Why I Choose to Abstain from Alcohol as a Woman with Bipolar Disorder

Photo by Michael Discenza on Unsplash

This post appeared on the International Bipolar Foundation’s website here.

As a social lubricant, alcohol takes top billing.

But if you have a mental illness like bipolar disorder, alcohol and other substances tend to tank your mental health. 

I’m not going to lie: alcohol temporarily helps decrease the suffering that comes from bipolar disorder. For many people, it feels great to drink, which is why studies show that there’s a 58% lifetime prevalence of co-occurring alcohol use disorders in individuals with bipolar I disorder.

But in the long run, alcohol is known to make bipolar mood episodes much, much worse. Drinking increases feelings of depression due to alcohol’s sedating effects and dramatically boosts the severity of manic symptoms. 

I don’t drink. I’ve never had more than a sip of my husband’s Christmas-only chocolate martinis. There’s one main reason why I don’t:

I’m scared to lose control.

It’s a visceral reason, something on a gut level that all humans experience: fear.

I’m scared. I’m scared that the stability I’ve worked so hard to earn over the years will spiral down the drain if I drink. I’m scared that more than a sip of alcohol will have me dancing on tables and shoot me into a full-blown manic episode. I’m scared that I’ll never recover from the inevitable crash and I’ll end up taking my own life.

My family has a history of addiction. I am scared that I’ve inherited those addictive behaviors and won’t be able to stop drinking once I start.

So the most powerful reason for me to never start drinking is fear of loss of control.

This may be an irrational fear. I may be able to control my impulses. I may be able to drink one drink a day and stop, indulging only a little at a time. 

But given that I have bipolar disorder, a disease marked by impulsivity and addictive behaviors, I don’t want to take the risk of drinking, even responsibly. 

Yes, not drinking means that people look at me funny at parties. It means I’m always the designated driver. It means that I’m often the sole sober person in a room full of drunk people, which can be funny sometimes and astonishing at others.

Staying sober means that I don’t have the social lubricant available to me, nor do I have a chemical way to unwind at the end of the day, which sounds tempting while being as wired and restless as I usually am in the evenings.

But it also means I am less likely to spin out into a manic episode that damages me and my family. Not drinking means my medications stay effective and I am less likely to suffer fatal toxicity. 

Because I’ve never drunk, it’s easier for me to abstain than someone with an alcohol use disorder. I can’t look at an addict and say, “Hey, you should stop drinking. It’s bad for you” with any results. 

However, I can say that drinking alcohol if you have bipolar disorder is bad for you, especially if you take an antidepressant. 

Alcohol counteracts the effects of your medication, which can lead to an increase in suicidal thoughts. Also, if you take MAOIs, a special kind of antidepressant, your blood pressure could rise quickly, and you could end up with a stroke. Also, sometimes fatal toxicity can happen because your liver just can’t handle the combination of alcohol and medications.

And that’s just the meds. Alcohol has been demonstrated in research to make bipolar disorder symptoms dramatically worse. And if you have a dual diagnosis of alcohol use disorder and bipolar disorder, each issue can worsen the other, making both difficult to treat.

So protecting your mental health, even out of fear, is a great reason not to drink, and for me, to never start. 

You may not be afraid of alcohol like I am. That’s good! I’m glad you’re able to handle drinking responsibly. But be careful. Alcohol use disorder is an easy disease to slip into; like I said at the beginning of this post, 58% of people with bipolar I suffer from a drinking problem. That’s more than half of us.

If you’re struggling with controlling your drinking – you drink too fast or too often – then help is available. Most people with alcohol use disorder can benefit from treatment.

If you have a drinking problem, medications and behavioral treatments are available to help you conquer it. Twelve-step programs offer valuable peer support. Contact your general practitioner today to see what resources are available to you in your community.

Whether you drink alcohol is your choice. Be careful to make sure you don’t bear the cost of drinking too much.

I wish you well in your journey.

