The prevalence and significance of substance use disorders in bipolar type I and II disorder

Abstract

The aim of this paper is to provide a systematic review of the literature examining the epidemiology, outcome, and treatment of patients with bipolar disorder and co-occurring substance use disorders (SUDs). Articles for this review were initially selected via a comprehensive Medline search and further studies were obtained from the references in these articles. Given the lack of research in this field, all relevant studies except case reports were included.Prior epidemiological research has consistently shown that substance use disorders (SUDs) are extremely common in bipolar I and II disorders. The lifetime prevalence of SUDs is at least 40% in bipolar I patients. Alcohol and cannabis are the substances most often abused, followed by cocaine and then opioids. Research has consistently shown that co-occurring SUDs are correlated with negative effects on illness outcome including more frequent and prolonged affective episodes, decreased compliance with treatment, a lower quality of life, and increased suicidal behavior. Recent research on the causal relationship between the two disorders suggests that a subgroup of bipolar patients may develop a relatively milder form of affective illness that is expressed only after extended exposure to alcohol abuse.There has been very little treatment research specifically targeting this population. Three open label medication trials provide limited evidence that quetiapine, aripiprazole, and lamotrigine may be effective in treating affective and substance use symptoms in bipolar patients with cocaine dependence and that aripiprazole may also be helpful in patients with alcohol use disorders. The two placebo controlled trials to date suggest that valproate given as an adjunct to lithium in bipolar patients with co-occurring alcohol dependence improves both mood and alcohol use symptoms and that lithium treatment in bipolar adolescents improves mood and SUD symptoms.Given the high rate of SUD co-occurrence, more research investigating treatments in this population is needed. Specifically, double blind placebo controlled trials are needed to establish the effectiveness of medications found to be efficacious in open label treatments. New research also needs to be conducted on medications found to treat either bipolar disorder or a SUD in isolation. In addition, it may be advisable to consider including patients with prior SUDs in clinical trials for new medications in bipolar disorder.

Bipolar disorder in Asia: Illness course and contributing factors

“…The lower prevalence rates in Asia may be explained by the cultural influences forbidding the use of substances in most of its countries. Globally, alcohol and cannabis were frequently used by BD patients (Cerullo and Strakowski, 2007;Gaudiano et al, 2008;Lagerberg et al, 2010). Alcohol, due to its availability and affordability is still the most common substance used in the Asian context (Sedain, 2013;Tsai et al, 1997).…”

Polygenic risk scores for schizophrenia and bipolar disorder associate with addiction

“…Addiction to tobacco, alcohol or drugs is frequently a co‐morbidity of other psychiatric disorders, including schizophrenia (SCZ) and bipolar disorder (BPD) (Cerullo & Strakowski 2007; Margolese et al 2004). The high rate of smoking among SCZ patients is well known, and increased rates of substance use disorders and smoking are observed among their first‐degree relatives (Smith et al 2008).…”

Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual

“…Son drogas habitualmente descritas en la relación con el TB (Cerullo y Strakowski, 2007;Merikangas et al, 2008;Salloum et al, 2005). Además en el caso del alcohol, se observa que los pacientes con TB se inician en el consumo de alcohol a una edad más precoz lo que podría sugerir un papel causal para el consumo de alcohol.…”

“…Así, la combinación de cocaína y alcohol parecen especialmente vinculadas con el trastorno bipolar por sus efectos especí-ficos sobre el estado afectivo (Pacini et al, 2010) y se ha sugerido que se asocian con diferentes manifestaciones clí-nicas (Mitchell, Brown y Rush, 2007). Se ha sugerido que algunos pacientes bipolares con formas leves manifestarían la enfermedad de forma clínicamente más relevante con la exposición prolongada al alcohol (Cerullo y Strakowski, 2007). Otros autores observan relaciones entre el tipo de manifestaciones clínicas en la manía y el consumo específi-co de drogas como el alcohol o el cannabis (Güclü, Şenor-manci, Aydin, Erkiran y Köktürk, 2014) o el uso diferencial de drogas como la cocaína, alcohol o cannabis según el tipo de fase del trastorno bipolar (mixta, hipomanía, manía o depresión) (Maremmani et al, 2012).…”