Excessive substance use in bipolar disorder is associated with impaired functioning rather than clinical characteristics, a descriptive study

Trine V Lagerberg,Sara Larsson,Petter A Ringen,Ole A Andreassen,Ingrid Agartz,Ingrid Melle,Akiah O Berg,Kjetil Sundet

doi:10.1186/1471-244x-10-9

Trine V Lagerberg, Sara Larsson + Show 6 more

Open Access

https://doi.org/10.1186/1471-244x-10-9

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Abstract

BackgroundThere is a strong association between bipolar disorder (BD) and substance use disorder (SUD). The clinical and functional correlates of SUD in BD are still unclear and little is known about the role of excessive substance use that does not meet SUD criteria. Thus, the aims of the current study were to investigate lifetime rates of illicit substance use in BD relative to the normal population and if there are differences in clinical and functional features between BD patients with and without excessive substance use.Methods125 consecutively recruited BD in- and outpatients from the Oslo University Hospitals and 327 persons randomly drawn from the population in Oslo, Norway participated. Clinical and functional variables were assessed. Excessive substance use was defined as DSM-IV SUD and/or excessive use according to predefined criteria.ResultsThe rate of lifetime illicit substance use was significantly higher among patients compared to the reference population (OR = 3.03, CI = 1.9-4.8, p < .001). Patients with excessive substance use (45% of total) had poorer educational level, occupational status, GAF-scores and medication compliance, with a trend towards higher suicidality rates, compared to patients without. There were no significant group differences in current symptom levels or disease course between groups.ConclusionThe percentage of patients with BD that had tried illicit substances was significantly higher than in the normal population. BD patients with excessive substance use clearly had impaired functioning, but not a worse course of illness compared to patients without excessive substance use. An assessment of substance use beyond SUD criteria in BD is clinically relevant.

Highlights

There is a strong association between bipolar disorder (BD) and substance use disorder (SUD)
Regarding clinical and functional outcome variables (Table 2), we found that the no use group had significantly more years of education than the patients with excessive substance use (15.1, SD 2.9 versus 13.5, SD 2.6, p = 0.001)
The proportion that was employed/full time students was significantly smaller in the excessive substance use group

Summary

Introduction

There is a strong association between bipolar disorder (BD) and substance use disorder (SUD). Comorbid bipolar disorder (BD) and substance use disorder (SUD) have been found to be highly prevalent in both epidemiological and clinical studies, with rates of SUD in subjects with BD ranging from 35-60% [1,2,3,4,5,6]. Most studies show a large prevalence of BD and SUD comorbidity, the rates vary widely This variation could be mirroring differences in substance use in the general population where the BD sample is recruited. In a smaller sample from an earlier part of our ongoing study, we showed elevated rates of lifetime use of illicit substances among patients with psychotic disorders (including BD) compared to the general population [12], and differences in patterns of substance use between schizophrenia and BD [13]. There is a need for studies comparing BD subjects with reference populations on substance use and they should be done with samples from the same geographical area within the same time period

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