Abstract
Objective: Comorbidity of alcohol use disorders in bipolar subjects is high as indicated by epidemiological and clinical studies. Though a more severe course of bipolar disorder in subjects with comorbid alcohol dependence has been reported, fewer studies considered the longitudinal course of alcohol dependence in bipolar subjects and the prospective course of comorbid bipolar II subjects. Beside baseline analysis, longitudinal data of the COGA (Collaborative Study on Genetics in Alcoholism) were used to evaluate the course of bipolar I and II disordered subjects with and without comorbid alcohol dependence over more than 5 years of follow-up.Methods: Characteristics of bipolar disorder, alcohol dependence and comorbid psychiatric disorders were assessed using semi-structured interviews (SSAGA) at baseline and at a 5-year follow-up. Two hundred twenty-eight bipolar I and II patients were subdivided into groups with and without comorbid alcohol dependence.Results: Of the 152 bipolar I and 76 bipolar II patients, 172 (75, 4%) had a comorbid diagnosis of alcohol dependence. Bipolar I patients with alcohol dependence, in particular women, had a more severe course of bipolar disorder, worse social functioning and more suicidal behavior than all other groups of subjects during the 5-year follow-up. In contrast, alcohol dependence improved significantly in both comorbid bipolar I and II individuals during this time.Conclusions: A 5-year prospective evaluation of bipolar patients with and without alcohol dependence confirmed previous investigations suggesting a more severe course of bipolar disorder in comorbid bipolar I individuals, whereas bipolar II individuals were less severely impaired by comorbid alcohol use disorder. While severity of alcohol dependence improved during this time in comorbid alcohol-dependent bipolar I patients, the unfavorable outcome for these individuals might be due to the higher comorbidity with personality and other substance use disorders which, together with alcohol dependence, eventually lead to poorer symptomatic and functional clinical outcomes.
Highlights
There are converging lines of evidence demonstrating that substance use disorders are overrepresented in individuals with bipolar disorder
Written informed consent to participate in the study was obtained from all enrolees. Probands and their relatives were interviewed at baseline by using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), which focuses on demography, substance use patterns, and the assessment of 17 axis I DSM-IV diagnoses, as well as characteristics of bipolar disorder [20]
While no further differences across groups were detected regarding years of education, gender, ethnicity, marital status and holding of college degrees, a significantly higher proportion of group 4 members compared to group 1 were unemployed
Summary
There are converging lines of evidence demonstrating that substance use disorders are overrepresented in individuals with bipolar disorder. Compared to patients with other types of psychiatric conditions, including schizophrenia, panic disorder, major depression, and dysthymia, subjects with bipolar I and bipolar II disorder were reported to have the highest lifetime rates of alcohol or substance use disorders (ASUD) [1]. The ECA Study reported a 60.7% lifetime prevalence rate for substance use disorders in persons with bipolar I disorder; alcohol was the most common substance abused [1]. A more recent epidemiologic investigation, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) of more than 43,000 respondents reported a rate of 23.6% of any alcohol use disorders in bipolar I subjects during the last 12 months and over 56% during lifetime [4] Several subsequent studies in epidemiological and clinical samples reported the rate of ASUD comorbidity in bipolar I and II patients to range between 14 and 65% [1, 2] compared to 6–12% in the general population [3].
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