PREVALENCE OF ALCOHOL USE DISORDER AND ITS CLINICAL IMPACT IN BIPOLAR DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS
Introduction: Bipolar disorder is among the most disabling psychiatric conditions worldwide and is frequently complicated by comorbid substance use disorders. Alcohol Use Disorder (AUD) is one of the most prevalent comorbidities, yet reported prevalence rates and clinical outcomes vary widely across studies.
Objective: To systematically review and meta-analyze the prevalence of AUD in individuals with bipolar disorder, and to examine its impact on clinical outcomes.
Methods: Following PRISMA 2020 guidelines, we systematically searched PubMed, Embase, and PsycINFO, up to 2005. Observational studies reporting prevalence of AUD in bipolar disorder or assessing its clinical impact were included. Data extraction was performed independently by two reviewers, with risk of bias assessed using JBI for prevalence studies and NOS/ROBINS-I for comparative designs. Random-effects models were planned for quantitative synthesis, with heterogeneity and publication bias formally evaluated.
Results: The literature consistently indicates that AUD is highly prevalent among individuals with bipolar disorder, with lifetime estimates frequently exceeding those observed in the general population. Beyond prevalence, AUD is strongly associated with a more severe illness course, including more frequent affective relapses, higher rates of hospitalization, and increased suicidal behavior. Despite some heterogeneity in study methods, the overall evidence suggests that comorbid AUD substantially worsens prognosis in bipolar disorder.
Conclusions: AUD is not only common in bipolar disorder but also exerts a significant negative influence on its course and outcomes. These findings highlight the clinical importance of systematic screening for alcohol misuse in bipolar populations and the integration of addiction management into standard psychiatric care.
Keywords: Bipolar disorder, Alcohol Use Disorder, Comorbidity, Meta-analysis
