Alcohol and Bipolar Disorder- The Connection

The Connection Between Alcohol and Bipolar Disorder

It is no secret that alcohol affects the brain. Constant heavy drinking can affect the hippocampus, the area governing memory and reasoning. It can shrink the brain in the long run, leading to difficulties in problem-solving, attention, processing speed, verbal learning, and impulsivity, to name a few.

As alcohol affects the brain, excessive drinking may contribute to (or result from) psychiatric problems as well. One such condition that frequently occurs with alcoholism is bipolar disorder.

Alcoholism and Bipolar Disorder

What is Bipolar Disorder?

Formerly known as manic depression, bipolar disorder is a mental health problem that is characterized by extreme mood swings. One day you’re on an emotional high (mania), full of energy, euphoric, and sometimes irritable. The next day, you might find yourself at the lowest of lows (depression) – sad, hopeless, without interest in activities you usually found pleasurable. These mood changes may occur frequently or very rarely.

According to the National Institute of Mental Health, about 4.4% of American adults develop bipolar disorder sometime in their lives.

As to why it happens, the true cause/s remain unknown. Experts, however, believe that structural brain changes play a role in the development of the condition. Genetics contributes greatly as well. Research shows that a family history of bipolar disorder is present in about 80% of the patients.

There are two types of bipolar disorder, namely:

Bipolar I

This severe form of bipolar disorder is characterized by any of the following:

    • Mania that lasts for at least 7 days, or a severe manic episode that warrants hospitalization. Depression may last for up to 2 weeks.
    • Depression with mixed features, as such, mania and depression occur at the same time.

Bipolar II

This ‘milder’ form comes with depression and hypomanic episodes.

Alcoholism and Bipolar Disorder

Several factors might predispose one to bipolar disorder. Apart from stressful events (say, a traumatic experience or the death of a loved one), drug or ALCOHOL use may trigger a bipolar episode. In fact, liquor consumption may worsen the symptoms, making the condition harder to treat.

According to Dr. Daniel Hall-Flavin of the Mayo Clinic, alcoholism and bipolar disorder frequently occur with each other due to the following reasons:

1. Depression

Bipolar disorder occurs with cycles of depression. Instead of seeking professional help, some people turn to the bottle instead. While it may appease the sadness for some time, alcohol ends up worsening the depression instead. This, in turn, leads to the drinking addiction that is even harder to treat.

2. Mania

Alternating with depression is mania – an intense feeling of elation and euphoria. It is characterized by hyperactivity, which may lead to disinhibition and poor judgment. This may lead to high-risk activities such as alcohol or drug abuse.

3. Brain chemistry

As has been mentioned, the risk of developing bipolar disorder is increased if you have a relative suffering from a similar condition. Unfortunately, the brain changes that are seen with bipolar disorder is somehow similar to what happens in alcoholism. This may explain why certain people are at a higher risk of developing both disorders.

Because of these factors, several studies have noted an increase in the rate of bipolar disorder with alcohol abuse. As per Sonne and Brady, these are the rates of co-occurrence:

Any substance abuse or dependence (%)

Alcohol dependence (%)

Alcohol abuse (%)

Any Bipolar Disorder




Bipolar I




Bipolar II




Apart from triggering a manic-depressive episode, alcoholism may also worsen the symptoms of bipolar disorder. According to Farren et al, alcoholism may lead to a poorer prognosis, increased morbidity, decreased functioning, and a heightened suicide risk in the bipolar individual. Financially speaking, co-occurring diseases may bring about higher treatment costs.

Which has a Better Prognosis?

As has been mentioned, alcoholism and bipolar disorder work like a two-way street. Liquor may trigger a bipolar episode, as the said mood disorder can lead to alcohol use as well. While the two disorders are often interrelated, the recovery time is different, depending on the condition that occurs first.

According to Farren et al, those who demonstrate alcoholism first tend to be older, and as such, better able to recover quickly. As for those who are diagnosed with bipolar disorder first, they usually suffer from the condition for a longer time. They exhibit a more severe form of alcohol addiction as well, which makes their condition harder to treat.

Integrated Approach for Bipolar Disorder and Alcohol Use Disorder

Because of the high rate of co-occurrence between bipolar disorder and alcohol use disorder, Farren and McElroy have developed the FIRESIDE principles. This integrative treatment was designed to address both problems at one fell swoop.

  • Follow up. The importance of follow-up visits is strongly emphasized.
  • Interrelationship of diagnoses. Can’t treat one disorder without addressing the problems of the other.
  • Relapse Prevention. The main addiction should be treated well to prevent the condition from resurfacing again.
  • Education. Knowledge is power, so the use of lectures, videos, and discussions are encouraged throughout the treatment process.
  • Stabilization of withdrawal and mood. Medications are used aggressively during and after the program to stabilize both disorders.
  • Individuation of program. It’s not a ‘one size fits all’ approach when it comes to therapy. The program should be flexible enough to cater to a person’s individual needs.
  • Diagnostic equivalence. Both diagnoses play a big role, as such, they should be emphasized equally.
  • Empowerment. The patient should be ‘enabled’ so he can fight his battles individually.

Apart from the above-mentioned approach, other interventions may be prescribed for a person suffering from both conditions. (Source: Occupational Therapy in Mental Health)

  • Screening Brief Intervention and Referral to Treatment. Evaluation is done, followed by education. Referral to treatment is done as needed.
  • Cognitive Behavioral Therapy. It works on identifying wrong beliefs so that they can be challenged and ‘removed’ from the system.
  • Motivational Interviewing. It focuses on establishing rapport so the individual can recognize the need to change.
  • Mindfulness Meditation. This treatment focuses on awareness of the present.
  • Enabling Spiritual Participation. The individual is asked to recognize his spiritual needs so he can participate in such practices.
  • Dialectical Behavior Therapy. This involves skills training in terms of emotion regulation, mindfulness meditation, and distress tolerance.

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