Bipolar Disorder and Alcohol Abuse

Written by MHAMP

Relationship between bipolar disorder and alcohol misuse and abuse, exploring treatment and diagnostic issues.

Inside the Bipolar Disorder and Alcohol Abuse Factsheet

• Introduction
• The relationship between bipolar disorder & alcohol misuse
• Where is bipolar disorder treated?
• Research findings: clinical characteristics
• Diagnostic issues
• Treatments for comorbid bipolar disorder & alcohol misuse

The Mental Health & Alcohol Misuse Project (MHAMP) provides factsheets, a newsletter and web pages aimed at sharing good practice between clinicians and professionals working in the mental health and alcohol fields. MHAMP promotes the inclusion of alcohol in strategies developed for the Mental Health National Service Framework, and updates the mental health and alcohol fields.

Project Factsheet 5:

This factsheet outlines the relationship between bipolar disorder and alcohol misuse, exploring treatment and diagnostic issues. Although bipolar disorder only affects 1-2% of the population, it often requires long-term treatment, which may involve a number of health and social care providers. Importantly, alcohol misuse is high among people with bipolar disorder, and it adversely affects the course of the illness.

Target audience

This factsheet is intended primarily for clinicians and staff working in mental health services, alcohol agencies and primary care. The factsheet may also be of interest to people working in Local Implementation Teams and Primary Care Trusts with an interest in commissioning and planning services to meet the needs of people with comorbid alcohol misuse and bipolar disorder.

Summary: The factsheet at a glance

• People with bipolar disorder are five times more likely to develop alcohol misuse or dependence than the rest of the population
• Comorbid bipolar disorder and alcohol misuse is commonly associated with poor medication compliance, heightened severity of bipolar symptoms, and poor treatment outcomes
• The complex relationship between co-existing alcohol problems and bipolar disorder demonstrates the pressing need to screen for and treat alcohol misuse in this group
• Alcohol misuse can mask diagnostic accuracy in determining the presence of bipolar disorder. Measures that can help determine whether bipolar disorder is present include taking a chronological history of when symptoms developed, considering family history, and observation of mood over extended periods of abstinence
• There are a number of treatment measures that may help those with concurrent alcohol misuse and bipolar disorder. These include screening for alcohol misuse in mental health and primary care settings, screening for mental health problems in primary care and substance misuse agencies and referral to mental health and substance misuse services as required, care planning, patient and carer advice and education, monitoring medication compliance, psychological interventions, and specialist relapse prevention groups.

Introduction

Description

Often called manic depression, bipolar disorder is a type of mood (affective) disorder that affects about 1-2% of the population (Sonne & Brady 2002). People with bipolar disorder experience extreme fluctuations in mood and levels of activity, from euphoria to severe depression, as well as periods of euthymia (normal mood) (Sonne & Brady 2002). Periods of elevated mood and increased energy and activity are called "mania" or "hypomania", while lowered mood and decreased energy and activity is considered "depression" (World Health Organization [WHO] 1992). Bipolar disorder may also include psychotic symptoms, such as hallucinations or delusions (O'Connell 1998).

Classification

Bipolar disorder can be characterised by different manifestations of the illness at different times. The ICD-10 features a range of diagnostic guidelines for various episodes of bipolar disorder: for example, current episode manic with or without psychotic symptoms; current episode severe depression with or without psychotic symptoms (WHO 1992). Bipolar disorders are classified as bipolar I and bipolar II. Bipolar I is the most severe, characterised by manic episodes that last for at least a week and depressive episodes lasting at least two weeks. People can also have symptoms of both depression and mania at the same time (called 'mixed mania'), which may carry a heightened risk of suicide. Bipolar II disorder is characterised by episodes of hypomania, a less severe form of mania, which lasts for at least four consecutive days. Hypomania is interspersed with depressive episodes that last for at least 14 days. Due to elevated mood and inflated self-esteem, people with bipolar II disorder often enjoy being hypomanic and are more likely to seek treatment during a depressive episode than a manic period (Sonne & Brady 2002). Other affective disorders include cyclothymia, characterised by persistent instability of mood, with frequent periods of mild depression and mild elation (WHO 1992).