Hypomania and Alcohol Use

Individuals with clinically significant Mood Disorders such as Depressive Disorder and Bipolar Disorder have long been considered to be at risk for alcohol abuse and dependence. Mood fluctuations such as those found in Bipolar Disorder are tied to substance use in multiple ways. Some with these conditions report substance use to self-medicate negative symptoms. The effects of substance use to self-medicate, however, are unpredictable, varied and can result in worsened symptoms or a free-standing Substance Use Disorder. Additionally, the more ‘pleasant’ (Piper, 2010) symptoms of Mood Disorders such as Bipolar I and Bipolar II also seem to impact patterns of substance use.

Periodic and problematic alcohol use such as binge-drinking may be an indicator that those who use alcohol this way are experiencing a type of mood instability known as hypomania. Hypomania is a type of mood problem characterized by periods of time in which one’s mood is persistently elevated, expansive or irritable over a period of several days. Hypomania is considered one of the mood stages found in Bipolar I Disorder and Bipolar II Disorder. It is a mood state that is distinctly different than the extreme mood ‘poles’ of depression or mania commonly seen in these conditions.

Researchers believe that those who have episodes of hypomania may experience a fluctuation in their drinking behaviors just as they experience a fluctuation in their moods. Individuals with hypomania may not drink consistently, but may drink more when they do drink. Over an extended period of time, for example, those whose moods fluctuate dramatically may have a significant number of abstinent days, but tend to have a widely varying pattern of use such as binge-drinking within that time. ‘Emotional binges’ and drinking binges may coincide in those with this particular type of mood instability.

Hypomania is a non-depressed state with similarities to mania. It is not, however, as severe as mania which can lead to the need for emergency psychiatric treatment. While hypomania typically tends toward mania in increased energy and increased activity, it is not severe enough to cause the type of impairment in social or occupational functioning that mania does. Hypomania does not require hospitalization and does not have psychotic features. A manic episode on the other hand may require hospitalization for protection and medical stabilization and may also involve hallucinations and/or delusions.

The symptoms of hypomania include the following:

  • an inflated self-esteem or grandiosity
  • an inflated sense of well-being
  • a decreased need for sleep
  • increased talking
  • racing thoughts
  • increased activity
  • increased pleasure-seeking

While those who experience hypomania can observe the symptoms in themselves, others note a change in those who have a hypomanic episode as well. The symptoms listed above are clearly present and observable by others who share a social or work setting with the affected individual and are mark a distinct change in usual functioning.

Hypomanic episodes may alternate with periods of depression to create significant distress or impairment in one’s ability to function socially, occupationally or in some other important area of life functioning. This occurs in Bipolar II Disorder, a mood disorder which can range from mild to severe in the effects upon one’s ability to function well over an extended period. Bipolar II Disorder is characterized by fluctuations in mood from depression to hypomania which occur over a period of time. Unlike Bipolar I Disorder, the extremes of mood fluctuations do not include mania in Bipolar II. The depressive symptoms in Bipolar II, however, can be severe and debilitating, requiring treatment. Those who have Bipolar II Disorder tend to view the hypomanic episodes as a positive period of relief from depression. These periods of hypomania, may, however, have their own negative consequences for those who use substances.

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