Bipolar adolescents continue to have elevated substance use disorder risk as young adults

August 30, 2016, Massachusetts General Hospital

A follow up to a previous study finding an association between adolescent bipolar disorder and the incidence of cigarette smoking and substance use disorder finds that risk was even greater five years later, particularly among those with persistent bipolar symptoms. The report from a team of Massachusetts General Hospital (MGH) investigators, published in the Journal of Clinical Psychiatry, also finds evidence that the presence of conduct disorder, in combination with bipolar disorder, may be the strongest influence on the risk of smoking and substance use disorder.

"We also made another interesting finding - that those originally diagnosed with who continued to have symptoms five years later were at an even higher risk for cigarette smoking and substance use disorder than those whose symptoms were reduced either because of remission from bipolar disorder or from treatment," says Timothy Wilens, MD, chief of Child and Adolescent Psychiatry at Mass. General Hospital for Children and co-director of the MGH Center for Addiction Medicine, who led both studies. "Both those with active symptoms and those whose symptoms had improved were at greater risk than our .

The original study, published in the June 2008 issue of Drug and Alcohol Dependence, analyzed extensive data - including family histories, information from primary care physicians and the results of structured psychiatric interviews - on 105 early adolescents diagnosed with bipolar disorder and a control group of 98 with no mood disorders. Among those participants, with an average age of 14, the rate of substance use disorder among those with bipolar disorder was 34 percent, while it was only 4 percent in controls. The risk for smoking was 22 percent for those with bipolar disorder and 4 percent for controls.

For the five-year follow up, structured psychiatric interviews were conducted for 68 of the original participants with bipolar disorder - 37 being lost to follow up - and 81 control group members. Among those in the bipolar group, 23 no longer met criteria for the disorder, 36 still were experience active symptoms and 9 had symptoms that did not meet full criteria. During the five years since the original study, more members of the bipolar group developed new cases of substance use disorder than did controls, leading to an overall incidence rate of 49 percent versus 26 percent.

While controlling for the presence of other disorders - including (ADHD) or - did not affect the bipolar-associated risk in the original study, the new analysis found that controlling for conduct disorder caused the increased levels of substance use disorder to disappear. That result suggests that co-occurring conduct disorder plays a significant role in the risk associated with bipolar disorder.

"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," says Wilens, who is an associate professor of Psychiatry at Harvard Medical School. "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."

Wilens and his colleagues are also analyzing a subgroup of study participants who received detailed brain imaging in an effort to understand the brain circuitry involved in these disorders and their interaction. They also plan to investigate factors underlying the persistence of bipolar disorder and the impact of treatment on the incidence of smoking and substance use disorder.

Explore further: Study details risk factors for substance use disorders after manic episode

More information: Journal of Clinical Psychiatry, DOI: 10.4088/JCP.14m094

Related Stories

Study details risk factors for substance use disorders after manic episode

July 22, 2014
(Medical Xpress)—Adolescents with bipolar disorder are more likely to develop substance use disorders than adolescents without psychiatric disorders. Now, researchers at the University of Cincinnati (UC) have identified ...

Study finds average six-year delay between onset and diagnosis of bipolar disorder

July 25, 2016
Crucial opportunities to manage bipolar disorder early are being lost because individuals are waiting an average of almost six years after the onset of the condition before diagnosis and treatment.

Adults with bipolar disorder at equal risk for anxiety or depression following mania

May 3, 2016
Adults with bipolar disorder are just as likely to develop anxiety as depression following an episode of mania, according to data from a national survey of more than 34,000 adults. This finding, published today in Molecular ...

Adolescent brain develops differently in bipolar disorder

June 1, 2015
In adolescents with bipolar disorder, key areas of the brain that help regulate emotions develop differently, a new study by Yale School of Medicine researchers shows.

Recommended for you

Study shows how bias can influence people estimating the ages of other people

October 17, 2018
A trio of researchers from the University of New South Wales and Western Sydney University has discovered some of the factors involved when people make errors in estimating the ages of other people. In their paper published ...

Infants are more likely to learn when with a peer

October 16, 2018
Infants are more likely to learn from on-screen instruction when paired with another infant as opposed to viewing the lesson alone, according to a new study.

Researchers use brain cells in a dish to study genetic origins of schizophrenia

October 16, 2018
A study in Biological Psychiatry has established a new analytical method for investigating the complex genetic origins of mental illnesses using brain cells that are grown in a dish from human embryonic stem cells. Researchers ...

Income and wealth affect the mental health of Australians, study shows

October 16, 2018
Australians who have higher incomes and greater wealth are more likely to experience better mental health throughout their lives, new research led by the Bankwest Curtin Economics Centre has found.

Linguistic red flags from Facebook posts can predict future depression diagnoses

October 15, 2018
In any given year, depression affects more than 6 percent of the adult population in the United States—some 16 million people—but fewer than half receive the treatment they need. What if an algorithm could scan social ...

Early changes to synapse gene regulation may cause Alzheimer's disease

October 15, 2018
Alzheimer's disease (AD) is the most common form of dementia, involving memory loss and a reduction in cognitive abilities. Patients with AD develop multiple abnormal protein structures in their brains that are thought to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.