How are alcoholism and bipolar disorder connected?

Bipolar disorder and alcoholism do co-occur at higher-than-expected rates.  No one knows why but it appears, surprisingly, that they are not genetically linked.  Bipolar men who are alcoholics often had a family history of alcoholism when compared with nonalcoholic bipolar men.  Alcoholism among bipolar women, however, was not associated with a family history of alcoholism.  Instead, their addiction often stemmed from anxiety and depression.  Bipolar women have a higher risk of developing alcoholism than non-bipolar women.  The rate in bipolar women for alcoholism is 29%, and in bipolar men it is 49%.

More importantly, alcohol, cocaine, heroin, PCP, and marijuana can all cause mood swings that make everyone using these drugs suspect of having a mood disorder in general and bipolar disorder more specifically.  When these patients are hospitalized psychiatrically as a result of an impulsive, potentially dangerous behavior in the context of their drug and alcohol abuse, the likelihood of their being discharged on a "cocktail" of psychiatric medications with a diagnosis of bipolar disorder is high.  With average lengths of stay in a psychiatric hospital of about a week the accuracy of such a diagnosis is suspect at best.  The proof is not even in the pudding, because complicating the picture is the fact that the medications one is discharged on are symptom and not diagnostic specific.  Therefore, although one's mood may stabilize with an anticonvulsant agent or antipsychotic, that does not mean one has bipolar disorder.  Unfortunately, the pitfall inherent in the diagnosis is that all too often these patients and their families focus entirely on the bipolar diagnosis, attributing continued relapse into drugs and alcohol to bipolar disorder while doing nothing to get treatment for substance or alcohol abuse.  But, alcohol and drugs of abuse worsen bipolar symptoms and go further toward explaining the mood swings than vice versa.  More likely, any mood swings stand a far better chance of improvement from abstinence than from any psychotropic medication offered.