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Bipolar Disorder and Alcohol Use Disorder: A Review

  • Bipolar Disorders (MA Frye, Section Editor)
  • Published:
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Abstract

Bipolar disorder and alcohol use disorder represent a significant comorbid population, which is significantly worse than either diagnosis alone in presentation, duration, co-morbidity, cost, suicide rate, and poor response to treatment. They share some common characteristics in relation to genetic background, neuroimaging findings, and some biochemical findings. They can be treated with separate care, or ideally some form of integrated care. There are a number of pharmacotherapy trials, and psychotherapy trials that can aid program development. Post-treatment prognosis can be influenced by a number of factors including early abstinence, baseline low anxiety, engagement with an aftercare program and female gender. The future development of novel therapies relies upon increased psychiatric and medical awareness of the co-morbidity, and further research into novel therapies for the comorbid group.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiological Catchement Area (ECA) Study. JAMA. 1990;264:2511–8.

    Article  PubMed  CAS  Google Scholar 

  2. Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States. Arch Gen Psychiatry. 2007;64:830–8425.

    Article  PubMed  Google Scholar 

  3. Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 2007;54:313–21.

    Article  Google Scholar 

  4. Cardoso BM, Kauer SM, Dias VV, Andreazza AC, Cereser KM, Kapczinski F. The impact of co-morbid alcohol use in bipolar patients. Alcohol. 2008;42:451–7.

    Article  PubMed  Google Scholar 

  5. Frye MA, Salloum IM. Bipolar disorder and co-morbid alcoholism: prevalence rate and treatment considerations. Bipolar Disord. 2006;8:677–85.

    Article  PubMed  CAS  Google Scholar 

  6. Feinman JA, Dunner DL. The effect of alcohol abuse on the course of bipolar affective disorder. J Affect Disord. 1996;37:43–9.

    Article  PubMed  CAS  Google Scholar 

  7. Salloum IM, Cornelius JR, Mezzich JE, Kirisci L. Impact of concurrent alcohol misuse on symptom presentation of acute mania at initial evaluation. Bipolar Disord. 2002;60:418–21.

    Article  Google Scholar 

  8. Strakowski SM, DelBello N, Fleck DE, Adler CM, Anthenelli RM, Keck PE, et al. Effect of co-occurring alcohol abuse on the course of bipolar disorder following a first hospitalization for mania. Arch Gen Psychiatry. 2005;62:851–8.

    Article  PubMed  Google Scholar 

  9. Van Zaane J, Van Der Brink W, Draisma S, Smit JH, Nolen WA. The effect of moderate and excessive alcohol use on the course and outcome of patients with bipolar disorder. J Clin Psychiatry. 2010;71:885–93.

    Article  PubMed  Google Scholar 

  10. Maier W, Merikangas K. Co-occurrence and cotransmission of affective disorders and alcoholism in families. Br J Psychiatry. 1996;30(Suppl):93–100.

    Google Scholar 

  11. Swann AC, Pazzaglia P, Nicholls A, Dougherty DM, Moeller FG. Impulsivity and phase of illness in bipolar disorder. J Affect Disord. 2003;73:105–11.

    Article  PubMed  Google Scholar 

  12. Frye MA, Altschuler LL, McElroy SL, Suppes T, Keck PE, Denicoff K, et al. Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder. Am J Psychiatry. 2003;160:883–9.

    Article  PubMed  Google Scholar 

  13. Craddock N, Sklar P. Genetics of bipolar disorder: successful start to a long journey. Trends Genet. 2009;25:99–105.

    Article  PubMed  CAS  Google Scholar 

  14. Farmer A, Elkin A, McGuffin P. The genetics of bipolar disorder. Curr Opin Psychiatry. 2007;20:8–12.

    Article  PubMed  Google Scholar 

  15. Serretti A, Mandelli L. The genetics of bipolar disorder: genome ‘hot regions’, genes, new potential candidates and future directions. Mol Psychiatry. 2008;13:742–71.

    Article  PubMed  CAS  Google Scholar 

  16. Mayfield RD, Harris RA, Schuckit MA. Genetic factors influencing alcohol dependence. Br J Pharmacol. 2008;154:275–87.

