While the course of alcohol dependence is improved during follow-up, its remaining symptoms still might interact with characteristics of psychiatric comorbidity and result in less treatment adherence and lower medication compliance. Together it might result in poorer symptomatic and functional recovery of these highly comorbid bipolar subjects (14, 33). Previous studies also noted that comorbid psychiatric disorders exacerbate bipolar disorder even without the negative effects of alcohol or substance abuse (30, 35).