Related Posts

• How Alcohol Complicates Bipolar Disorder
• My Advice to a Relative Facing a Bipolar Disorder Diagnosis — And What This Diagnosis Really Means
• Top Tips for Surviving the Holidays with Bipolar Disorder

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How Alcohol Complicates Bipolar Disorder

Alcohol, the social lubricant. Some people drink because alcohol relaxes them in social situations. The drink isn’t called “liquid courage” for nothing.

But alcohol is an addictive substance, which has great potential to be misused, especially by people who also suffer from bipolar disorder.

The Connections Between Alcohol Use and Bipolar Disorder

Studies have shown that people who abuse alcohol are more likely to have bipolar disorder. According to a 2013 review, up to 45% of people with bipolar disorder also have alcohol use disorder (AUD).

Overwhelming feelings of sadness from bipolar depression make people more likely to self-medicate with substances like alcohol. And self-medicating makes it more likely for people with bipolar disorder to not stick to their medication regime or attend therapy sessions.

Alcohol also affects people with bipolar disorder in different ways than the neurotypical population.

A 2006 study showed that people with bipolar disorder are adversely affected by even small amounts of alcohol, which may both trigger and worsen manic and depressive symptoms.

Mania is known to increase impulsiveness. Because alcohol reduces inhibitions, consuming alcohol during a manic episode may encourage risky and irrational behaviors.

Alcohol, a central nervous system depressant, also contributes to lethargy and sadness during depressive episodes. The symptoms of depression triggered by alcohol are increased when people first stop drinking, so recovering alcoholics with a history of depression may relapse in the first few weeks of dealing with withdrawal.

People who suffer from psychosis triggered by manic episodes are also adversely affected by alcohol. Consuming alcohol during psychosis contributes to both long-term and short-term complications. Alcohol also complicates the treatment of psychosis, contributing to dangerous medication interactions.

How Alcohol Affects Medications

Medications that are part of your treatment plan are strongly affected by alcohol.

Valproic acid, known commonly as Depakote, is often prescribed to treat symptoms of bipolar disorder. Similar to alcohol, Depakote is a central nervous system depressant which affects the liver. Combining alcohol and Depakote increases the chance of  liver damage.

Similarly, consuming alcohol with lithium, which is frequently prescribed to treat symptoms of bipolar disorder, can contribute to liver disease. Lithium has side effects such as gastrointestinal problems, lethargy, and tremors, all of which alcohol can increase.

Antidepressants and antipsychotics may not work as well when combined with alcohol. Side effects can be increased, and you may feel more depressed and anxious.

You may decide to skip your medication in order to drink. This is a bad idea, as your symptoms of bipolar disorder may return quickly, triggering an episode. Stopping your dosages of medications without tapering off under the guidance of a professional is detrimental to your mental and physical health.

Alternatives to Alcohol

Alcohol can help you relax and socialize. Cutting down on alcohol can be difficult. It may be helpful to replace some of your drinking with relaxing habits.

Some alternatives to having a drink are:

• Getting a massage
• Attending a yoga or taekwondo class
• Meditating
• Exercising
• Taking a warm bath
• Using aromatherapy

Final Thoughts

Drinking responsibly takes on a whole new level when you suffer from bipolar disorder. You not only need to be aware that drinking, especially to excess, triggers and worsens manic and depressive episodes, but also that your medication may interact poorly with the substance.

I’m not saying to cut all alcohol out of your life if you have bipolar disorder. If you are a responsible adult, there is no reason you can’t drink. But be aware of the complications alcohol brings to your life. You may find it easier to abstain.

I wish you well in your journey.

Related:

• Substance Abuse and Bipolar Disorder
• Why Should You Chart Your Moods if You Have Bipolar Disorder?
• Bipolar Disorder is Toxic–-Literally

Good, Good, Good Nutrition, Part II: Foods to Avoid When Managing Bipolar Disorder

We all know that an unhealthy diet can affect our bodies in negative ways. But did you know that some foods are especially bad for mental health? Studies show that the following foods are really, really bad for you if you have bipolar disorder, or suffer from depression.