    Article  PubMed  CAS  Google Scholar 

  17. Kendler KS, Schmitt E, Aggen SH, Prescott CA. Genetic and environmental influences of alcohol, caffeine, cannabis, and nicotine use from early adolescence to middle adulthood. Arch Gen Psychiatry. 2008;65:674–82.

    Article  PubMed  Google Scholar 

  18. Smyth BP, Kelly A, Cox G. Decline in age of drinking onset in Ireland, gender and per capita alcohol consumption. Alcohol Alcohol. 2011;46:478–84.

    PubMed  Google Scholar 

  19. Dick DM, Jones K, Saccone N, Hinricks A, Wang JC, Goate A, et al. Endophenotypes successfully lead to gene identification: results from the collaborative study on the genetics of alcoholism. Behav Genet. 2006;36:112–26.

    Article  PubMed  Google Scholar 

  20. Strat YL, Ramoz N, Schumann G, Gorwood P. Molecular genetics of alcohol dependence and related endophenotypes. Curr Genomics. 2008;9:444–51.

    Article  PubMed  CAS  Google Scholar 

  21. Schuckit MA. Low level of response to alcohol as a predictor of future alcoholism. Am J Psychiatry. 1994;151:184–9.

    PubMed  CAS  Google Scholar 

  22. Garbutt JC, Osborne M, Gallop R, Barkenbus J, Grace K, Cody M, et al. Sweet liking phenotype, alcohol craving, and response to naltrexone treatment in alcohol dependence. Alcohol Alcohol. 2009;44:293–300.

    PubMed  CAS  Google Scholar 

  23. Cloninger CR. Neurogenic adaptive mechanisms in alcoholism. Science. 1987;236:410–6.

    Article  PubMed  CAS  Google Scholar 

  24. Irwin M, Schuckit M, Smith TL. Clinical importance of age of onset in Type 1 and Type 2 primary alcoholics. Arch Gen Psychiatry. 1990;47:320–4.

    Article  PubMed  CAS  Google Scholar 

  25. Babor TF, Hofmann M, DelBoca FK, Hesselbrock V, Meyer RE, Dolinsky ZS, Rounsaville B. Types of alcoholics I. Evidence for an empirically derived typology based on indicators of vulnerability and severity. Arch Gen Psychiatry. 1992;49:599–608.

    Article  PubMed  CAS  Google Scholar 

  26. Kendler KS, Heath AC, Neale MC, Kessler RC, Eaves LJ. A population-based twin study of alcoholism in women. JAMA. 1992;268:1877–82.

    Article  PubMed  CAS  Google Scholar 

  27. Yasseen B, Kennedy JL, Zawertailo LA, Busto UE. Comorbidity between bipolar disorder and alcohol use disorder. Association of dopamine and serotonin gene polymorphisms. Psychiatry Res. 2010;176:30–3.

    Article  PubMed  CAS  Google Scholar 

  28. Chang K, Adelman NE, Dienes K, Simeonova DI, Menon V, Reiss A. Anomolous prefrontal-subcortical activation in familial pediatric bipolar disorder. Arch Gen Psychiatry. 2004;61:781–92.

    Article  PubMed  Google Scholar 

  29. Strakowski SM, DelBello MP, Adler CM. The functional neuroanatomy of bipolar disorder: a review of neuroimaging findings. Mol Psychiatry. 2005;10:105–16.

    Article  PubMed  CAS  Google Scholar 

  30. Farren CK, Buchsbaum M, Hazlett E, Banks A. FDG-PET scanning in newly abstinent alcoholics: Fronto-striatal abnormalities. Alcohol Clin Exp Res. 2001;25(Suppl):78A.

    Google Scholar 

  31. Myrick H, Aonton RF, Li X, Henderson S, Randall PK, Voronin K. Effects of naltrexone and ondansetron on alcohol cue-induced activation of the ventral striatum in alcohol-dependent people. Arch Gen Psychiatry. 2008;65:466–75.

    Article  PubMed  CAS  Google Scholar 

  32. Volkow ND, Wang G-J, Telang F, Fowler JS, Logan J, Jayne M, et al. Profound decreases in dopamine release in striatum in detoxified alcoholics: possible orbitofrontal involvement. J Neurosci. 2007;27:12700–6.

