Bipolar Disorder and Alcohol Use Disorder: A Review
- 1.2k Downloads
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.
KeywordsAlcohol use disorder AUD Bipolar disorder BD Comorbidity Genetics Neuroimaging Treatment Integrated Psychotherapy Pharmacotherapy Treatment program FIRESIDE Integrated group therapy Psychiatry
This paper was supported, in part, by Grant K24DA022288 (RDW) and K99/R00DA029115 (KPH) from the National Institute on Drug Abuse.
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 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
- 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
- 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
- 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.PubMedGoogle 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..PubMedCrossRefGoogle Scholar
- 48.Weiss RD, Connery HS. Integrated group therapy for bipolar disorder and substance abuse. New York: Guilford Press; 2011.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.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.PubMedCrossRefGoogle Scholar
- 68.Salloum I, Cornelius J, Thase M, Daley D, Kirisci L, Spotts C. Naltrexone utility in depressed alcoholics. Psychopharmacology. 1998;34:111–5.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.PubMedCrossRefGoogle Scholar