Question:
I've done a very quick search of medline, and found an
immense amount of research into the above subject. I've culled a few
articles and edited them a bit for brevity. I thought you might be
interested, particularly in the life-course symptomatology; early onset of
mood symptoms vastly increases risk for substance abuse. Aside: Rob, read the whole thing, ponder it, and then pontificate, OK?
Answer:
Risk for substance use disorders in youths with child- and adolescent-onset
bipolar disorder.
OBJECTIVE: Previous work in adults has suggested that early-onset
bipolar disorder (BPD) is associated with an elevated risk for
substance use disorders (SUD). To this end, the authors assessed the
risk for SUD in child- versus adolescent-onset BPD with attention to
comorbid psychopathology.
RESULTS: In mid-adolescence, youths with adolescent-onset BPD
were at significantly increased risk for SUD relative to those with
child-onset BPD (39% versus 8%; p = .001). Compared with those with
child-onset BPD, those with adolescent-onset BPD had 8.8 times the
risk for SUD (95% confidence interval = 2.2-34.7; chi 7(2) = 9.7, p =
.002). The presence of conduct disorder or other comorbid
psychopathology within BPD did not account for the risk for SUD.
CONCLUSIONS: Adolescent-onset BPD is associated with a much higher
risk for SUD than child-onset BPD, which was not accounted for by
conduct disorder or other comorbid psychopathology. Youths with
adolescent-onset BPD should be monitored and educated about SUD risk.
The identification and treatment of manic symptomatology may offer
therapeutic opportunities to decrease the risk for SUD in these
high-risk youths. Clinical characteristics of psychiatrically referred adolescent outpatients
with substance use disorder.
...Controlling for age, adolescents with
SUD had higher risk for mood and disruptive behavioral disorders
compared with psychiatric controls. In the majority of cases, the
onset of psychopathology preceded the onset of SUD by at least 1 year.
The group with SUD also had lower overall functioning and more school
dysfunction and psychiatric hospitalizations than their non-SUD peers.
Pediatric-onset bipolar disorder: a neglected clinical and public health
problem.
...Pediatric BPD is familial more often than is adult-onset BPD, may be
associated with a premorbid cyclothymic or hyperthymic temperament,
and can be precipitated by antidepressant treatment. Pediatric BPD
episodes frequently include irritability, dysphoria, or psychotic
symptoms; they are commonly chronic and carry high risks of substance
abuse and suicide.
Comorbidity of substance use disorders with mood and anxiety disorders: results
of the International Consortium in Psychiatric Epidemiology.
This article reports the results of a cross-national investigation of
patterns of comorbidity between substance use and psychiatric
disorders in six studies participating in the International Consortium
in Psychiatric Epidemiology. In general, there was a strong
association between mood and anxiety disorders as well as conduct and
antisocial personality disorder with substance disorders at all sites.
The results also suggest that there is a continuum in the magnitude of
comorbidity as a function of the spectrum of substance use category
(use, problems, dependence), as well as a direct relationship between
the number of comorbid disorders and increasing levels of severity of
substance use disorders (which was particularly pronounced for drugs).
I wasn't going to respond until I read this .. But Let me remind you
something about psychology and how their studies are performed, and this is
something I learned in a psychology class which I paid good money for (as a
reminder: there's a lot of free infomration out there, that doesn't mean
it's true). That is : All the below information is strictly based on
statistics, and (as we reviewed once per day in Psych 210) "There are three
types of lies: Lies, damned lies, and statistics". It was a quote from Mark
Twain, and the professor of the class was a Dr. Richard Perlow. (OF course,
he also began each class with the phrase "A day without statistics, is like
a day without sunshine." -- and if he equated statistics with lies, then I
don't know what to say about him :->). I was also asked, however, when first diagnosed if I had ever used drugs. I
had to honestly answer that yes, at one point I tried marijuana. I wasn't
specific at the time, but back when I "tried" it, realistically I was
pressured by my roomate and when I tried I *couldn't* inhale (I got half a
breath and coughed like crazy and said "forget it"). Still, they probably
recorded that in their statistics as associating "substance abuse" use with
bipolar as you quoted below. Like I said "Lies, Damned Lies, and
Statistics".