    Article  PubMed  CAS  Google Scholar 

  33. Lam DH, Watkins ER, Hayward P, Bright J, Wright K, Kerr N, et al. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry. 2003;60:145–52.

    Article  PubMed  Google Scholar 

  34. Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry. 2003;60:904–12.

    Article  PubMed  Google Scholar 

  35. Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA, Fagiolini AM, et al. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry. 2005;62:996–1004.

    Article  PubMed  Google Scholar 

  36. Colom F, Vieta E, Martinez-Aran A, Reinares M, Goikolea JM, Benabarre A, et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry. 2003;60:402–7.

    Article  PubMed  Google Scholar 

  37. Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: project MATCH posttreatment drinking outcomes. J Stud Alcohol. 1997;58:7–29.

    Google Scholar 

  38. Anton RF, O’Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence. The COMBINE study: a randomized controlled trial. JAMA. 2006;295:2003–17.

    Article  PubMed  CAS  Google Scholar 

  39. Hien DA, Cohen LR, Miele GM, Litt LC, Capstick C. Promising treatments for women with comorbid PTSD and substance use disorders. Am J Psychiatry. 2004;161:1426–32.

    Article  PubMed  Google Scholar 

  40. Ziedonis DM, Smelson D, Rosenthal RN, Batki SL, Green AI, Henry RJ, et al. Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations. J Psychiatr Pract. 2005;11:315–37.

    Article  PubMed  Google Scholar 

  41. Bellack AS, Bennett ME, Gearon JS, Brown CH, Yang Y. A randomized clinical trial of a new brehavioral treatment for drug abuse in people with severe and persistent mental illness. Arch Gen Psychiatry. 2006;63(4):426–32.

    Article  PubMed  Google Scholar 

  42. •• Farren CK, McElroy S. Predictive factors for relapse after an integrated inpatient treatment program for unipolar depressed and bipolar alcoholics. Alcohol Alcohol. 2010;45:527–33. This research assesses the predictive factors that have been identified that predict response to an integrated inpatient treatment programme for BD and AUD.

    PubMed  Google Scholar 

  43. Farren CK, McElroy S. Treatment response of bipolar and unipolar alcoholics to an inpatient dual diagnosis program. J Affect Disord. 2008;106:265–72.

    Article  PubMed  Google Scholar 

  44. Farren CK, Snee L, McElroy S. Gender differences at 2-year follow-up of treated bipolar and depressed alcoholics. J Stud Alcohol Drugs. 2011;72:872–80.

    PubMed  Google Scholar 

  45. Weiss RD, Griffin ML, Greenfield SF, Najavits LM, Wyner D, Soto JA, Hennen JA. Group therapy for patients with bipolar disorder and substance dependence: results of a pilot study. J Clin Psychiatry. 2006;61:361–7.

    Article  Google Scholar 

  46. Weiss RD, Griffin ML, Kolodziej ME, Greenfield SF, Najavits LM, Daley DC, Doreau HR, Hennen JA. A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence. Am J Psychiatry. 2007;164:100–7.

    Article  PubMed  Google Scholar 

  47. •• Weiss RD, Griffin ML, Jaffee WB, Bender RE, Graff FS, Gallop RJ, Fitzmaurice GM. A “community-friendly” version of integrated group therapy for patients with bipolar disorder and substance dependence: a randomized controlled trial. Drug Alcohol Depend. 2009;104:212–9. This paper examines the effectiveness of the novel therapy IGT in the treatment of comorbid BD and substance dependence in the real world setting of community treatment programmes, applicable outside research centres..

    Article  PubMed  Google Scholar 

  48. Weiss RD, Connery HS. Integrated group therapy for bipolar disorder and substance abuse. New York: Guilford Press; 2011.

    Google Scholar 

  49. Weiss RD, Kolodziej ME, Najavits LM, Greenfield SF, Fucito LM. Utilization of psychosocial treatments by patients diagnosed with bipolar disorder and substance dependence. Am J Addict. 2000;9:314–20.

