[Frank et.al, 2006)] Baethge et.al (2005) examined substance use disorders in patients with first episode BP 1 disorder using 'Structured Clinical Interview for DSM-IV Axis I Disorders' (SCID). The study included a total of 172 patients who were admitted in the McLean hospitals between 1989 and 1996 for clinically diagnosed first lifetime manic/mixed BP 1 episodes. All the 172 subjects underwent follow-up assessment at 6,12 and 24 months respectively. Results from the study indicate that 37 (33.0%) were substance addicts at entry and this increased to 38.8% at the end of the study period. Statistical analysis further revealed that cannabis dependent subjects had more prolonged manic episodes (mean=26.8%, SD=34.0%, versus mean=11.5%, SD=19.1%; ratio=2.3:1), whereas alcohol dependant subjects had increased episodes of depression (mean=11.9%, SD=22.9%, in mania vs. mean=21.9%, SD=29.5%, in depression; ratio=1:1.8). Also morbidity was higher among polysubstance abusers. [Baethge et.al, 2005]

A more recent study by Wilens et.al (2009) analyzed 105 bipolar adolescent probands and 98 non-mood disordered control subjects. The first-degree relatives of the subjects were also assessed. This study by the Massachusetts General Hospital used DSM-IV-based structured interviews. The researchers interviewed primary caregivers, adolescent subjects and their siblings. Data pertaining to substance abuse was gathered using the DSM-IV Kiddie Schedule for Affective Disorders (KSADS) diagnostic criteria. The results indicated that subjects with BP disorder had an overall higher rate of substance use disorder (controls 4% and BPD 34%). Alcohol abuse (controls 3%, BPD 23%) and drug abuse (controls 1%, BPD 22%) were higher among the BP subjects. Statistical analysis also revealed that 14% of BP subjects had both alcohol and drug use disorder compared to none in the control group. This study clearly showed that there was a clear association between BP disorder and different types of substance use disorders. [Wilens et.al (2009)]

Another recent study by Pacchiarotti et.al (2009) focused on the onset of BP disorder preceded by substance abuse. For this purpose the researchers studied the clinical outcome of BP disorder (1 and 2) patients who had a history of substance use that preceded BP diagnosis. A group of BP disorder patients (n=145) who had a history of substance...

Final analysis of the socio demographic and the clinical variables indicated that the SUBP patients had less severe and less frequent hypomanic episodes suggesting a milder psychopathology compared to the control group. The result of this study suggests that first time clinical diagnosis of BP preceded by substance use is often a milder form and is more effectively managed by prevention programs for substance misuse. [Pacchiarotti et.al (2009)]
Conclusion

Compared to the general population, patients with bipolar disorder are more at risk for substance abuse and addiction. Substance abuse also has a bi-directional influence. Since substance abuse is a common disorder in a wide spectrum of psychiatric conditions such as BP, ADHD, CD, etc., understanding the comorbid relations would help in better treatment and management of the patients presenting with these conditions. Prophylactic and early interventions among BP disorder patients would substantially improve clinical outcome.

Bibliography

1) NIMH, (2009),'Bipolar Disorder', retrieved Dec 7th 2009, from http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml#pub5

2) Ellen Frank, Elaine Boland, & Danielle M. Novick et.al (2006), 'Association between illicit drug and alcohol use and first manic episode', Pharmacol Biochem Behav. 2007 February; 86(2): 395 -- 400.

3) Christopher Baethge, M.D. & Ross J. Baldessarini, MD et.al (May 2005), ' Substance abuse in first episode Bipolar 1 disorder: Indications for early intervention', Am J. Psychiatry 162:1008-1010. available online at, http://ajp.psychiatryonline.org/cgi/content/full/162/5/1008

4) Timothy E. Wilens, Joseph Biederman, & Joel J. Adamson, (2009),'Further Evidence of an association between Adolescent Bipolar Disorder with Smoking and Substance Use Disorders: A controlled Study', Drug Alcohol Depend. 2008 June 1; 95(3): 188 -- 198., Available Online at, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2365461/?tool=pmcentrez

5) Isabella Pacchiarotti; Silvia Di Marzo & Francesco Colom et.al (2009), 'Bipolar Disorder…