Teens With Bipolar Disorder Face High Risk of Substance Abuse as Adults

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Teens living with bipolar disorder face a particularly high risk of developing problems with substance abuse by the time they reach adulthood, according to new findings published this week in Journal of Clinical Psychiatry.

Following up a previous study showing that adolescents with bipolar disorder were more likely to smoke cigarettes and develop substance use disorder, researchers from Massachusetts General Hospital (MGH) found the risk increases even more five years later, especially among those with persistent bipolar symptoms.

The researchers followed up on over 100 teenagers diagnosed with bipolar disorder five years after their initial extensive interviews. After locating and re-interviewing 68 of these participants, the latest interviews showed the individuals had elevated risk of suffering from a substance use disorder or starting smoking compared to a control group of similarly followed participants.

Specifically, the researchers found those with bipolar disorder saw a 49 percent rate of new substance use disorder compared to 26 percent in those without the BD. However, those who had recovered from their bipolar disorder symptoms showed a distinct decrease in risk compared to those still experiencing symptoms.

“We also made another interesting finding — that those originally diagnosed with bipolar disorder 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,” said lead author of both studies Dr. Timothy Wilens, chief of Child and Adolescent Psychiatry at the Mass. General Hospital for Children and co-director of the MGH Center for Addiction Medicine, in a statement. “Both those with active symptoms and those whose symptoms had improved were at greater risk than our control group.”

In addition to these findings, the team noted that those with specific behavioral and emotional issues also faced a heightened risk of substance use issues. The report shows that bipolar teens also diagnosed with conduct disorder – characterized by anti-social and sometimes violent behaviors – were at particularly high risk of substance abuse. Those with bipolar disorder and attention-deficit hyperactivity disorder did not see the same high risk.

“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,” said Wilens. “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.”

The team says they hope their research will help medical professionals better address the specific health issues common among young patients with bipolar disorder.

“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,” he said.

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