Substance use disorders among adolescents with bipolar spectrum disorders


  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

  • Preliminary findings were presented in poster form at the 160th Annual Meeting of the American Psychiatric Association, May 2007, San Diego, CA, USA and at the Seventh International Conference on Bipolar Disorder, June 2007, Pittsburgh, PA, USA. This paper was awarded the 2008 Samuel Gershon Award for Junior Investigators from the International Society for Bipolar Disorders.

Corresponding author: Benjamin I Goldstein, MD, PhD, Western Psychiatric Institute and Clinic, 100 North Bellefield Avenue, #607, Pittsburgh, PA 15213, USA. Fax: +1 412 246 5230; e-mail:


Objective:  We set out to examine the prevalence and correlates of substance use disorders (SUD) in a large sample of adolescents with bipolar disorder (BP).

Methods:  Subjects were 249 adolescents ages 12 to 17 years old who fulfilled DSM-IV criteria for bipolar I disorder [(BPI), n = 154], or bipolar II disorder [(BPII), n = 25], or operationalized criteria for BP not otherwise specified [(BP NOS), n = 70], via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS). As part of the multi-site Course and Outcome of Bipolar Youth study, demographic, clinical, and family history variables were measured via intake clinical interview with the subject and a parent/guardian.

Results:  The lifetime prevalence of SUD among adolescents with BP was 16% (40/249). Results from univariate analyses indicated that subjects with, as compared to without, SUD were significantly less likely to be living with both biological parents, and that there was significantly greater lifetime prevalence of physical abuse, sexual abuse, suicide attempts, conduct disorder, and posttraumatic stress disorder among subjects with SUD. Subjects with SUD reported significantly greater 12-month prevalence of trouble with police, and females with SUD reported significantly greater 12-month prevalence of pregnancy and abortion. Significant predictors of SUD in a logistic regression model included living with both biological parents (lower prevalence), conduct disorder and suicide attempts (increased prevalence). In logistic regression analyses controlling for demographic differences and conduct disorder, SUD remained significantly associated with trouble with police, whereas the association of SUD with pregnancy and abortion was reduced to a statistical trend. The prevalence of SUD was not significantly different among child- versus adolescent-onset BP subjects.

Conclusions:  SUD among adolescents with BP is associated with profound hazards including suicide attempts, trouble with police, and teenage pregnancy and abortion.