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Subjective response to alcohol in young adults with bipolar disorder and recent alcohol use: a within-subject randomized placebo-controlled alcohol administration study

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Abstract

Limited data exists on mechanisms contributing to elevated risk for alcohol use disorder (AUD) in bipolar disorder. Variation in subjective response to alcohol may relate to alcohol use and risk for AUD. This study used a randomized, placebo-controlled, cross-over, within-subjects design to investigate differences in subjective response to alcohol in 50 euthymic young adults (n = 24 with and n = 26 without bipolar disorder type I). Eighty-three percent of participants with bipolar disorder were medicated. Participants completed assessments of clinical history, alcohol expectancies, and recent alcohol use. Participants were dosed to a .08 g% breath alcohol concentration. The placebo condition occurred on a separate counter-balanced day. Subjective response to alcohol was investigated at similar time points during both conditions. Group, condition, and group-by-condition interactions were modeled, with condition and time of subjective response assessment as repeated within-subject variables, and subjective response to alcohol as the dependent variable. Greater stimulating effects and liking of alcohol were reported in people with bipolar disorder (group-by-condition interactions, p < .05) than healthy young adults. While young adults with bipolar disorder reported anticipating feeling less “mellow/relaxed” when drinking (p = .02), during both beverage conditions they reported feeling more “mellow/relaxed” (main effect of group, p = .006). Feeling more “mellow/relaxed” during the alcohol condition related to greater recent alcohol use in bipolar disorder (p = .001). Exploratory analyses suggested anticonvulsants and sedatives/antihistamines may relate to differences in subjective response to alcohol in bipolar disorder. Results suggest young adults with bipolar disorder may differ in alcohol expectancies and experience alcohol intoxication differently—with distinct relations between subjective response to alcohol and alcohol use—compared to healthy young adults.

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Data Availability

Data is available upon reasonable request to the corresponding author.

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Acknowledgements

We thank our participants for volunteering their time and supporting our research. This clinical trial is registered at ClinicalTrials.gov under the title “Acute Alcohol Response In Bipolar Disorder: a fMRI Study” (Identifier: NCT04063384) and can be found at https://clinicaltrials.gov/ct2/show/NCT04063384.

Funding

This study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) K01AA027573. The authors were supported by research grants from the NIAAA: K01AA027573 (ETCL, RK, VL); R21AA027884 (ETCL, RK, VL, KF, SMS, JRCA); R01AA020637 (KF); F31AA029005 (DK); and the Jones/Bruce Fellowship from the Waggoner Center for Alcohol and Addiction Research (DEK).

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA

    Elizabeth T. C. Lippard, Dylan E. Kirsch, Raquel Kosted, Vanessa Le, Jorge R. C. Almeida & Stephen M. Strakowski

  2. Department of Psychology, University of Texas, Austin, TX, USA

    Elizabeth T. C. Lippard, Kim Fromme & Stephen M. Strakowski

  3. Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA

    Elizabeth T. C. Lippard, Dylan E. Kirsch, Kim Fromme & Stephen M. Strakowski

  4. Institute for Neuroscience, University of Texas, Austin, TX, USA

    Elizabeth T. C. Lippard, Dylan E. Kirsch & Stephen M. Strakowski

  5. Institute of Early Life Adversity Research, University of Texas, Austin, TX, USA

    Elizabeth T. C. Lippard

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  1. Elizabeth T. C. Lippard
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Contributions

All authors had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept, design, and acquisition of funding: ETCL. Acquisition of data: ETCL, DEK, VL, RK. Statistical analyses and interpretation of data: ETCL, DEK. Drafting of manuscript: ETCL, DEK, RK, VL. Critical revision of the manuscript: ETCL, DEK, RK, VL, JRCA, SMS, KF. Administrative, technical, and material support: ETCL, DEK, RK, VL, JRCA, KF, SMS. Study supervision: ETCL.

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Correspondence to Elizabeth T. C. Lippard.

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Conflict of interest

We do not believe any of these relationships could influence the reported results, but we report them for transparency. SMS serves as DSMB chair for Sunovion and served recently on a DMC for Otsuka. He is also a contributor to Medscape. ETCL, JRCA, and SMS received funding for a Janssen-sponsored study through University of Texas at Austin. All other authors report no conflicts of interest.

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Lippard, E.T.C., Kirsch, D.E., Kosted, R. et al. Subjective response to alcohol in young adults with bipolar disorder and recent alcohol use: a within-subject randomized placebo-controlled alcohol administration study. Psychopharmacology 240, 739–753 (2023). https://doi.org/10.1007/s00213-023-06315-9

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