    Article  PubMed  CAS  Google Scholar 

  50. Daley DC, Mercer D, Carpenter G. Group drug counseling for cocaine dependence: therapy manuals for drug addition. United States Department of Health and Human Services, 2002.

  51. Crits-Christoph P, Siqueland L, Blaine J, Frank A, Luborsky L, Onken L, et al. Psychosocial treatments for cocaine dependence: results of the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Arch Gen Psychiatry. 1999;56:493–502.

    Article  PubMed  CAS  Google Scholar 

  52. Bowden CL, Brugger AM, Swann AC, Calabrese JR, Janicak PG, Petty F, et al. Efficacy of dibalproex vs, lithium and placebo in the treatment of mania [published erratum appears in JAMA]. JAMA. 1994;271:918–24.

    Article  PubMed  CAS  Google Scholar 

  53. Hillborn M, Tokola R, Kuusela V, Karkkainen P, Kalli-Lemma L, Pilke A, Kaste M. Prevention of alcohol withdrawal seizures with carbamazepine and valproic acid. Alcohol. 1989;6:223–6.

    Article  Google Scholar 

  54. Hammer BA, Brady KT. Valproate treatment of alcohol withdrawal and mania. Am J Psychiatry. 1996;153:1232.

    PubMed  CAS  Google Scholar 

  55. Johnson BA, Ait-Daoud N, Bowden CL, DiClemente CC, Roache JD, Lawson K, et al. Oral topiramate for treatment of alcohol dependence: a randomized controlled trial. Lancet. 2003;361:1677–85.

    Article  PubMed  CAS  Google Scholar 

  56. Brady KT, Myrick H, Henderson S, Coffey SF. The use of divalproex in alcohol relapse prevention: a pilot study. Drug Alcohol Depend. 2002;67:323–30.

    Article  PubMed  CAS  Google Scholar 

  57. Salloum IM, Cornelius JR, Daley DC, Kirisci L, Himmeloch JM, Thase ME, et al. Efficacy of valproate maintenance in patients with bipolar disorder and alcoholism: a double-blind placebo-controlled study. Arch Gen Psychiatry. 2005;62:37–45.

    Article  PubMed  CAS  Google Scholar 

  58. Kemp DE, Gao K, Ganocy SJ, Elhaj O, Bilali SR, Conroy C, et al. A 6-month double-blind, maintenance trial of lithium monotherapy versus the combination of lithium and divalproex for rapid-cycling bipolar disorder and co-occurring substance abuse or dependence. J Clin Psychiatry. 2009;70:113–21.

    Article  PubMed  CAS  Google Scholar 

  59. Drake RE, Xie H, McHugo GJ, Green AI. The effects of clozapine on alcohol and drug use disorders among patients with schizophrenia. Schizophr Bull. 2000;26:441–9.

    Article  PubMed  CAS  Google Scholar 

  60. Littrell KH, Petty RG, Hilligoss NM, Peabody CD, Johnson CG. Olanzapine treatment for patients with schizophrenia and substance abuse. J Subst Abus Treat. 2001;21:217–21.

    Article  CAS  Google Scholar 

  61. Zimmet SV, Strous RD, Burgess ES, Kohnstamm S, Green AI. Effects of clozapine on substance use in patients with schizophrenia and schizoaffective disorder: a retrospective survey. J Clin Psychopharmacol. 2000;20:94–8.

    Article  PubMed  CAS  Google Scholar 

  62. Kampman KM, Pettinati HM, Lynch KG, Whittingham T, Macfadden W, Dackis C, et al. A double-blind, placebo-controlled pilot trial of quetiapine for the treatment of type A and type B alcoholism. J Clin Psychopharmacol. 2007;27:344–51.

    Article  PubMed  CAS  Google Scholar 

  63. Brown ES, Garza M, Carmody TJ. A randomized, double-blind, placebo-controlled add-on trial of quetiapine in outpatients with bipolar disorder and alcohol use disorders. J Clin Psychiatry. 2008;69:701–5.

