The reasons for alcohol misuse in bipolar disorder: a systematic review

shutterstock_63718723 man drinking bottle of beer

Alcohol misuse is common in people with mental health problems and the rates of drinking are particularly high in bipolar disorder. Studies show that the lifetime prevalence of substance use disorders is at least 40% in bipolar I patients (ref Cerullo et al).

Researchers from Newcastle University in the UK have conducted a systematic review to find out the self-reported reasons and motives for alcohol use in bipolar disorder, to try and understanding why people drink in excess and develop appropriate ways to help them.

The reviewers found 6 relevant studies from a search of Medline and PsychInfo and assessed the quality of the research using criteria they developed for this review. The quality of the included studies was limited, as the patients included in the different studies were quite different from one another and there were inconsistencies in the way the studies measured data.

Clearly this is not the most reliable of systematic reviews as the studies included are variable and there are a number of biases that could creep in when the reasons for drinking are self-reported. However, given the paucity of high quality evidence in this area, the results of this study are worth considering.

The review confirmed the widely held belief that many people with bipolar disorder self-medicate with alcohol, in an attempt to relieve distressing mood states. Furthermore, the researchers found that there were other reasons given for drinking – to enhance euphoric mood and just to be sociable.

The reviewers discuss their findings in the context of the self-medication hypothesis and cognitive motivational models of alcohol use.

They concluded:

Although implicitly alcohol use in patients with bipolar disorders is often been interpreted as evidence of a co-morbid alcohol use disorder or an inadequate coping pattern, it is essential to test this belief as a clinician. An adequate formulation has to consider that the motives to drink alcohol vary between patients with bipolar disorders and might also vary between mood states.

McDonald JL, Meyer TD. Self-report reasons for alcohol use in bipolar disorders: why drink despite the potential risks? Clin Psychol Psychother. 2011 Sep;18(5):418-25. doi: 10.1002/cpp.782. [PubMed abstract]

Cerullo MA, Strakowski SM. The prevalence and significance of substance use disorders in bipolar type I and II disorder. Subst Abuse Treat Prev Policy. 2007 Oct 1;2:29.

See also Equilibrium – The Bipolar Foundation, recent studies about bipolar disorder and substance misuse.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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