Bipolar Disorder and Alcohol: What's the Connection?

Bipolar disorder is a mood disorder characterized by distinct high and low mood episodes. Periods of mania, hypomania, and depression in bipolar disorder can significantly affect a person's level of functioning and quality of life.

Alcohol use disorder (AUD) is a pattern of alcohol use characterized by an inability to control drinking and other behaviors that cause significant impairment. When they occur together, bipolar disorder and alcohol use can exacerbate each other.

Read more to learn about bipolar disorder, alcohol use disorder, and the connection between these conditions.

What Is the Connection Between Bipolar Disorder and Alcohol Use Disorder?

When bipolar disorder and alcohol use disorder occur together, the combination can be more severe than having each diagnosis independently.

Research indicates a person will experience a decrease in functioning, an exacerbation (worsening) of manic or depressive symptoms, and a higher risk of suicide when these conditions co-occur. In addition, experiencing bipolar disorder and AUD together can cause longer-lasting symptoms and a poorer response to treatment.

Mood states are relevant, as some people may use alcohol to cope with emotional discomfort or feelings such as anxiety and depression.

In bipolar disorder, mania reduces inhibitions. Alcohol has the same effect. Mania coupled with alcohol use can further decrease inhibitions, leading to risky behaviors and painful consequences.

Genetics

Genetics is linked to bipolar disorder. Individuals with a first-degree family member, such as a parent or sibling, who has bipolar disorder are more likely to develop the condition.

Similarly, there is a genetic component associated with alcohol use disorder. The National Institute on Alcohol Abuse and Alcoholism estimates heritability at 60% in families. This can also be influenced by other factors, like witnessing heavy alcohol use in parents.

Understanding Bipolar Disorder

Bipolar disorder involves changes in mood and energy levels. It is categorized into different types, including bipolar 1 and bipolar 2.

Bipolar 1 Disorder

Bipolar 1 is characterized by at least one episode of mania that lasts at least one week, or by manic symptoms that require hospitalization. This may precede or be followed by an episode of hypomania or depression.

Symptoms of mania include:

• Racing thoughts
• Pressured speech
• Inflated sense of self
• Euphoric mood
• Decreased need for sleep
• Distractibility
• Engagement in activities that may be risky
• Psychosis, in some cases
  

Bipolar 2 Disorder

Bipolar 2 disorder is characterized by depressive episodes and hypomania, a less intense form of mania that can persist for at least four days.

Depressive symptoms affect people with bipolar 1 and bipolar 2, but they tend to occur more often and last longer in bipolar 2 disorder.

With symptoms lasting for at least two weeks, a depressive episode can present as:

• Depressed or low mood
• Lack of interest in activities that once brought joy or pleasure
• Fluctuations in eating patterns
• Disruption to sleeping habits
• Agitation
• Fatigue or lethargy
• Trouble concentrating
• Feelings of helplessness or worthlessness
• Isolation and withdrawal
• Thoughts of death or suicide
  

Symptoms of Alcohol Use Disorder

A person must exhibit at least two of the following symptoms within a 12-month period to be diagnosed with alcohol use disorder:

• Cravings or intense urges to drink
• Drinking more significant amounts of alcohol or drinking over more prolonged periods 
• Unsuccessful attempts to reduce or stop drinking
• Continued use despite negative consequences at home, school, or work
• Continued drinking despite repercussions in interpersonal relationships
• Drinking in situations that may be dangerous
• Recurrent use of alcohol when the person has mental or physical health-related issues that are made worse by drinking
• Tolerance, as defined by needing more alcohol to achieve intoxication or diminished effect over time when consuming the same amount of alcohol 
• Withdrawal symptoms (nausea, tremors, insomnia, anxiety, etc.)
  

Manic Symptoms and Alcohol

Alcohol and mania can both lower inhibitions.

Impulsivity (not thinking before acting) and engaging in risky situations that may lead to painful consequences can accompany mania. One of these risks includes excessive alcohol use.

Conversely, alcohol can worsen symptoms of mania.

Depressive Symptoms and Alcohol

During a depressive episode, a person will already be experiencing a low mood and perhaps lethargy. Alcohol is a depressant. Consuming alcohol while feeling depressed can intensify lethargy and reduce inhibitions.

