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

Brainwaves show how exercising to music bends your mind

February 18, 2018
Headphones are a standard sight in gyms and we've long known research shows listening to tunes can be a game-changer for your run or workout.

People find comfort listening to the same songs over and over, study finds

February 16, 2018
With the frequency that some people play their favorite song, it's a good thing vinyl records aren't used often because they might wear out.

Ketamine found to reduce bursting in brain area reducing depression quickly

February 15, 2018
A team of researchers at Zhejiang University in China has found that the drug ketamine reduces neuronal bursting in the lateral habenula (LHb) brain region, reducing symptoms of depression in rodent models. In their paper ...

What predicts the quality of children's friendships? Study shows cognition, emotion together play

February 15, 2018
Whether children think their peers' intentions are benign or hostile, and how those children experience and express their own emotions, may influence the quality of their friendships, according to a new study from the University ...

Evidence shows pets can help people with mental health problems

February 15, 2018
The study of 17 research papers by academics at the Universities of Manchester, Southampton and Liverpool, concludes that pets can help people manage their long-term mental health conditions.

Personality: Where does it come from and how does it work?

February 14, 2018
How do our personalities develop? What do we come with and what is built from our experiences? Once developed, how does personality work? These questions have been steeped in controversy for almost as long as psychology has ...

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.