Comorbid Bipolar and Alcohol Use Disorder—A Therapeutic Challenge

Abstract

Comorbidity rates in Bipolar disorder rank highest among major mental disorders, especially comorbid substance use. Besides cannabis, alcohol is the most frequent substance of abuse as it is societally accepted and can be purchased and consumed legally. Estimates for lifetime comorbidity of bipolar disorder and alcohol use disorder are substantial and in the range of 40–70%, both for Bipolar I and II disorder, and with male preponderance. Alcohol use disorder and bipolarity significantly influence each other's severity and prognosis with a more complicated course of both disorders. Modern treatment concepts acknowledge the interplay between these disorders using an integrated therapy approach where both disorders are tackled in the same setting by a multi-professional team. Motivational interviewing, cognitive behavioral and socio- therapies incorporating the family and social environment are cornerstones in psychotherapy whereas the accompanying pharmacological treatment aims to reduce craving and to optimize mood stability. Adding valproate to lithium may reduce alcohol consumption whereas studies with antipsychotics or naltrexone and acamprosate did not affect mood fluctuations or drinking patterns. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.

Bipolar Disorder and Comorbid Use of Illicit Substances

“…Compared to comorbid AUD and BD [4], much less is known about the optimized treatment of comorbid BD and illicit substance use. Given the wide variety and modes of action of illicit substances and drugs of dependence potential, treatment needs to be rather individual.…”

“…Over the last decades, specific psycho and socio-therapeutic interventions have been developed and tested for BD comorbid with SUD; however, they target almost exclusively BD with comorbid AUD [4]. Different from the traditional paradigm to achieve complete abstinence first before focusing on mood, it appears nowadays to be common sense that group and individual integrated psychotherapies which address both disorders are more effective than interventions focusing on either disorder alone [7,20].…”

“…BD is a risk factor for addictions, both behavioral, such as gambling [2] and substance use disorders [3]. Besides a strong association between alcohol [4] and nicotine [5] dependence and BD [4], the abuse of other drugs, such as cocaine, amphetamines, opiates, cannabis, and prescription medications is also an important health concern in people with BD. When conceptualizing this article, the authors noticed that there is a fair number of reviews on alcohol use disorder in individuals with BD, including their own recent publication [1], whereas there is a relative paucity of up-to-date, comprehensive reviews on the subject of bipolarity and illicit drugs.…”

Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study

“…Previous data support difficulty in impulse control [ 25 ], and high rates of substance use [ 26 ] and nonadherence to pharmacotherapy [ 27 ] in people diagnosed with BD, which are all linked to increased relapse rates and decreased quality of life [ 4 , 5 ]. Thus, interventions, mainly psychotherapeutic, toward addressing these issues need to be further explored [ 28 ]; the combination of in-person and web-based interventions is highly recommended for effective management of symptoms [ 29 ].…”

Reducing Addiction in Bipolar Disorder via Hacking the Dopaminergic System

“…Its prevalence is estimated to be at least around 1% in the general population, and it is associated with premature death with a loss of 10–20 years of life attributable to both physical and psychiatric comorbidities ( 1 ). Its co-occurrence with other mental illnesses is the norm rather than the exception, especially with substance use disorder (SUD) ( 2 ).…”