There is also a greater risk of suicide in individuals who have bipolar disorder and alcohol use disorder.

Psychosis and Alcohol

In certain cases, psychosis with delusions or hallucinations can occur in people with bipolar disorder. Drinking alcohol can aggravate these symptoms.

Diagnosis

Diagnosing Bipolar Disorder

To diagnose bipolar disorder, a psychiatrist or licensed mental health professional will use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), the American Psychiatric Association's handbook for diagnosing mental health conditions, to evaluate a person's symptoms and history.

They may also recommend a physical health evaluation to rule out any other potential medical causes.

Diagnosing Alcohol Use Disorder

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.

When Alcohol Abuse Causes Misdiagnosis of BD

Bipolar disorder can be challenging to diagnose. Other mental health conditions such as ADHD, depression, and schizophrenia may present with overlapping symptoms.

There is also the possibility that bipolar disorder and alcohol use disorder symptoms will present concurrently, which adds a level of complexity with diagnosis.

Additionally, when someone is going through alcohol withdrawal, it can potentially mirror some symptoms of bipolar disorder.

Treatment

Choosing a Treatment Approach

Symptoms present differently in every person. For example, some people may develop bipolar disorder first, while in others, AUD may appear first.

It is also possible for the conditions to present simultaneously. Therefore, healthcare providers should conduct a thorough evaluation to determine how to treat each person based on their diagnosis and symptoms.

Providers may treat bipolar disorder and alcohol use disorder sequentially (one before the other), independently (by themselves), or using an integrative approach (together).

Treatments for AUD

Individual, family, or group therapy may occur in an inpatient or outpatient setting depending on what is best for the person's needs.

Treatment options include:

• Depending on a person's alcohol usage, medically supervised detox may required to treat withdrawal symptoms.
• Medically assisted treatments (the use of certain prescribed medications in combination with counseling and behavioral therapies) for alcohol use disorder may be recommended.
• Research indicates cognitive behavioral therapy as an effective treatment method to help people identify triggers, explore thoughts and feelings about themselves and their relationship with alcohol, and prevent relapse.
• Motivational interviewing, which explores ambivalence about changing behavior and draws on a person's motivations for change, can be used alone or in addition to other therapies.
• Group therapy conducted in a clinical setting can help people identify relapse thoughts and behaviors, recovery thoughts and behaviors, and develop skills for recovery.
• 12-step programs like Alcoholics Anonymous provide an atmosphere where people can find community and support in recovery.

Psychological Treatments for Bipolar Disorder

• People living with bipolar disorder can benefit from cognitive behavioral therapy techniques, such as developing healthier ways of thinking about themselves and their condition and developing coping and problem-solving skills.
• Skills to help people regulate their emotions are taught in dialectical behavior therapy, which can help people manage feelings of discomfort.
• Interpersonal and social rhythm therapy can help people improve their mood, understand their sleep-wake cycle, establish habits that cultivate well-being, and manage their relationships.
  

Alcohol and Mood Stabilizers

Mood stabilizers are the main treatment for bipolar disorder. A healthcare provider may prescribe mood stabilizers to treat symptoms of bipolar disorder, especially mania. Some of these medications include:

• Valproate
• Lithium
• Lamotrigine
• Atypical antipsychotics

Combining alcohol with mood stabilizers is not recommended, as the interactions can cause increased drowsiness, memory issues, impaired judgment, or liver problems.

People with bipolar disorder and alcohol use disorder should work closely with a healthcare provider to determine the best medication regimen to manage symptoms.

Summary

Bipolar disorder is defined by mood episodes that fluctuate between highs and lows. When coupled with alcohol use disorder, symptoms of either condition may worsen. There are a variety of treatment options, including talk therapy and medication, to treat these conditions separately or as they co-occur.

A Word From Verywell

If you are struggling with bipolar disorder and alcohol use disorder, you are not alone. Resources and support are available from the Substance Abuse and Mental Health Services Administration, as well as other organizations. Your healthcare provider can also help you seek treatment. Remember to be kind to yourself and be open with your care team. Recovery is an ongoing, active process, but it is always possible.