- Psychiatric Annals
- May 2012 - Volume 42 · Issue 5: 190-197
The strikingly high prevalence of substance use disorders in persons with bipolar disorder is well-established.1–3
Epidemiologic studies have found that 50% to 60% of people with bipolar disorder will develop at least one substance use disorder (SUD) in their lifetime, establishing bipolar disorder as the Axis I diagnosis most commonly associated with a comorbid SUD.4–8
Alcohol use disorders affect roughly half of people with bipolar disorder at some point in their lives, progressing to dependence in more than 30% of those with bipolar I disorder and nearly 20% of persons with bipolar II disorder.8 Similarly, nicotine dependence is disproportionately high in people with bipolar disorder.9 Despite the reduction in US smoking rates overall, both lifetime prevalence and current smoking rates have remained 2 to 3 times higher in those with bipolar disorder than in the general population.10
The impact of SUD comorbidity in bipolar disorder is enormous, both for patients and their families and for the US health care system. Substance-dependent individuals with bipolar disorder experience higher rates of unemployment,11 increased rates of violence12 and incarceration,13 and lower overall quality of life14 than their counterparts without comorbid SUDs. Clinically, the presence of comorbid SUDs in people with bipolar disorder is associated with poor treatment adherence,15 longer and more frequent mood episodes,16 more mixed episodes,17 and poor response to standard treatment,18 all of which contribute to increased use of emergency medical services19 and higher rates of hospitalization.20 Tragically, SUDs are associated with roughly twice the number of suicide attempts relative to bipolar patients without comorbid SUD.21–23
Both authors are Assistant Professors with the Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
Disclosure: The authors have disclosed no relevant financial relationships.
Address correspondence to: Bryan K. Tolliver, MD, PhD, Clinical Neuroscience Division Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425; email: .firstname.lastname@example.org