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Substance abuse, smoking more common in youth with mood disorders
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Adolescents with bipolar disorder, particularly those with comorbid conduct disorder, were significantly more likely to smoke cigarettes and have substance use disorder, compared with peers without mood disorders.
“We were surprised to find that conduct disorder, but not ADHD, played such a large role in mediating the increased risk of substance use disorder among those with bipolar disorder,” Timothy E. Wilens, MD, of Massachusetts General Hospital, Boston, said in a press release. “While this might be result of having only a few participants with bipolar disorder alone, it may be that it is the presence of conduct disorder that drives substance use disorder as adolescents with bipolar disorder become young adults. Since symptoms of bipolar disorder usually appear before substance use disorder develops, clinicians following youth with bipolar disorder should carefully monitor for cigarette smoking and substance use, along with treating bipolar symptoms.”
To assess risk for substance use disorders and cigarette smoking in adolescents with bipolar disorder, researchers evaluated a case-controlled, 5-year prospective follow-up of adolescents with (n = 105) and without (n = 98) bipolar disorder. Study participants had a mean age of 13 years at baseline. Follow-up included 73% of the original cohort.
Rates of substance use disorder (49% vs. 26%; HR = 2; 95% CI, 1.1-3.6; P = .02) and cigarette smoking (49% vs. 17%; HR = 2.9; 95% CI, 1.4-6.1; P = .004) were significantly higher among adolescents with bipolar disorder, compared with controls.
Participants with bipolar disorder were more likely to report earlier onset of substance use disorder (14.9 years vs. 16.5 years; P = .01), compared with controls.
Substance use disorder and nicotine dependence were more common among participants with conduct disorder, compared with those with only bipolar disorder or controls (P < .05 for all).
When adjusting for conduct disorder, socioeconomic status and parental substance use disorder, all associations lost significance, according to researchers.
Participants with a persistent bipolar disorder diagnosis were more likely to report cigarette smoking and substance use disorder, compared with those who lost a bipolar disorder diagnosis or controls at follow-up.
“These findings have important clinical considerations. Since [bipolar disorder] onset occurs prior to the [substance use disorder] in the majority of cases, practitioners following these individuals should treat symptoms of [bipolar disorder] and continue to carefully monitor for cigarette smoking and the development of [substance use disorder]. Finally, youth with persistent [bipolar disorder] and comorbid [conduct disorder] appear to be at the greatest risk for [substance use disorder], and it may be that [conduct disorder] is the primary mediator between [bipolar disorder] and SUD,” the researchers concluded. – by Amanda Oldt
Disclosure: Wilens reports receiving grant support from the following sources: NIH’s NIDA and Pfizer; serving as a consultant for Euthymics/Neurovance, NIH (NIDA), Theravance, and TRIS; publishing a book with Guilford Press: Straight Talk About Psychiatric Medications for Kids; co-editing the books ADHD in Children and Adults and Comprehensive Clinical Psychiatry; serving as director of the Center for Addiction Medicine at Massachusetts General Hospital, Boston; and serving as a consultant to the U.S. National Football League (ERM Associates), U.S. Minor/Major League Baseball, and Bay Cove Human Services (Clinical Services). Please see the full study for a list of all authors’ relevant financial disclosures.