There isn’t much research that describes how to best combine treatment for bipolar disorder and AUD, but emerging recommendations from studies are available. In the United States, about 4.4 percent of adults will experience bipolar disorder at some point in their lives, according to the National Institute of Mental Health. A bipolar diagnosis is described as type 1 or 2, depending on the severity of symptoms. Another explanation for the connection is that people with bipolar disorder can exhibit reckless behavior, and AUD is consistent with this type of behavior. Conversely, researchers suggest that decreased alcohol use may reduce bipolar disorder symptoms and vice versa.
The Enkephalinergic System and Ethanol Effects
This approach may also prove fruitful to refine current nosology of dual diagnosis based on more biologically informed grounds (Frangou, 2014). In sum, the bipolar-addiction comorbidity may benefit from the application of holistic approaches, such as staging and systems biology. These findings also suggest that future neurocognitive studies of BD should take into account the potential confounding effects of comorbid AUDs, including past exposures to psychoactive substances (Savitz et al., 2005). In our opinion, two additional implications for research merit further discussion. Cosci and Fava (2011) have recently proposed an alternative strategy to examine dual diagnosis based on clinimetric methods, helped by staging and evaluation of subclinical symptoms.
How do comorbid BD and AUD develop?
It has been found that significant disparities exist in treatment outcomes and disease prognosis among patients presenting different onset-symptom types of the disease 2. Patients experiencing a depressive first-episode polarity often exhibit a more chronic illness trajectory characterized by a higher frequency and longer duration of depressive episodes, along with increased incidences of suicidal behavior and alcohol misuse. In contrast, those with a manic polarity at onset typically manifest more manic or hypomanic episodes, heightened psychotic symptoms, and a greater prevalence of familial psychiatric history 3, 4. Some people use alcohol as a way to cope with the symptoms of depressive episodes, while others may misuse alcohol during manic periods when they have less impulse control.
Familial Risk of Bipolar Disorder and Alcoholism
In the past, researchers have noted that symptoms of bipolar disorder appear as a person withdraws from alcohol dependence. Some scientists have suggested that alcohol use or withdrawal and bipolar disorder affect the same brain chemicals, or neurotransmitters. Alcohol can affect a person with bipolar disorder differently, compared with someone who does not have it. A person with bipolar disorder can also be more likely than others to misuse alcohol.
Despite the considerable public health significance of co-occurring BD and alcohol dependence, there are few effective pharmacotherapeutic interventions. Pharmacotherapy clinical trials for BD and those for alcohol dependence have often excluded co-occurring disorders in an attempt to reduce confounding variables. As a result, there is a limited literature that clinicians can draw upon when treating patients with co-occurring BD and alcohol dependence. Weiss et al. (2007) then conducted a randomized controlled study in which IGT was compared to an active control condition, Group Drug Counseling (GDC) (Daley et al., 2002).
Some people may also use alcohol to self-medicate and reduce symptoms of depression, mania, or hypomania. Although drinking may make people feel more in control in the short term, long-term side effects have the potential to cause severe illness, injury, or even death. Alcohol addiction is very dangerous, how to store pee for drug test and most people find it hard to stop without the aid of rehabilitation programs or professional mental health treatment. With proper treatment, support, and commitment to self-care, individuals with bipolar disorder can successfully manage their condition and achieve lasting sobriety.
A third feature of IGT is a discussion of the relationship between the two disorders. If commonalities in the recovery and relapse process in the two disorders can be seen as parallels between the two disorders, the focus on the relationship between the two disorders can be viewed as the intersection between BD and alcohol dependence. Thus, patients are told that drinking will negatively affect the course of their BD, and that non-adherence to their BD medication will increase their risk of relapse to drinking. Again, the focus on the intersection between the two disorders is consistent with the single-disorder paradigm. If you’ve lost control over your drinking or you misuse drugs, get help before your problems get worse and are harder to treat. Seeing a mental health professional right away is very important if you also have symptoms of bipolar disorder or another mental health condition.
The last two decades have substantially expanded scientific literature exploring PBD. Previous studies have centered their focus on changes in individuals experiencing different mood episodes of the disorder. From the initial emergence of symptoms, it can take approximately 8 to 10 years to definitively diagnose 35. While increasing evidence supports the idea of subcortical structural changes in PBD, too few published studies have specifically compared initial symptoms. Different subregions of the thalamus, hippocampus, and amygdala have different physiological functions and play various roles in BD disease models 36.
- Integrated treatment can occur either at the programmatic level or at the individual or group patient level.
- This suggests that bipolar patients may use alcohol primarily as a means to medicate their affective symptoms, and if their bipolar symptoms are adequately treated, they are able to stop abusing alcohol.
- The patients with primary alcoholism had significantly fewer episodes of mood disorder at followup, which may suggest that these patients had a less severe form of bipolar illness.
Numerous studies have affirmed the significant role that the hippocampus plays in memory function and complex cognitive processes. There seems to be a slight decrease in hippocampal volume in individuals diagnosed with BD, a change that is potentially more noticeable in cases of early-onset BD 17, 18. The amygdala is a region highly involved in emotion processing with unique developmental alterations in bipolar disorder 19,20,21. Notably, a consistent decrease in amygdala volume has been reported in many past studies involving PBD 22, 23. In contrast, studies of the amygdala in adult BD patients have been markedly heterogeneous 24. The thalamus is a relay station between the cortex and subcortical regions, holding significant importance in the pathophysiology of emotional disorders.
Persistent neurocognitive deficits (Balanzá-Martínez et al., 2005) likely result from the combination of genetic and environmental risk factors, as well as neurodevelopmental and neuroprogressive processes (Goodwin et al., 2008). Subsyndromal depressive symptoms, comorbidites and side effects of medications may compound and further worsen these deficits yet cannot fully explain them (Balanzá-Martínez et al., 2010). Fortunately, there are numerous resources available for individuals dealing with both bipolar disorder and alcohol use issues.
