Alcoholism and Bipolar Disorder

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Are You or Someone You Love Suffering from Bipolar Disorder and Alcoholism? 

Self Medication

One of the reasons people drink is  to self medicate. This is a common term people use to describe the coping skill of escape through drugs or alcohol.


One could imagine all kinds of scenarios that might cause a healthy non mentally ill person to self medicate: the everyday stress of social relationships, work or family life parenting, financial problems. All of these situations may be a trigger for seeking relief through substances.

People with bipolar disorder are much more likely to suffer from alcoholism. In fact one study showed women , in particular, are 7 xs more likely to suffer from alcoholism if they are bipolar (Allen, 2003).

Stress is more of an issue for those with bipolar, as they are more sensitive to all forms of it. 

A person who has bipolar disorder may constantly feel their life is out of control and too painful to cope with. Without proper help support and treatment their life can feel unmanageable. Alcohol gives them the false sense of control and provides a temporary escape from painful intense emotions. The connection between bipolar disorder and alcoholism can easily be understood in this way.

Unfortunately, being intoxicated   is a false sense of control, and mood stabilizers prescribed by a physician can do a much better and safer job of treating the effects of bipolar disorder

Genetic Component

There is a genetic component that contributes to the relationship between bipolar disorder and alcoholism that isn’t quite understood. We do know that there is a very high rate of alcoholism in the families of persons with bipolar disorder. Many of my clients who are bipolar have a strong history of alcoholism in their family. Of course there is a genetic component to both of these illnesses, so it seems that if you are bipolar you are likely to have someone in the family who was bipolar and if you are an alcoholic the same is true.

Complications with Diagnosis

The symptoms of bipolar disorder and alcoholism may look the same. Someone who is drunk may act manic while under the influence of alcohol. Depression is also commonly associated with alcohol withdrawal.

Most mental illness cannot be diagnosed unless the person has had a period of abstinence where they are not suffering from withdrawal and the symptoms of illness are present. People suffering from alcoholism also have dramatic mood swings that can mimic those a person with bipolar disorder suffers. Often when someone stops drinking or using drugs, they go through a period of withdrawal which may include depression, anxiety ,and mood swings which later levels out. Clearly these two illnesses interact in damaging ways and exacerbate one another.

The Course of the Illness and the Prognosis may be Worsened

Obviously if you have bipolar disorder and you are also suffering from alcoholism your prognosis for stability is not as good. The chemical changes alcoholism creates in the brain and body interact with the bipolar disorder in a way that makes it more difficult to treat. Also, the alcohol itself may alter the course of the illness. The course of an illness is how it evolves over time. If you have bipolar disorder and you are drinking, the cycles and severity of the episodes may be altered and permanently changed.

Alcohol abuse is more common in those who have bipolar than unipolar depression.

People with bipolar disorder are more likely than those with depressive disorders to have alcohol dependence. Some research suggests that this is almost twice as likely in bipolar than with unipolar depression. Additionally, about half of people who suffer from bipolar also have alcoholism. ( 1999).

Medications

Most studies have suggested that lithium is less effective in a client who has bipolar disorder and alcoholism. This could be because many of those clients present with a more rapid cycling -mixed manic bipolar and that is known to be less responsive to lithium. More often a doctor will choose Depakote which has actually been shown to decrease patients drinking (Allen, 2003) in addition to leveling out the mood. The exception seems to be adolescents with BPD and alcoholism who, in one study, were shown to respond to lithium. (Sonne, 2002)


What to do if you Suffer From Alcoholism and Bipolar Disorder

  • Seek help from a professional who will coordinate with other treatment providers. For example, a psychiatrist who will work with a therapist and substance abuse clinic will be more helpful for someone who has a dual diagnosis.
  • Follow up after your treatment with AA and a sponsor 
  • Understand that you need to stop drinking first prior to getting help for your bipolar illness. It is impossible to understand what is triggering the illness if alcohol is in the mix.  A large part of managing your illness consists of understanding your triggers. 
  • Recognize that in the short term, going without alcohol will be challenging and painful but over the long haul will result in much better results for you.

