Dual Diagnosis: Alcoholism & Bipolar

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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Bipolar Disorder and Alcohol 

Is it possible for someone with alcoholism and bipolar disease to achieve a life of sobriety and balance? Yes, it is, and it starts with understanding the interconnected relationship between the disorders. Those who struggle with alcoholism have a greater risk of developing a personality disorder. And those with bipolar disorder have a higher risk of developing alcoholism or some other type of substance use disorder. 

Understanding Alcoholism

According to research, approximately 10 out of every 100,000 people in the United States die from an alcoholic liver disease each year. More than half the nation (adult population only) drinks at least 12 alcoholic drinks every 12 months. Over a quarter of all adults in the country experience at least one day each year in which they drink heavily. For men, this means drinking five or more alcoholic beverages in less than 24 hours. For women, it means drinking four or more drinks during a 24-hour period. 


The symptoms a person experiences as a result of alcoholism depend significantly on the length and severity of the addiction. The longer the addiction, the worse the symptoms. Some symptoms can last for several hours to several weeks. The short-term symptoms of alcoholism are:

  • Impaired judgment
  • Slurred speech
  • Drowsiness
  • Fatigue
  • Nausea
  • Coordination issues
  • Mood swings
  • Increased heart rate
  • Vomiting
  • Memory impairment 

Long-Term Effects

Alcohol abuse over an extended period of time may cause potentially fatal liver diseases, such as cirrhosis, alcoholic hepatitis, and fatty liver. There’s also a higher risk of hypertension, cardiac arrhythmias, and cardiomyopathy, a malformation of the heart muscle. Additionally, drinking alcohol regularly can harm the brain, increasing the risk of diseases like Wernicke-Korsakoff syndrome as well as cognitive impairments and memory loss.

Alcohol misuse may aggravate pancreatic inflammation, leading to severe stomach discomfort and digestive problems, often known as pancreatitis. It even increases the risk of getting cancer, especially in the mouth, throat, esophagus, and liver. Drinking weakens the immune system, which leaves you vulnerable to diseases and infections. It also raises the possibility of developing mental health issues, such as anxiety, depression, and suicide attempts.

Prolonged alcoholism often results in strained interpersonal relationships, problems finding work, and a general reduction in quality of life. Drinking weakens judgment and coordination, which increases the chance of mishaps, injuries, and dangerous conduct. Lastly, a cycle of obsessive alcohol use can result in developing a strong dependency and addiction.

Understanding Bipolar Disorder

According to a study published by the National Comorbidity Survey Replication, roughly 2.8% of adults in the United States suffer from bipolar disorder. Approximately 4.4% of adults in the country receive a bipolar diagnosis at some point in their lives. Of those adults with bipolar disorder, about 83% of them report a serious impairment, and 17% report only moderate impairments. 

Bipolar disorder is a mood disorder that results in fast and sometimes long-lasting shifts in mood. Those with bipolar tend to experience extremely high highs and extremely low lows. As their bodies fluctuate between alternating moods, so do their thinking, behaviors, and resting patterns. As a consequence of these shifts, regular activities, like going to work or school and sustaining relationships, may become very challenging. 


Bipolar disorder comes in three basic types. Each type has varying symptoms. Bipolar I disorder tends to manifest symptoms for a period of at least seven days. Bipolar II disorder presents symptoms of depressive and hypomanic episodes; however, symptoms are less severe than bipolar I symptoms. The third type of bipolar disorder is cyclothymic disorder. This disorder presents the symptoms of very mild depressive and hypomanic episodes; these symptoms usually don’t last longer than seven days. 

During a manic episode, a bipolar person is likely to experience the following symptoms:

  • Feeling energetic and jumpy
  • Extreme irritability
  • Lack of patience
  • Little need to sleep
  • Racing thoughts
  • Inability to focus
  • Strong desire for food, sex, alcohol, or drugs
  • A false sense of invincibility

During depressive episodes, these symptoms usually become present:

  • Feeling a sense of dread
  • A constant feeling of sadness
  • Overwhelming anxiety
  • Restless during the day and night
  • Difficulty falling asleep
  • Inability to sleep for several days
  • Talking slowly
  • Feeling of constant confusion
  • Trouble making decisions
  • Lack of interest in hobbies
  • Feeling hopeless
  • Suicidal thoughts


The root of bipolar disease remains a mystery. Research, however, reveals that other variables may have a role in causing the condition. There seems to be a strong genetic component to the hereditary nature of bipolar disease with certain families being disproportionately affected. 

Despite an elevated chance of developing bipolar illness in people with a family history, most individuals do not develop the condition themselves. And even though genes have a role, they aren’t everything. Bipolar disease, for example, can manifest differently in each member of a pair of identical twins.

How Do Bipolar Disorder and Alcoholism Affect One Another?

Alcoholism and bipolar illness often coexist, generating a complicated interaction that can amplify the effects of both disorders. There is a higher risk of alcohol use disorder among those who have bipolar disorder because they may use alcohol as a kind of self-medication to deal with their mood fluctuations. 

In contrast, heavy drinking may exacerbate preexisting mood swings in people with bipolar disorder, making it more difficult to control their conditions. Given the reciprocal nature of this connection, it is clear that treating both illnesses at once is essential for a full and lasting recovery. This complex interaction between bipolar illness and drinking requires specialized treatment approaches.


