The Effect of Comorbid Substance Use Disorders on the... : Harvard Review of Psychiatry (original) (raw)

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The Effect of Comorbid Substance Use Disorders on the Course of Bipolar Disorder: A Review

Tohen, Mauricio MD, DrPH1,2,3,4,†; Greenfield, Shelly F. MD, MPH1,2; Weiss, Roger D. MD1,2; Zarate, Carlos A. Jr. MD1,2; Vagge, Lisa M. BA1

1_From the Bipolar and Psychotic Disorders Program and the Alcohol and Drug Abuse Program McLean Hospital, Belmont_

2_the Consolidated Department of Psychiatry, Harvard Medical School, Boston, Mass_

3_the Department of Epidemiology, Harvard School of Public Health, Boston, Mass_

4_Lilly Research Laboratories, Indianapolis, Ind_

Supported in part by National Institute of Mental Health grant MH-48444 (Dr. Tohen); National Institute on Drug Abuse grants DA09400 (Drs. Tohen, Greenfield, and Weiss) and DA00326 (Dr. Weiss); National Institute on Alcohol Abuse and Alcoholism grant AA09881 (Dr. Greenfield); the Atlas Foundation (Dr. Tohen); the Dr. Ralph and Marian C. Falk Medical Research Dust (Drs. Greenfield and Weiss); and a National Alliance for Research on Schizophrenia and Depression Young Investigator Award (Drs. Tohen and Zarate).

Original manuscript received 7 June 1996; revised manuscript received 4 February 1998, accepted for publication 4 March 1998.

†Correspondence: Mauricio Tohen, Eli Lilly Research Laboratories, Lilly Corporate Center, DC0538, Indianapolis, IN 46285.

Abstract

Population-based studies have documented that among all patients with major psychiatric disorders, those with bipolar disorder have the highest prevalence of comorbid substance abuse and dependence. The cause of this high comorbidity rate has not been clearly established, and the relationship is probably bidirectional. Articles published in English from 1980 through 1997 containing the terms comorbidity, mania, outcome, and substance use were identified by searching Medline and then the bibliographies of the articles identified in this search. The literature review showed several risk factors to be associated with comorbid substance use disorders in bipolar disorder patients: early age of onset, gender, family history of substance use disorders, and presence of mixed mania. Methodological enhancements that have helped to advance understanding in this area include distinguishing between primary and secondary disorders, between the different subtypes of bipolar disorder, and between first and subsequent episodes of illness. In order to determine the temporal sequence of onset, longitudinal studies initiated at the onset of either illness need to be pursued. Increased understanding of the association between bipolar disorder and comorbid substance use disorder will facilitate improved detection and intervention, as well as more-effective preventive measures that could improve outcome for patients with bipolar disorder.