Alcoholism and Bipolar Disorder

Getting treatment for bipolar disorder can be challenging, especially if you also experience alcoholism.1 Alcohol use can worsen, or even mirror, the effects of bipolar disorder.2, 3

In this article: 

Bipolar Disorder and Alcohol Use Disorder

Co-occurring disorders, or dual diagnosis, develops when you experience two or more mental health disorders at one time. It is common for individuals with dual diagnosis to experience a substance use disorder, such as alcohol use disorder (AUD).3.4

With AUD and bipolar disorder, you may have a hard time figuring out where one disorder ends and the other begins.4

Signs and Symptoms of Alcohol Use Disorder (AUD)

You can develop an AUD when your alcohol misuse becomes so severe that it impairs your ability to function.3 You only need to experience two of the following symptoms in a year for an AUD diagnosis:3

  • Using alcohol longer or in larger quantities than you originally intended
  • Constantly wanting to quit drinking or struggling to do so
  • Spending a lot of time getting alcohol, drinking, or recovering from alcohol use
  • Experiencing strong cravings or urges to drink
  • Drinking even if it interferes with your responsibilities
  • Drinking in situations that could cause physical harm
  • Giving up important activities because of drinking
  • Experiencing relationship or social problems due to drinking
  • Needing more alcohol to achieve the same effects
  • Developing withdrawal symptoms or drinking to avoid withdrawal symptoms
  • Drinking despite the effects on your physical or mental health

The more symptoms of AUD you experience, the more severe your AUD diagnosis may be classified.3 The way that your AUD progresses can increase your risk of developing symptoms of bipolar disorder.3

Symptoms of alcohol intoxication and withdrawal can look like other mental health disorders, including bipolar disorder. Alcohol intoxication occurs while using alcohol or shortly thereafter.3

Intoxication can impact the way you think and act, causing problems with:3

  • Inappropriate sexual behavior
  • Aggression
  • Mood swings
  • Poor judgment
  • Speech
  • Coordination
  • Memory and attention
  • Consciousness

Withdrawal symptoms can start hours or days after you quit using alcohol. These symptoms may include:3

  • Hand tremors
  • Increased heart rate or sweating
  • Inability to sleep
  • Stomach issues
  • Hallucinations
  • Anxiety
  • Seizures
  • Psychomotor agitation

 Alcohol-Induced Bipolar Disorder

Sometimes certain symptoms of an AUD can become so severe that they begin to look like bipolar disorder.3 Severe alcohol withdrawal or intoxication symptoms can cause alcohol-induced bipolar disorder.3

You can tell the difference between bipolar disorder and alcohol-induced bipolar disorder by the length of time the symptoms last.3 Alcohol-induced bipolar disorder can only last from several days to a month after severe alcohol intoxication or withdrawal has ended.3 Longer lasting symptoms may qualify for an independent diagnosis of bipolar disorder.3

AUD symptoms can make it hard to establish a clear diagnosis and may obscure the need for treatment of a dual diagnosis.1 An assessment by a qualified clinician can provide an accurate diagnosis of your AUD and other potential mental health issues.3

Call 800-839-1686Who Answers? to speak with a treatment specialist if you need support finding a treatment program or getting an assessment.

Signs and Symptoms of Bipolar Disorder

Characterized by significant changes in mood, bipolar and related disorders can fall under several categories:3

  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder
  • Substance or medication-induced bipolar and related disorder
  • Bipolar and related disorder due to another medical condition
  • Other specified bipolar and related disorder
  • Unspecified bipolar and related disorder

While several other mental health disorders appear similar to bipolar and related disorders, these diagnoses have unique traits even between themselves.3 This article will focus primarily on bipolar disorders I and II.

Bipolar I Disorder

To qualify for a diagnosis of Bipolar I Disorder, you must experience at least one manic episode in your life.3 This manic episode must have lasted for at least one week or resulted in hospitalization due to its severity.3

A manic episode occurs when you experience an abnormal and constant elevated, expansive, or irritable mood.3 During this episode, you may notice an abnormal increase in your energy or activity levels.3

Other symptoms of a manic episode include:3

  • Elevated self-esteem
  • Grandiosity
  • Needing less sleep to feel rested
  • Pressured speech or talking more than usual
  • Racing thoughts
  • Easily distractibility
  • Increased engagement in projects or goal-driven activities
  • Increased risk-taking behavior
  • Symptoms of psychosis, hallucinations, or delusions

If you experience Bipolar I Disorder, you may not recognize your need for treatment, especially during a manic episode.3 As noted, alcohol intoxication can also intensify impaired judgment and risky behavior.3

Bipolar I can cause you to become hostile or aggressive towards others, especially if you experience delusions.3 Impulsive behavior, a desire to relieve tension, a need for stress reduction, and irritability may contribute to alcohol misuse during a Bipolar I episode.3, 5