Self-medication is a common symptom of the cyclical relationship between drinking and bipolar illness. Some people with bipolar disorder turn to alcohol during manic or depressive episodes to calm their racing thoughts and regulate their overwhelming energy. Because of the cyclical nature of the link, it is crucial that patients treat both illnesses simultaneously for optimal results.


The impulsivity shared by people with bipolar illness and alcoholism compound the difficulties of living with both disorders. In manic episodes of bipolar disease, impulsivity may lead to excessive alcohol intake as a form of self-medication, heightening the risk of alcoholism. However, alcohol use may increase impulsivity, which can exacerbate the effects of mania. This two-way connection highlights the need for impulsivity-specific therapies, whether in the context of mood management for bipolar illness or as part of initiatives to reduce risky behavior in people with co-occurring disorders.

Extreme Mood Changes

Extreme mood fluctuations in persons with co-occurring bipolar illness and drinking create a tricky dynamic. Self-medicating with alcohol during depressed episodes may provide short-term respite but exacerbate emotional fluctuations. Consuming alcohol during a manic episode aggravates the symptoms of hyperactivity and agitation. This increases the likelihood of prolonged addiction and makes treatment for both disorders more challenging. Achieving stability calls for a holistic approach that takes into account the complex interaction between mood regulation and alcohol use. Individuals navigating the complicated consequences of significant mood fluctuations in the setting of bipolar illness and alcoholism must have access to professional intervention, treatment, and support.

Social Isolation

Individuals struggling with bipolar illness and alcoholism face additional difficulties when they socially isolate themselves; this often occurs during depressive episodes. Their isolation may worsen if they use alcohol as a means of coping. On the other hand, the impulsivity that alcohol causes during mania usually puts a strain on their relationships and leads to further isolation. As a consequence, social networks diminish, which compromises a person’s ability to heal and achieve sobriety. This is why it’s so important to provide integrated care that addresses both illnesses while also focusing on reestablishing social ties. Developing a supportive environment makes it possible to mitigate the isolating effects of bipolar disorder.

What Is Dual-Diagnosis Treatment?

Due to the complex interaction between bipolar illness and alcoholism, dual-diagnosis therapy is very helpful for those with the disorder who want to overcome their addictions to alcohol. The comorbidity of bipolar illness and drinking might make therapy more challenging. However, dual-diagnosis treatment offers an integrated strategy, allowing you to concurrently address your bipolar symptoms and alcohol use disorder. Personalized treatments, medication management, and psychoeducation are all part of a holistic approach to care because of the interconnected nature of many medical conditions.

Medication Management

Individuals who suffer from both alcoholism and bipolar need a deliberate strategy when it comes to managing their medication. Mood stabilizers, such as lithium or anticonvulsants, assist in treating bipolar symptoms and fostering emotional equilibrium. Medication for alcoholism, such as acamprosate or naltrexone, may help people stay sober by decreasing cravings or inhibiting the rewarding effects of alcohol. 

Medication management is most effective when evaluated and adjusted regularly by trained medical personnel. Regardless of the medications prescribed, constant observation guarantees the safety and efficacy of the drugs. Taking medications under the supervision of a treatment provider provides a two-pronged strategy that ensures clients have access to a full toolkit for dealing with both alcohol dependency and mood management issues.


Treatment providers use a wide range of psychotherapeutic approaches to treat the relationship between drinking and bipolar illness. Cognitive behavioral therapy is a kind of therapy that focuses on helping clients recognize and alter unhelpful ways of thinking and behaving. Dialectical behavioral therapy works exceptionally well for co-occurring disorders. This form of therapy integrates cognitive behavioral strategies with mindfulness practices to help clients learn to control their emotions. Those who are resistant to change might find renewed inspiration via motivational enhancement therapy. Family therapy strengthens existing social networks and provides additional encouragement to live a sober lifestyle. 


Among those with bipolar disorders, almost 10% of them require an inpatient stay at a hospital. Roughly 93% of them partake in outpatient mental health visits, and roughly 90% of them receive psychiatric counseling. During inpatient treatment for bipolar disorder and alcoholism, the client takes part in a variety of services, including:

  • Assessments
  • Detoxification
  • Medication management
  • Therapeutic interventions
  • Structured educational activities
  • Counseling sessions
  • Recreational activities
  • Dual diagnosis-focused approaches
  • Transition to outpatient care

What Happens After Treatment?

Individuals recovering from alcoholism and bipolar illness often benefit from access to aftercare programs. After completing treatment, clients need consistent follow-up care to help them integrate their newfound knowledge and skills to remain sober. 

A continuation of treatment, aftercare helps people deal with everyday stresses, avoid relapse, and adapt to their changing mental health requirements. Maintaining success and avoiding setbacks are the goals of support groups, counseling, and periodic assessments. The planned and continuing nature of aftercare considerably boosts the chance of long-term recovery, boosting emotional well-being and resilience as patients reintegrate into their everyday lives. 

AlcoholAwareness.org focuses on connecting people with comprehensive care for mood disorders and substance abuse. We are sensitive to the difficulties associated with a dual diagnosis and provide a helpful hub for facilitating introductions to appropriate treatment. The inpatient and outpatient treatment facilities in our vast network are all fully certified. Our program connects you with licensed professionals who can help with every aspect of your rehabilitation, from therapy to medication management to family counseling. Get help now by visiting AlcoholAwareness.org and taking the first step toward a healthier, sober lifestyle. Your path to rehabilitation starts with a click or call.