Integrating research data and electronic health records to examine medical and treatment outcomes in co-occurring bipolar and alcohol use disorder

Psychiatry Res. 2026 Nov 5;367:117564. doi: 10.1016/j.psychres.2026.117564. Online ahead of print.

ABSTRACT

Co-occurrence of bipolar spectrum disorders (BD) and alcohol use disorder (AUD) is common and associated with poorer clinical outcomes, higher utilization of emergency and inpatient psychiatric services, and unique challenges in care delivery. This study investigated treatment patterns and healthcare utilization among individuals with BD+AUD compared to those with BD alone, drawing on a longitudinal research cohort and the University of Michigan’s Health Services (UMHS) electronic health record cohort (EHR) from a Midwest community. Results revealed high rates of AUD among individuals with BD, with lower AUD prevalence among females than males in both cohorts, consistent with general-population patterns, and higher odds of comorbid AUD among those with BD NOS relative to BD I. Individuals with BD+AUD were more likely to engage in addiction-focused and supportive interventions, including counseling, self-help groups, and multiple alcohol treatment programs, as well as have elevated rates of naltrexone prescription. However, preventive outpatient psychiatric care was less common, while crisis-driven emergency and inpatient service use was increased. Notably, there remain substantial gaps between evidence-based guidelines and real-world treatment, particularly in the underutilization of certain recommended pharmacotherapies. The findings underscore the need for integrated, gender- and subtype-sensitive models of care and smoother coordination across psychiatric and addiction services to improve long-term outcomes for this population.

PMID:43003021 | DOI:10.1016/j.psychres.2026.117564