“…Accordingly, both substances are found to significantly impact illness trajectory, with increased rates of mood episode recurrence and severity (Rakofsky and Dunlop, 2013, Salloum et al, 2002, Waxmonsky et al, 2005, worsening general function (Cardoso et al, 2008), increased morbidity (Farren et al, 2012), poorer response to treatment (Berk et al, 2008), lengthier stays in hospital (Dodd et al, 2010) and increased risk of suicide (Oquendo et al, 2010). Despite the increased understanding of the clinical impact of these modifiable environmental exposures (Berk et al, 2011, Berk et al, 2013) knowledge of the neural interaction between alcohol/tobacco and BD pathophysiology remains limited.…”