QUESTIONS AND ANSWERS 

Questions that have been sent in with permission to be published. 

Can Bipolar Behavior Mimic what is Considered Alcoholic Behavior?

I am 58 years old, in recovery for alcoholism and also diagnosed with biploar II. I take medication daily for the bipolar, which has evened out my life. So I have both issues. My 30 year old son struggles in life with finances, relationships, committments, keeping his word and he's usually all over the map. My ex-wife, his mom, also an AA member like myself, beats the drum that it's alcoholism, even though the son isn't drinking that much. Any behavior that is off beat, she says is alcoholism.



He went to see a Psychiatrist, at my urging, and he was diagnosed as bipolar II, which I suspected. But his mom doesn't understand bipolar and it seems like she is in resistance to acknowledging it. She keeps saying that he needs to go to AA and that is the answer. 


I heard that the behaviors of bipolar, the un-manageable ones, can look like and the un-magability of the alcoholic, thus confusing the two. Can you shed some light on this. Can bipolar behaviors be mistaken for alcoholic behaviors, especially when the person is not having withdrawl or heavy drinking?


On another note, since I have come to understand bipolar issues, I have seen people in AA with years of sobriety struggle with their sobriety and when listening to what they describe it smells of bipolar. But they refuse to believe it's something other than their alcoholism, so they don't get treatment for it. I have also noticed that there is a prejudice amongst some members in AA regarding newly discovered mental disorders. Old timers are quick to dis-spell any notion that anything else could be responsible for the insanity an alcoholic suffers other than alcohol. Your thoughts please.

ANSWER

This is a good question for several reasons. Firstly it is important to keep in mind that the process of assessing diagnosis isextremely complicated. It is far from and exact science. Bipolar disorder is frequently misdiagnosed.

Can bipolar behaviors be mistaken for alcoholic behaviors, especially when the person is not having withdrawal or heavy drinking?

The actual diagnosis for bipolar disorder cannot be made if the symptoms are due to “the direct of physiological effects of a substance”. Generally, withdrawal is also considered a period of time when observed symptoms would not be considered to be attributable to a diagnosis like bipolar.


When someone is high on substances it is possible that their behavior will mimic symptoms more commonly seen when in a manic state, and when someone is withdrawing from substances the symptoms of depression can be more easily confused. 


Being intoxicated or being in withdrawal can also produce psychotic symptoms such as hallucinations in the person who is using substances. Those symptoms are similar to those seen in both phases of bipolar disorder.

In order for the diagnosis to be made of bipolar disorder, the symptoms cannot be due to substance abuse or withdrawal so this needs to be carefully assessed.


So the answer is yes. Substance abusers can look like they have bipolar disorder when they do not. 

However, 65 percent of people with bipolar disorder also have substance abuse problems, so it is not unlikely that those people who are in recovery that you speak of, who are exhibiting those symptoms you are observing actually do have a mood disorder. Alcoholics or substance abusers who are not using or in withdrawal, do not have symptoms that mimic a mood disorder unless they have a mood disorder ( or a physical condition that accounts for it) . 


This does not mean that your son does not have bipolar disorder. Symptoms are also exacerbated in those that have bipolar disorder and are using substances, and that may be the case with your son.

Bibliography

Allen, C. (2003, May 5). Alcoholism and Bipolar Disorder. Retrieved May 4, 2008, from Psychology Today Online: http://www.psychologytoday.com/articles/pto-20030505-000003.html

 Sonne, S.C. P. a. (2002). Bipolar Disorder and Alcoholism. Retrieved May 4, 2008, from National Institute on Alcohol Abuse and Alcoholism (NIAAA): http://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm

Sonne, S.C., and BRADY, K.T. Substance abuse and bipolar comorbidity. Psychiatric Clinics of North America. 22:609–627, 1999b.

University Of Pittsburgh Medical Center (2005, January 19). Anticonvulsant Drug Cuts Drinking In Bipolar Alcoholics, Shows University Of Pittsburgh Research. ScienceDaily. Retrieved May 4, 2008, from http://www.sciencedaily.com¬ /releases/2005/01/050110123206.htm


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