How Alcohol Affects Bipolar Affective Disorder

Bipolar affective disorder (BD) is a mental health condition characterized by mood swings, alternating between episodes of mania, hypomania, and depression. Alcohol consumption, especially in excess, can significantly worsen this condition. Studies show that individuals with bipolar disorder often also struggle with alcohol use disorder (AUD), a combination that tends to intensify symptoms and complicate treatment.

There is a strong link between BD and alcohol use disorders. Several surveys indicate that this comorbidity is quite common (1). This overlap is not mere coincidence; genetic and environmental factors can predispose individuals to both conditions. Unfortunately, having both bipolar disorder and alcoholism is associated with worse clinical outcomes than having bipolar disorder alone. For instance, patients with BD who also abuse alcohol tend to have an earlier onset of the disorder, more episodes throughout life, and higher rates of hospitalization. Overall, this combination is associated with a more complicated prognosis and greater functional impairment (2). In other words, alcohol tends to increase the severity of bipolar disorder, making the mood highs and lows harder to manage.

Long-term studies with bipolar patients show that increases in alcohol consumption are followed by worsening depressive and manic symptoms in the months that follow (2). Excessive alcohol use can disrupt neurotransmitters involved in mood regulation—such as GABA, glutamate, and dopamine—leading to more intense mood swings. Additionally, alcohol disrupts sleep quality and the circadian rhythm—both of which are crucial for mood stability. Alcohol also causes dehydration and physical stress, which can strain the body and trigger sudden mood changes. In summary, alcohol and bipolar disorder tend to feed into each other: alcohol worsens emotional instability, and instability can, in turn, lead to impulsive behaviors such as increased drinking. This interaction sustains a harmful cycle of relapse. Research confirms that when alcohol and bipolar disorder co-occur, they exacerbate one another, resulting in more severe manic and depressive episodes and a more difficult clinical course (3).

Alcohol and the Treatment of Bipolar Affective Disorder

Alcohol use not only worsens symptoms but also undermines the effectiveness of bipolar disorder medications. Mood stabilizers (like lithium, valproate, and carbamazepine), antipsychotics, and benzodiazepines can have reduced effectiveness or intensified side effects when combined with alcohol. For example, alcohol enhances the sedative effects of many psychiatric medications, leading to excessive drowsiness, poor motor coordination, and increased risk of accidents or falls. Alcohol also places additional stress on the liver, the organ responsible for metabolizing many medications; this can alter the drugs’ elimination, increasing the risk of toxic effects or, conversely, reducing their therapeutic concentration in the blood.

Another important issue is that alcohol consumption often leads to poor treatment adherence. Patients under the influence may forget to take their medication or choose to skip doses in order to drink, which disrupts the management of bipolar disorder. Even small amounts of alcohol can interfere with the consistency and routine required for effective treatment. In practice, alcohol makes it harder for patients to maintain the stability achieved with mood stabilizers and other medications. Large-scale studies on people with bipolar disorder emphasize that treating only the mood disorder while ignoring AUD leaves gaps in care, resulting in poorer treatment response and higher relapse rates (2). This is why healthcare professionals advocate for integrated approaches: ideally, both bipolar disorder and alcohol use should be treated simultaneously through counseling, psychotherapy, or specific medications for addiction. This integrated management increases the chances of success by addressing all aspects of the problem.

In conclusion, alcohol can have a profoundly negative impact on bipolar affective disorder, worsening symptoms and undermining treatment success. Because it is a legal and socially accepted substance, its risks are often underestimated—but in the context of bipolar disorder, experts strongly advise extreme caution. Avoiding alcohol, or seeking help to quit, is a crucial step for those living with bipolar disorder, as it contributes to a more stable and healthier life.

References:

1. Pozzolo Pedro, M. O., Pozzolo Pedro, M., Martins, S. S., & Castaldelli-Maia, J. M. (2023). Alcohol use disorders in patients with bipolar disorder: a systematic review and meta-analysis. International review of psychiatry (Abingdon, England), 35(5-6), 450–460. https://doi.org/10.1080/09540261.2023.2249548
2.  
   Sperry, S. H., Stromberg, A. R., Murphy, V. A., Lasagna, C. A., McInnis, M. G., Menkes, M. W., Yocum, A. K., & Tso, I. F. (2024). Longitudinal Interplay Between Alcohol Use, Mood, and Functioning in Bipolar Spectrum Disorders. JAMA network open, 7(6), e2415295. https://doi.org/10.1001/jamanetworkopen.2024.15295
3. Grunze, H., Schaefer, M., Scherk, H., Born, C., & Preuss, U. W. (2021). Comorbid Bipolar and Alcohol Use Disorder-A Therapeutic Challenge. Frontiers in psychiatry, 12, 660432. https://doi.org/10.3389/fpsyt.2021.660432