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Am J Psychiatry 1995; 152:365-372
Copyright © 1995 by American Psychiatric Association
Alcoholism in manic-depressive (bipolar) illness: familial illness, course of illness, and the primary-secondary distinction [published erratum appears in Am J Psychiatry 1995 Jul;152(7):1106]
G Winokur, W Coryell, HS Akiskal, JD Maser, MB Keller, J Endicott and T Mueller
Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City 52242.
OBJECTIVE: This 5-year follow-up study was designed to explore the factors
that might lead to alcoholism in patients with bipolar disorder. METHOD:
The authors studied patients with bipolar illness (70 with alcoholism and
161 without), their relatives, and a comparison group composed of
relatives' acquaintances. All were evaluated with versions of the Schedule
for Affective Disorders and Schizophrenia, and diagnoses were made
according to the Research Diagnostic Criteria. Thirty of the bipolar
alcoholic patients whose affective disorder was primary were also compared
with 34 whose alcoholism was primary. RESULTS: Alcoholism was more frequent
in the bipolar patients than in the comparison subjects. There no
significant differences between the alcoholic and nonalcoholic bipolar
patients in family history of alcoholism or affective disorders, suggesting
that bipolar illness with alcoholism is not explicable by a family history
of alcoholism and that the alcoholism seen in bipolar illness is dissimilar
to alcoholism as a primary disorder. Alcoholism associated with bipolar
illness was more likely to remit than primary alcoholism. There was no
significant difference in family history between the patients with primary
alcoholism and those with primary bipolar disorder. The patients with
primary alcoholism had significantly fewer episodes of affective disorder
during followup, suggesting that their type of bipolar illness was less
severe and may have needed the added insult of alcoholism to make it
manifest. CONCLUSIONS: The study supports the idea that not all alcoholism
is primary with a corresponding familial diathesis. Rather, alcoholism
associated with bipolar disorder is often a secondary complication.
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