by Samuel Power

Created on: December 29, 2006   Last Updated: April 18, 2007

Impulsivity, which is prominent in both bipolar disorder and substance abuse, may have behavioral and biological factors that contribute to the overlap between the two disorders. Although impulsivity is a common symptom of bipolar mania, impulsivity is much more frequent when acute mania is complicated by current alcohol misuse. Substance abuse is present in many patients with bipolar disorder and associated with poor treatment outcome and increased risk of suicide. Over half (56%) of individuals afflicted with bipolar disorder have lifetime diagnosis of co-occurring substance use disorder (Salloum, Cornelius, Mezzich, Kirisci, p. 418-20, 2002). This combination is also associated with earlier onset and more sever course of illness for bipolar disorder. The strength of the association between bipolar disorder and chemical dependence suggests a common behavioral physiology (Swann, Dougherty, Pazzaglia, Pham, Moeller, p. 204, 2004). Mania has been found to be more strongly related to 12-month and lifetime diagnosis of alcohol or drug dependence than any other mood or anxiety disorder. Mania, more so than depression, is also reported to be associated with escalating alcohol use. This increase in alcohol use has been attributed to the presence of high levels of impulsivity during the manic episode. The need to self-medicate the manic symptoms is also a probable underlying reason an individual in a manic state is more likely to have an increase in alcohol consumption (Weiss and Mirin, p.441-52, 1997). Age and gender-controlled analysis has revealed that a group of bipolar patients who used or abused alcohol presented more severe psychopathology, as indicated by a higher number of total mood-related symptoms as well as of higher total number of manic symptoms. Specifically, they presented with significantly higher rates of mood lability and impulsivity, and also demonstrated higher rates of violent behavior and other drug use (Salloum, et al., p. 418, 2002).

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