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Alcohol experimentation among substance abuse predictors in bipolar teens

Findings from a recent study demonstrate that about one in three teens with bipolar disorder developed a substance use disorder during 4 years of follow-up. Cannabis and alcohol were the most commonly abused substances.

According to researchers, the strongest predictor of first-onset substance use disorder was experimentation with alcohol. Five other baseline characteristics were also predictors of a substance use disorder (SUD): Presence of oppositional defiant disorder and panic disorder, family history of substance use disorders, low family cohesiveness and lack of treatment with antidepressants.

The study included 167 youth (aged 12 to 17 years) with DSM-4 BP-I, BP-II or operationalized bipolar disorder not otherwise specified from the Course and Outcome of Bipolar Youth (COBY) study. None of the participants had a history of substance abuse.

After a mean 2.7 years from enrollment, 32% of participants developed first-onset SUD. The risk for first SUD increased among participants with more than one predictor: 54.7% of those with three or more predictors developed SUD vs. 14.1% of those with fewer than three predictors (HR=5.41; 95% CI, 2.7-11), according to the study.

During follow-up, SUD was also more likely among those with greater hypo/manic symptom severity in the preceding 12 weeks, whereas those exposed to lithium in the preceding 12 weeks had a lower risk for SUD.

"Present findings suggest that mood symptoms, inadequate treatment, recreational alcohol use, and familial factors may be important variables to examine in future studies regarding first-onset SUD among adolescents with BP," the researchers wrote. "These findings, albeit tentative, further suggest that treatment of psychiatric comorbidity, both internalizing and externalizing, and incorporating family therapy may confer benefits with regard to SUD."

Disclosure: See the study for a full list of all researchers’ relevant financial disclosures.