People often assume that those with bipolar disorder drink alcohol to cope with their symptoms, such as mood swings, anxiety, and trouble sleeping. This idea is known as “self-medication.”
However, a new study from the University of Michigan challenges this assumption, showing that the connection between alcohol and bipolar disorder is more complicated than previously thought.
The research, conducted by the Heinz C. Prechter Bipolar Research Program, followed nearly 600 people with bipolar disorder for ten years.
The findings, published in JAMA Network Open, revealed something surprising: drinking more alcohol led to worse mood symptoms, but worsening mood symptoms did not make people drink more. This suggests that people with bipolar disorder are not necessarily drinking more to cope with their mood swings.
Dr. Sarah Sperry, the lead author of the study, explained that drinking more than usual— even just a slight increase—was linked to more severe depressive and manic episodes over the next six months.
This pattern held true even for those who did not have a diagnosed alcohol use disorder. Surprisingly, even moderate drinking could lead to negative effects, which goes against the common belief that only heavy drinking is harmful.
One of the major findings was that increased alcohol use worsened everyday functioning, particularly in work life. This effect was seen in both types of bipolar disorder—bipolar I and bipolar II. However, it was especially noticeable in people with bipolar II disorder, who tend to experience more depressive episodes.
This is important because more than half of people with bipolar disorder develop alcohol use disorders at some point in their lives. Many turn to alcohol to help them sleep or reduce anxiety. Yet, this study suggests that even small increases in alcohol use can disrupt their recovery and worsen their symptoms over time.
The researchers used data from the Prechter Longitudinal Study of Bipolar Disorder, which has been collecting information from over 1,500 participants with and without bipolar disorder.
Every two months, participants provide updates on their mood, alcohol use, and how they are functioning in their daily lives. This long-term tracking allowed Dr. Sperry and her team to analyze how changes in drinking habits affected mood and behavior.
One of the study’s key recommendations is that mental health clinics should regularly ask patients about their drinking habits. The researchers suggest using standardized tools like the Alcohol Use Disorder Identification Test (AUDIT) to measure alcohol use consistently. This way, doctors can spot problems early and offer support before things get worse.
Dr. Sperry’s team is now looking deeper into why drinking has such a strong impact on people with bipolar disorder. They suspect it might be related to changes in the brain’s reward system and disruptions in circadian rhythms—the body’s natural clock that regulates sleep and mood.
To understand this better, they are using advanced technologies like EEG and wearable devices to study brain activity and real-world behavior. They are also recruiting more participants for their research to gain a clearer understanding of the connections between alcohol and bipolar disorder.
For people with bipolar disorder, the study sends a clear message: keeping alcohol use steady and minimal is important. Just as it’s crucial to stick to regular sleep and medication routines, managing alcohol intake can prevent mood swings from becoming more severe.
Dr. Sperry advises that patients avoid using alcohol as a sleep aid or as a way to calm anxiety. She also suggests that those with bipolar disorder avoid social situations where there is pressure to drink heavily.
The study’s findings encourage better conversations between patients and their doctors about alcohol use. Rather than assuming alcohol is just a form of self-medication, it’s important to understand its real impact on mood and everyday life.
These discussions can help patients make informed decisions about whether to quit drinking altogether or use harm-reduction strategies to limit their intake.
Researchers hope that by understanding this complex relationship, they can develop better ways to help people with bipolar disorder manage both their mood and their alcohol use. For now, the takeaway is clear: even small changes in drinking can have big effects, and staying consistent with alcohol habits is just as important as managing sleep and medications.
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