An uneasy but fairly common relationship exists between bipolar disorder, misuse of alcohol, or misuse of other psychoactive substances such as cocaine. Explanations have tended to cluster into two main categories. The first suggests that substance misuse acts as a form of self-medication, which stems from the underlying mental state of the individual. The second views substance misuse as an entirely separate issue and one that can cause symptoms associated with bipolar or other serious mental illnesses. More recently, greater attention has been given to the notion of bipolar co-existing with substance misuse in a way that one feeds off the other. This ‘comorbid' state, creates problems with accuracy of diagnosis and as a consequence, correct focus of treatment.
Alcohol is by far the most common form of substance misuse. People with bipolar are five times more likely to abuse or become dependent on alcohol than the general population. Dr. Susan Sonne and Dr. Kathleen Brady are active researchers in the areas of substance misuse, bipolar disorder and dual diagnosis. They identify a variety of possible explanations for the relationship between alcohol misuse and bipolar, which include:
Bipolar disorder may be a risk factor for alcohol misuse.
Bipolar symptoms may emerge during alcohol intoxication or during alcohol withdrawal.
People with bipolar may self-medicate in an attempt to extend the pleasurable aspects of mania, or to dampen down the agitation associated with mania.
Alcohol use or withdrawal may affect brain chemicals in such a way as to promote the symptoms of bipolar disorder.
Sonne & Brady (2002) also note evidence of familial transmission of both alcohol misuse and bipolar disorder.
The picture is further complicated by the fact that bipolar disorder often co-exists with other psychological conditions such as anxiety disorders, on top of substance misuse. Men tend to have more problems with alcohol than women, a trend reflected in the general population.
Perhaps the greatest danger of substance misuse is the increased risk of suicide. One study by Potash et al (2000) calculated 38 per cent of people with comorbid bipolar attempted suicide at least once, compared with 22 per cent with bipolar disorder alone. Comorbidity also points to earlier age of bipolar onset, frequent hospitalizations and poorer adherence to medication.
For some time clinicians have been encouraged to screen for alcohol misuse when patients appear to have symptoms associated with bipolar disorder. Alcohol induced symptoms can appear quite similar to mood changes associated with bipolar. It is recognized that mood stabilizing drugs such as lithium are less effective for comorbid problems. There is some evidence that cognitive therapy can be useful in the treatment of comorbid conditions and may work well as an addition to medication.
Sonne, S.C. & Brady, K.T. (2002) Bipolar Disorder and Alcoholism. Alcohol Research and Health 26 (2): 103-108.
Potash et al (2000). cited in Alcohol Concern Factsheet 5. Mental Health and Alcohol Misuse Project. http://www.alcoholconcern.org.uk
Published On: March 05, 2009
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