    Article  PubMed  CAS  Google Scholar 

  64. Stedman M, Pettinati HM, Brown ES, Kotz M, Calabrese JR, Raines S. A double-blind, placebo-controlled study with quetiapine as adjunct therapy with lithium of divalproex in bipolar I patients with coexisting alcohol dependence. Alcohol Clin Exp Res. 2010;34:1822–31.

    Article  PubMed  Google Scholar 

  65. Martinotti G, Andreoli S, Di Nicola M, Di Giannantonio M. Quetiapine decreases alcohol consumption, craving, and psychiatric symptoms in dually diagnosed alcoholics. Hum Psychopharmacol Clin Exp. 2008;23:417–24.

    Article  CAS  Google Scholar 

  66. Kranzler HR, Van Kirk J. Efficacy of naltrexone and acamprosate for alcoholism treatment: a meta-analysis. Alcohol Clin Exp Res. 2001;25:1335–41.

    Article  PubMed  CAS  Google Scholar 

  67. Croop RS, Faulkner EB, Labriola DF. The safety profile of naltrexone in the treatment of alcoholism. Results from a multicenter usage study. The Naltrexone Usage Study Group. Arch Gen Psychiatry. 1997;54:1130–5.

    Article  PubMed  CAS  Google Scholar 

  68. Salloum I, Cornelius J, Thase M, Daley D, Kirisci L, Spotts C. Naltrexone utility in depressed alcoholics. Psychopharmacology. 1998;34:111–5.

    CAS  Google Scholar 

  69. Maxwell S, Shinderman MS. Use of naltrexone in the treatment of alcohol use disorders in patients with concomitant major mental illness. J Addict Disord. 2000;19:61–9.

    Article  CAS  Google Scholar 

  70. Morris PL, Hopwood M, Whelan G, Gardiner J, Drummond E. Naltrexone for alcohol dependence: a randomized controlled trial [comment]. Addiction. 2001;96:1565–73.

    Article  PubMed  CAS  Google Scholar 

  71. Petrakis IL, Poling J, Levinson C, Nich C, Carroll K, Rounsaville B. Naltrexone and disulfiram in patients with alcohol dependence and comorbid psychiatric disorders. Biol Psychiatry. 2005;57:1128–37.

    Article  PubMed  CAS  Google Scholar 

  72. Brown ES, Beard L, Dobbs L, Rush AJ. Naltrexone in patients with bipolar disorder and alcohol dependence. Depress Anxiety. 2006;23:492–5.

    Article  PubMed  CAS  Google Scholar 

  73. • Brown ES, Carmody TJ, Schmitz JM, Caetano R, Adinoff B, Swann AC, Rush AJ. A randomized, double-blind, placebo-controlled pilot study of naltrexone in outpatients with bipolar disorder and alcohol dependence. Alcohol Clin Exp Res. 2009;33:1863–9. This study examines a study response to the anticraving medication naltrexone in BD and AUD in an outpatient setting. Although essentially a negative study, it is an important milestone in pharmacotherapy trials for this comorbidity.

    Article  PubMed  CAS  Google Scholar 

  74. Tolliver B, McRae A, Sonne SC, Brady KT. Safety and tolerability of acamprosate in alcohol-dependent individuals with bipolar disorder. An open-label pilot study. Addict Disord Treat. 2009;8:33–8.

    Article  Google Scholar 

  75. Tolliver BK, DeSantis SM, Brown DG, Prisciandaro JJ, Brady KT. A randomized, double-blind, placebo-controlled trial of acamprosate in alcohol-dependent individuals with bipolar disorder: a preliminary report. Bipolar Disord. 2012;14:54–63.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This paper was supported, in part, by Grant K24DA022288 (RDW) and K99/R00DA029115 (KPH) from the National Institute on Drug Abuse.

Disclosure

C. K. Farren: consultant for Lundbeck and travel/accommodations/meeting expenses reimbursed from GlaxoSmithKline; K. P. Hill: none; R. D. Weiss: consultant for Titan Pharmaceuticals and Reckitt Benckiser.

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Farren, C.K., Hill, K.P. & Weiss, R.D. Bipolar Disorder and Alcohol Use Disorder: A Review. Curr Psychiatry Rep 14, 659–666 (2012). https://doi.org/10.1007/s11920-012-0320-9

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