Substance and alcohol use disorder can, unfortunately, go hand-in-hand with co-occuring mental illnesses and disorders. The National Institute on Drug Abuse estimates that 7.7 million people with substance use disorder, including alcohol use disorder, also have a co-occuring mental illness such as bipolar disorder, depression, anxiety, and PTSD among others.

The prevalence of alcohol use disorder and bipolar disorder is alarmingly high, yet the link between the two remains slightly mysterious. Several studies have shown that bipolar disorder and alcohol do have a direct correlation with each other, making it difficult to treat both bipolar and alcohol disorders in conjunction with each other.

What's the Association Between Bipolar Disorder and Alcohol Use Disorder?

There is no one solid answer on why the prevalence of alcohol use disorder is higher than average in people with bipolar disorder. However, several theories have been proposed. To understand these theories, it's important to understand what exactly are bipolar and alcohol use disorders.

Bipolar disorder is a mental illness characterized by periods of extreme heightened mood, euphoria, sleeplessness, and even psychosis which is known as mania. This period of mania is combined with periods of severe depression. There are various types of Bipolar Disorder, which can all be affected by the use of alcohol and substances. These different types of Bipolar Disorder include:

• Bipolar I Disorder - Characterized by severe mania that requires hospitalization lasting more than one week, and also severe depressed mood that lasts more than two weeks.
• Bipolar II Disorder - Also characterized by mania, although not as severe and often not requiring hospitalization. Depressive episodes are also common.  
• Cyclothymic Disorder - A somewhat rare mood disorder where there are noticeable shifts in mood and manic and depressive episodes. However, they are not as severe as those in Bipolar I or II Types.

Both people with type 1 and type 2 Bipolar Disorders as well as those with Cyclothymic disorder might use alcohol differently. Those with Cyclothymia might use alcohol in an effort to attempt to balance their constantly shifting moods. 

People with Bipolar Disorder might also use alcohol in order to self-medicate and decrease the agitation associated with manic episodes. Similarly, alcohol can enhance and prolong feelings of euphoria during these same manic episodes. Unfortunately, alcohol is also a central nervous system depressant, and can severely impact and worsen feelings of depression.

What Factors Play a Role?

There is no clear cause for why some people develop both Bipolar Disorder and alcohol use disorder. However, the prevalent theory is that genetics play a roll in the development of both Bipolar and alcohol use disorder. Having a family member with either one of these issues can, therefore, increase an offspring's risk of developing both.

For those wondering can drugs and alcohol cause bipolar, studies have suggested that the development of bipolar disorder might occur during the detoxification or withdrawal period from alcohol. This is because alcohol and bipolar disorders affect the same neurotransmitters in the brain. 

Finally, the type of bipolar disorder one has might impact how their alcohol disorder progresses and affects them. In people with Bipolar Type 1 and 2, a recent study showed that people with Bipolar II Disorder had a higher rate of liver disease caused by their alcohol use disorder than those with Bipolar I Disorder (10.7% and 1.7% respectively). The same study showed that alcohol use disorder made symptoms of Bipolar Disorder more severe in those with Bipolar type 1.

How Does Alcohol Affect Bipolar Disorder?

Alcohol abuse has been shown to mimic the symptoms of bipolar disorder, making it difficult for people to receive a proper diagnosis. Alcohol use disorder is also associated with lifetime manic episodes and emergency department visits in men, and lifetime depressive episodes in women. Even a moderate amount is enough to cause a severe impact on alcohol use disorder.

Furthermore, alcohol use can worsen mixed mania symptoms, lead to rapid cycles of mania and depression, and overall worsen Bipolar Disorder treatment outcomes.