ALCOHOLISM IN MANIC-DEPRESSIVE (BIPOLAR) ILLNESS - FAMILIAL ILLNESS, COURSE OF ILLNESS, AND THE PRIMARY-SECONDARY DISTINCTION

Objective: This 5-year follow-up study was designed to explore the fac tors that might lead to alcoholism in patients with bipolar disorder. Method: The authors studied patients with bipolar illness (70 with alc oholism and 161 without), their relatives, and a comparison group comp osed 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: Alcoholis m was more frequent in the bipolar patients than in the comparison sub jects. There were no significant differences between the alcoholic and nonalcoholic bipolar patients in family history of alcoholism or affe ctive disorders, suggesting that bipolar illness with alcoholism is no t explicable by a family history of alcoholism and that the alcoholism seen in bipolar illness is dissimilar to alcoholism as a primary diso rder. Alcoholism associated with bipolar illness was more likely to re mit than primary alcoholism. There was no significant difference in fa mily history between the patients with primary alcoholism and those wi th primary bipolar disorder. The patients with primary alcoholism had significantly fewer episodes of affective disorder during followup, su ggesting that their type of bipolar illness was less severe and may ha ve needed the added insult of alcoholism to make it manifest. Conclusi ons: The study supports the idea that not all alcoholism is primary wi th a corresponding familial diathesis. Rather, alcoholism associated w ith bipolar disorder is often a secondary complication.