People with this diagnosis may also experience hypomanic episodes and major depressive episodes.3 Episodes of depression can occur simultaneously with a manic episode and may last moments or continue for days at a time.3

Bipolar II Disorder

This type of bipolar disorder occurs when a person has experienced at least one hypomanic episode and one major depressive episode.3 The major depressive episode must have lasted at least two weeks, while the hypomanic episode must have taken place over at least four days.3

Much like the manic episode of Bipolar I, a hypomanic episode involves an “elevated, expansive, or irritable mood.”3 The main difference between manic and hypomanic episodes is the difference in the symptoms. A hypomanic episode does not include psychotic features, impact your functioning to the same degree as a manic episode, or typically result in hospitalization.3

Though previously considered a less severe diagnosis than Bipolar I, mental health professionals now recognize the potential impact Bipolar II Disorder can have on your quality of life.3 The effects of hypomanic and depressed moods can impact several important areas of your life and increase your risk for impulsivity.3 This impulsivity can contribute to your risk of engaging in alcohol misuse.3

A major depressive episode may include the following symptoms:3

  • Depressed mood
  • Low interest or experiences of pleasure in once enjoyed activities
  • Significant weight changes
  • Poor sleep—too much or too little
  • Increased or decreased movement
  • Low energy
  • Feeling worthless or guilty
  • Poor concentration
  • Thoughts of death
  • Suicidal ideation or actions

While both Bipolar I and II have distinct features, people diagnosed with either disorder may face a higher risk of experiencing a dual diagnosis, especially with a substance use disorder.3

Treating Alcoholism and Bipolar Disorder

When considering treatment, focus on the most severe symptoms first.6 With an AUD, the alcohol withdrawal symptoms may become severe or life-threatening.6 You may require medical monitoring to ensure that you detox safely.6

Consider the relationship between bipolar disorder, AUD, and the symptoms of each when you reach out for help. Psychiatric care can promote safe stabilization at the start of treatment.6 Symptoms associated with alcohol use and bipolar disorder can look similar, though they can require different treatment approaches.3, 7 A combined approach of inpatient medical and psychiatric interventions may be necessary for you to begin the process of recovery from a dual diagnosis of bipolar disorder and alcohol use disorder.6, 7

After completing medical measures, such as detox and stabilization, consider the benefits of continuing care.

Residential Treatment

The residential level of care can offer a place of support away from your home, routine, or regular environment, allowing you to focus on healing.6 Psychotherapy at this stage of treatment can help you identify triggers that may have led to alcohol misuse in the past and could lead to alcohol relapse if not managed in the future.6 Having a plan to respond to cravings or relapse can help you recover quickly, even if you start to drink again.7

Group therapy and peer-support groups can also offer support for those in early recovery.6 Connecting with others as you navigate bipolar disorder and AUD can help you learn gain insight from other experiences managing co-occurring disorders.7

Medication can support your efforts to heal from both bipolar disorder and AUD.7 Mood stabilizers may help with the shift in manic, hypomanic, or depressed moods.7 Medication can support recovery from an AUD through the detox process and, in some cases, through medication-assisted treatment (MAT).7 Some prescribing professionals may offer anti-craving medications such as acamprosate and naltrexone to support your wellness over time.7

Outpatient Treatment

You can continue to recover outside of residential treatment programs with outpatient treatment.6 An outpatient treatment program can help you connect to the education, medication, counseling, and peer support you need to manage bipolar disorder and alcoholism.6, 7

If you or someone you love is suffering from alcoholism and bipolar disorder, call 800-839-1686Who Answers? today to speak with a treatment specialist about recovery options.

Resources

  1. Salloum, I. M., & Brown, E. S. (2017). Management of comorbid bipolar disorder and substance use disorders. American Journal of Drug & Alcohol Abuse, 43(4), 366–376.
  2. Sonne, S.C., & Brady, K.T. (2002). Bipolar disorder and alcoholism. Alcohol Research and Health, 26(2), 103-108.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  4. S. National Library of Medicine. (2021, May 4). Dual Diagnosis.
  5. Azorin, J.-M., Perret, L. C., Fakra, E., Tassy, S., Simon, N., Adida, M., & Belzeaux, R. (2017). Alcohol use and bipolar disorders: Risk factors associated with their co-occurrence and sequence of onsets. Drug and Alcohol Dependence, 179, 205–212.
  6. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2011). Treating addiction: A guide for professionals. The Guilford Press.
  7. Grunze, H., Schaefer, M., Scherk, H., Born, C. & Preuss, U. W. (2021). Comorbid Bipolar and Alcohol Use Disorder—A Therapeutic Challenge. Frontiers in Psychiatry, 12.

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