Alcohol and Bipolar Disorder

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Addiction and struggles with mental health commonly co-occur. Referred to as co-occurring disorders or having a dual diagnosis, these conditions occur when someone struggles with a substance use disorder and the symptoms of at least one mental health condition. Data from the National Survey on Drug Use and Health indicates dual diagnosis conditions occur in as many as 45% of people in the United States. Data from the same survey showed that more than half of the people diagnosed with bipolar disorder also have at least one addiction. Co-occurring conditions occur because drugs or alcohol generally provide relief from the emotional struggles and episodes of mania that are part of bipolar disorder. Unfortunately, this often leads to chronic struggles with substance abuse as bipolar symptoms return or worsen with time.

What is Alcohol Addiction?

Data provided by the National Institutes on Alcohol Abuse and Alcoholism show more than seventeen million Americans over the age of eighteen have an alcohol use disorder. In addition, another nine million individuals between the ages of twelve and seventeen also meet the diagnostic criteria for alcohol use disorders. In the mental health treatment environment, alcohol use disorders are classified according to severity. Depending on one's relationship with alcohol, their condition may be classified as mild, moderate, or severe. The Diagnostic and Statistical Manual of Mental Disorders, or DSM, lists eleven criteria used to determine the severity of an alcohol use disorder. It is not necessary to present with all eleven measures to have an alcohol use disorder. In most cases, two or three signs signify a mild alcohol use disorder; four or five signifies moderate addiction, and six or more are considered severe. Whether mild or severe, it is essential to seek early professional treatment for alcohol addiction.

The Effects of Alcohol on the Body

Contrary to common belief, the effects of alcohol begin soon after you take your first drink. Some of the effects of alcohol can intensify the symptoms of common mental health disorders, including bipolar disorder. Alcohol is a central nervous system depressant meaning it slows the activity of the central nervous system. The intensity of alcohol’s effects will depend on how much one drinks and how quickly alcohol is consumed in one sitting. The first drinks of alcohol lead to chemical changes in the brain that enhance feelings of relaxation and significantly reduce inhibition. As one continues to drink, symptoms such as increased anxiety, increased depression and other mental health symptoms occur.

What is Bipolar Disorder?

Bipolar disorder occurs when there are extreme shifts or alterations in mood.  It is estimated that as many as 2.5 million Americans meet the diagnostic criteria for bipolar disorder, making it a widespread mental illness in the United States. Bipolar disorder is typically diagnosed when one reaches their early twenties; however, depending on symptoms, diagnoses may occur during childhood or in the teen years as well. Currently, there is no cure for bipolar disorder, but mental health treatment can minimize the impact of symptoms.

Understanding Bipolar Disorder Symptoms

When someone struggles with bipolar disorder, they experience three primary symptoms; mania, hypomania, and depression.

Mania

Mania occurs when the person goes through experiences of intense emotional highs. During mania or a "manic episode," they will experience a range of emotions, including excitement, impulsivity, and euphoria. They will also have excessive amounts of energy, which can impact sleep or rest. During episodes of mania, someone with bipolar disorder may also engage in undesirable or harmful behaviors such as spending sprees, unprotected sexual encounters, or substance use. Episodes of mania may last for several days or weeks.

Hypomania

Hypomania is a symptom commonly associated with bipolar II disorder. Hypomania is similar to mania; however, symptoms and emotional highs are not as notable or severe. Also, unlike episodes of mania, hypomania may not result in difficulties at work, school, or social relationships. Someone with hypomania will still notice alterations in their mood, yet their alterations are not as significant as those experienced during a manic episode.

Depression

Depressive episodes are the exact opposite of manic episodes. During an episode of depression, feelings of deep sadness, hopelessness, loss of energy, and lack of interest in commonly enjoyed activities occur. Other challenges such as excessive sleep, self-harm, and suicidal thoughts also happen. Depressive episodes related to bipolar disorder will last around two weeks.

Types of Bipolar Disorder

There are three primary types of bipolar disorder. The type of bipolar disorder one has will depend on the kind of symptoms they experience and the severity of those symptoms. A mental health provider will work with you to evaluate your symptoms and better understand your bipolar diagnosis.

Bipolar I

Bipolar I disorder involves at least one episode of mania. Someone with bipolar I may experience hypomania or major depression before and after they experience an episode of mania. Both men and women are equally affected by Bipolar I.

Bipolar II

People with Bipolar II experience one episode of major depression, which lasts at least two weeks. They also have at least one episode of hypomania, which lasts a few days. Although women are considered to be more affected by Bipolar II, both men and women are affected equally by Bipolar II.

Cyclothymia

Someone with cyclothymia will experience hypomanic and depressive episodes. The duration and severity of symptoms are much less than that of the two other types of bipolar. Most people with cyclothymia usually have stable moods and only experience episodes once or twice per month.

The Relationship Between Alcohol and Bipolar Disorder

Alcohol addiction and bipolar disorder are closely linked. As previously noted, as many as half of the individuals diagnosed with bipolar disorder also struggle with alcohol addiction. While statistics verify there is indeed a connection between alcohol addiction and bipolar disorder, the reasons behind the relationship are poorly understood. Links such as genetic predisposition and mental health history have been identified as possible connections between use of alcohol and bipolar diagnoses.