Caffeine

Caffeine is a stimulant which can make you jittery and on edge, and cause you to miss out on sleep, which is crucial for managing your mood–and may tip you into mania if you don’t get enough sleep. If you’re trying to stop eating or drinking caffeine, make sure you wean yourself off of it gradually, as stopping abruptly can have adverse effects on your body.

Caffeine is found in the following:

• coffee
• soda
• chocolate
• tea
• weight-loss pills
• energy water

Credit to flickr.com user Peter Anderson. Used with permission under a Creative Commons license.

Alcohol

Alcohol is a depressant, even though it can seem to raise your spirits (pun intended). Drinks can also lower inhibitions and increase impulsivity. In a recent study in the journal Addiction, researchers found that alcohol misuse doubled the risk of the development of major depressive disorder. Even for people who are not alcoholics, drinks may fuel suicidal ideation. As with caffeine, doctors recommend weaning yourself off alcohol gradually.

Tyramine

If you take monoamine oxidase inhibitors, like my dear friend Dyane Hardwood, then there are some dietary requirements you need to pay attention to. Most importantly, you need to avoid tyramine, which can cause the amino acid to spike, which increases blood pressure to dangerous levels. Tyramine is found in:

• aged cheeses
• cured, processed, and smoked meats
• fermented foods such as sauerkraut and kimchi
• soybeans
• dried fruit

Nitrates

A recent study shows that nitrates, which are chemicals used to process and cure meats, can contribute to mania. They’ve also been linked to pancreatic cancer and Alzheimer’s disease, and children under six should avoid them in general.

Nitrates can be found in:

• bacon
• pepperoni
• salami
• hot dogs

Supplements

Supplements like St. John’s wort aren’t really food, but some of them can interact negatively with your bipolar medications, making them less effective, or spiking their levels. Talk to your doctor about what interactions occur with supplements and herbal therapies.

Sugar

In bipolar disorder patients especially, refined sugars can cause wild mood swings. Too much sugar can contribute to obesity, which makes some bipolar medications less effective, especially if the weight is gained around the middle. Instead, look to complex carbohydrates, like whole grains and vegetables.

All in all, diet is extremely important to mental health. If you stay on top of your food and supplement intake, you’ll be able to manage your brain’s ups and downs much more effectively.

Substance Abuse and Bipolar Disorder

Credit to flickr.com user Zhao. Used with permission under a Creative Commons license.

Sometimes, the symptoms of bipolar disorder–including periods of elevated mood, depression, and irritability–are too difficult to deal with. Often, people turn to drugs and alcohol to try to cope.

“Some people attempt to treat symptoms of their mental illness with substances, but substance abuse can activate or prolong symptoms,” Marissa Krick, a writer for DrugRehab.com, said in an email.

Krick cited studies saying that up to 60 percent of people who suffer from bipolar disorder confess that they’ve also abused drugs or alcohol. People who suffer symptoms of acute mania or bipolar II disorder are significantly more likely to abuse benzodiazepine and alcohol than people who suffer from depression, according to the Zurich Cohort Study. In addition, a history of substance abuse complicates recovery from acute manic states.

The writers at DrugRehab.com have penned an extensive report on substance abuse in conjunction with bipolar disorder. It’s worth a read. According to the report, “Substance abuse makes symptoms of bipolar disorder worse and decreases the benefits of standard treatment. People tend to take longer to recover, spend more time in health facilities and be more likely to contemplate suicide when they misuse substances during treatment.”

But there is hope. Rehabilitation facilities can treat both substance abuse and bipolar disorder concurrently. Treatment for substance abuse starts with a detoxification process, whereas treatment for bipolar disorder involves medication and behavioral therapy. Patients going through drug or alcohol withdrawal are kept as comfortable as possible.