Substance Abuse in First-Episode Bipolar I Disorder: Indications for Early Intervention

Authors:
  • RBRoss J. Baldessarini
    Ross J. Baldessarini
  • HKHari-Mandir Kaur Khalsa
    Hari-Mandir Kaur Khalsa
  • JHJohn Hennen
    John Hennen
  • PSPaola Salvatore
    Paola Salvatore
  • MTMauricio Tohen
    Mauricio Tohen
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Abstract
This study clarified the early characteristics of substance use disorders in patients with first-episode bipolar I disorder. The authors evaluated substance use disorders, associated factors, and clinical course, prospectively, in the first 2 years of DSM-IV bipolar I disorder with standardized methods. Baseline substance use disorder was found in 33% (37 of 112) of the patients at baseline and in 39% at 24 months. Anxiety disorders were more frequent in the patients with than without substance use disorder (30% and 13%, respectively). Associations of alcohol dependence with depressive symptoms and cannabis dependence with manic symptoms were suggested. Patients using two or more substances had worse outcomes. Since substance use disorders were frequent from the beginning of bipolar I disorder and were associated with anxiety disorders and poor outcome, early interventions for substance use disorder and anxiety might improve later outcome.