When someone struggles with bipolar disorder, the symptoms can be challenging to manage. It is not uncommon for people to turn to alcohol to help dull the symptoms of mental illnesses, including bipolar disorder. Unfortunately, consuming alcohol can intensify the symptoms of bipolar disorder due to the sedative properties of alcohol. Because alcohol is a depressant, drinking alcohol can intensify depressive episodes.

Conversely, alcohol use can intensify the severity of manic episodes. Some individuals may use alcohol during manic episodes as a way to self-medicate for various reasons. The first may be to provide sedation to reduce the intensity of the emotions associated with manic episodes. Another reason may be to prolong the pleasurable effects of a manic state. Ongoing alcohol use with bipolar disorder can lead to significantly worsening bipolar symptoms in time.

Another suggestion is that bipolar disorder symptoms may emerge and evolve with chronic patterns of drinking and alcohol withdrawal. It is believed the process of detox and withdrawal may hasten or trigger the development of bipolar symptoms. Some researchers have found that alcohol withdrawal may impact the neurotransmitters in the brain that are also affected by bipolar disorder.

A Word About Bipolar Medications and Alcohol

It is not uncommon for medical or mental health providers to diagnose bipolar disorder before diagnosing alcohol addiction. This is possible because many people turn to alcohol to help alleviate bipolar symptoms. Therefore, bipolar disorder is present before an alcohol use disorder develops. In addition to therapy, several medication options are available to reduce the intensity and severity of bipolar symptoms. These include mood stabilizers and benzodiazepines. Benzodiazepines are classified as tranquilizers (or sedatives), meaning they have a calming effect on the brain and body. These drugs have many of the same effects on the body as alcohol.

Consuming alcohol while taking medications for bipolar disorder can be dangerous. Both alcohol and bipolar medications have sedative effects, and consuming both can effectively double the sedative impact. Common effects of combining alcohol and bipolar medications may include dizziness, slowed respiratory rate, tremors, new or worsening depression, significant drowsiness, blackouts, and death.

Treatment for Alcohol Addiction and Bipolar Disorder

Left untreated, an ongoing struggle with bipolar disorder and alcohol addiction can have severe and dangerous physical and psychological consequences. Someone who struggles with both conditions and does not receive help addressing their symptoms may experience worsened symptoms of bipolar disorder. Additionally, they are at a higher risk of self-harm and suicide. Unfortunately, it is not uncommon for alcohol addiction and bipolar disorder to be diagnosed at separate times, limiting early and effective simultaneous treatment at first. Fortunately, some therapies and medications can address the symptoms of both conditions as part of a comprehensive treatment program.

The most effective treatment for bipolar disorder and alcohol addiction is comprehensive, evidence-based inpatient treatment. It is essential to choose a treatment program where treatment professionals are skilled in managing the challenges of alcohol detox and treatment along with bipolar disorder treatment and support. At a professional rehab, treatment staff will work with you to design a comprehensive treatment plan that addresses the symptoms of each disorder so you can safely and successfully recover. It is crucial for your treatment plan to address the root causes of each disorder as co-occurring conditions often build on each other.

The first step of treatment for bipolar disorder and alcohol addiction is detoxification. This process involves ridding the body of alcohol. It is crucial to detox in a safe and supported environment like an addiction treatment center where medical supervision is available. In some cases, withdrawal symptoms associated with detox can be dangerous or lead to medical complications. As part of a medically supervised detox program, trained treatment staff are available to monitor your vital signs and your physical and emotional health to ensure your safety during the most difficult stages of detox.

Once detox is complete, a comprehensive therapy program focused on addressing the symptoms of bipolar disorder, and alcohol addiction can begin. An effective therapeutic model that is proven effective in managing symptoms of both conditions is cognitive-behavioral therapy or CBT.  Cognitive-behavioral therapy aims to encourage participants to consider and examine the unhealthy thoughts and behaviors that lead to emotional challenges. Once these emotions are clearly understood, it is possible to learn the tools and skills necessary to replace harmful thoughts with healthy, productive ones. The ability to change, examine, and replace unhealthy thoughts and behaviors is also a highly valuable coping skill vital to ongoing relapse prevention after treatment ends.

It is vital to address alcohol addiction early in treatment as a common element of bipolar disorder treatment involves medication. Bipolar medications and alcohol do not mix, so it is essential to get and remain sober as bipolar treatment continues. Common medications used as part of a bipolar disorder treatment program include mood-stabilizing drugs such as Lithium and various anticonvulsant medications. Other medication options include antipsychotics, antidepressants, and benzodiazepines. Although medications can be a valuable part of a treatment plan, not all medications work well for all people or cases. Your mental health provider will work with you to determine which medications work best for your treatment needs and goals. It may take time to develop the ideal medication regimen.

If you or a loved one struggle with bipolar disorder and an alcohol use disorder, comprehensive treatment is essential to recovery. It is vital to find a treatment program where staff is trained to manage the unique nature of dual-diagnosis conditions. Seeking treatment for bipolar disorder while still struggling with addiction (or vice versa) may help manage and reduce the intensity and severity of symptoms of one condition; however, the possibility of relapse is significantly increased. A dual-diagnosis treatment that addresses each condition as part of a simultaneous and comprehensive treatment program faciliates learning and practicing safer, healthier coping strategies to manage bipolar disorder or alcohol addiction symptoms.