Bipolar Disorder and Alcohol Misuse, Who is more at risk?

Based on the article: Sukhmeet Singh, Liz Forty, Arianna di Florio, Katherine

Gordon-Smith, Ian Jones, Nick Craddock, Lisa Jones and Daniel J. Smith, Affective temperaments and concomitant alcohol use disorders in bipolar disorder, Journal of Affective Disorders, http://dx.doi.org/10.1016/j.jad.2015.07.027

We all have heard that bipolars shouldn’t take alcohol, never mind misuse it, but still alcohol misuse is so prevalent amongst us. Why is that? And why is it easier for some to fall into that trap than for others? Let’s investigate

Almost a third of bipolars struggle with problems relating to alcohol use, this is much higher than for the rest of the population. Alcohol misuse is an important issue since it can contribute to treatment non-adherence, higher rates of suicide and the abuse of other substances.

 There are several theories around the mechanism behind the development of AM (alcohol misuse) problems amongst bipolars. The most prevalent one is the self-medication hypothesis which suggests that alcohol is used to cope with the symptoms and stress associated with bipolar disorder. Another hypothesis is that there are shared genetic risk factors for both BD and AM as well as shared abnormalities within neurotransmitter systems. So this might help shed light on why we like to drink more. But there is more to it, some of us are more susceptible to AM than others.

According to this article affective temperaments also play a role in this whole matter of AM within BD. Affective temperaments refer to, as I understand it, inherent attributes of a person relating to their mood or general disposition. The aim of the study reviewed here was to determine whether certain affective temperaments could be associated with AM amongst bipolars. They found that individuals that were irritable or hyperthymic (excessively positive temperament) had a greater chance of misusing alcohol. They also found that affective temperaments weren’t the only contributor to whether a bipolar would be more vulnerable to AM. Cannabis abuse and tobacco smoking also increased the odds of AM, even more so than irritability and having a hyperthymic disposition.

People that are hyperthymic tend to be more outgoing, upbeat and fun-loving, AM may be an attempt to maximise these traits. On the other hand, people with an irritable temperament tend to be more critical, dissatisfied, angry and jealous. These traits may be amplified during a period of high mood and such a person may choose to use alcohol to minimise the impact of these traits.

A high correlation between cyclothymic (lots of mood swings) and irritable temperaments have been found, especially amongst bipolars, affecting the clinical course and expression of BD, the history of suicide attempts and the presence of comorbid eating disorders. Irritability is also associated with Type IV of the Lesch Alcohol Typology, whereby individuals seem to consume alcohol in order to cope with mood swings, depression, fear and irritation.

Impulsivity, which is more prominent amongst bipolars with an irritable temperament may also add to AM.

Affective temperament is considered to be innate and enduring. Thus determining whether affective temperaments like irritability and hyperthymia is present early on in the course of BD, can help clinicians develop preventative treatment plans or interventions to avoid AM

I know I have an irritable temperament, and unfortunately I have to admit that although I don’t drink alcohol often, I do turn to it when the irritability is so high I want to scream at everything including my plastic plants. Does this new knowledge shed some light on your behaviour, do tell…

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