinical researchers believe that brain chemistry may influence both bipolar disorder and substance abuse. Individuals diagnosed with bipolar disorder often have abnormal levels of serotonin, dopamine, and norepinephrine compared with the brains of healthy people.
These chemicals interfere with vital body functions like stress response, sleep, appetite, and metabolism, as well as affecting emotions and mood. While many turn to alcohol to ease the negative effects, this often has the opposite effect, making symptoms of bipolar disorder worse.
People with bipolar disorder tend to be reckless or impulsive, and abusing alcohol is consistent with this type of behavior. In essence, they want something now, not later. They don’t think before they act, or they act without discipline.
Furthermore, in a manic episode, they may crave excitement and have an intense need for positive feelings, which they may find at the bottom of a bottle of alcohol. Conversely, they may feel depressed and get the notion that drinking will make them feel better. So, they buy a six-pack without thinking of the consequences.
Although there seems to be evidence that bipolar disorder leads to alcoholism, some researchers say the opposite may be the case as well. Symptoms of bipolar disorder, such as manic moods or depression, may be triggered by chronic alcohol abuse or withdrawal.
There is growing evidence that supports the possibility of genetic transmission of both bipolar disorder and alcoholism. One recent study evaluated 226 people with alcoholism with and without a mood disorder as well as family members of those people and found a greater familial association between alcoholism and bipolar disorder (odds ratio of 14.5) than between alcoholism and unipolar depression (odds ratio of 1.7). These findings show that a positive family history of bipolar disorder or alcoholism is a clear risk factor for offspring.
Diagnosing and Treating These Disorders
The combination of alcohol misuse and bipolar disorder can have severe consequences. People with both conditions are likely to worsen their bipolar symptoms and also have a higher risk of committing suicide. But is a bipolar disorder causing you to drink or is your drinking causing bipolar disorder? Knowing the difference is crucial to treatment.
Diagnosing bipolar disorder in the face of alcohol abuse can be difficult because the symptoms can mimic nearly any psychiatric disorder. As a general rule, it seems that a more reliable diagnosis comes from evaluating whether bipolar disorder symptoms occur before the onset of the alcoholism or if they persist during sustained abstinence (though the adequate period of time has not yet been defined).
Given that bipolar disorder and alcohol abuse co-occur so frequently, screening for alcoholism in people seeking treatment for bipolar disorder is a common precursor to treatment.
While bipolar disorder and substance use disorders were once diagnosed and treated as separate conditions, today a more integrated approach is used. Instead of referring those diagnosed with bipolar disorder to mental health treatment centers and sending those actively abusing alcohol to rehab, today, they’re commonly treated together at a single rehabilitation facility.
Features of an integrated treatment program for bipolar disorder and alcohol addiction include:
- A collaborative treatment team of addiction counselors, psychologists, medical professionals, nutritionists, and other professionals trained in dual diagnosis care
- Personalized psychotherapy focusing on managing stress and emotions, and minimizing the risk of substance abuse or relapse
- Psychiatric medication as needed to manage bipolar disorder
- Group therapy and support with others battling mood disorders and/or addiction
- Cognitive-behavioral therapy focuses on changing the negative thoughts and behaviors that are associated with depression.
- Family-focused therapy, which helps both the patient and their family member learn about the illness and ways they can treat it in a safe and caring environment.
In some cases, doctors might choose to go the medication route when treating alcohol and bipolar disorders. These medications may include mood stabilizers, antipsychotic medications, antidepressants, or even lithium. Lithium is specifically used in the treatment of bipolar disorder patients because it helps stabilize them quickly. Before beginning any sort of medication treatment, the patient and their doctor will discuss options as well as dosage.
Is Bipolar Disorder Causing You to Drink?
It’s simply not enough to treat bipolar disorder without addressing the problem of alcohol addiction, and vice versa. Until you receive comprehensive care for both conditions, the chances of relapse are extremely high. At Unity Behavioral Health, we are highly skilled and experienced at treating the dual diagnosis of bipolar disorder and alcoholism.
Our dual diagnosis treatment is especially beneficial to those recovery-resistant individuals who are stuck in the vicious cycle of treatment and relapse. We know what you are going through can be scary and tough and you shouldn’t have to do it alone. If you’d like to learn more about our programs, contact us today.