ABSTRACT
Of all major psychiatric diagnoses, bipolar disorder (BP) arguably shares the strongest association with substance use disorders (SUDs). This chapter will detail the current state of knowledge regarding bipolar-substance comorbidity among adolescents. By way of introduction, however, it is important to address this topic by first summarizing briefly what is known about this comorbidity among adults. Both clinical and epidemiologic studies have documented the exceedingly high rate of SUDs among persons suffering from BP. When SUD occurs with BP, recovery is delayed, relapse is hastened, symptoms are greater in number and persist between episodes, and disability and mortality are increased (Cassidy, Ahearn, & Carroll, 2001). Compared to BP patients without SUDs, those with SUDs demonstrate increased impulsivity (Swann, Dougherty, Pazzaglia, Pham, & Moeller, 2004), increased suicidality (Dalton, Cate-Carter, Mundo, Parikh, & Kennedy, 2003), decreased medication compliance (Weiss et al., 1998), and decreased quality of life (Singh, Mattoo, Sharan, & Basu, 2005). Even those who manage to recover from SUDs exhibit impaired role functioning compared to patients with no history of SUDs (Weiss et al., 2005). Recent data suggest that even moderate alcohol use may be associated with increased severity of illness in BP (Goldstein, Velyvis, & Parikh, 2006).
