Abstract
Substance misuse is highly prevalent in bipolar disorder even in the early illness phases. However, the trajectories of misuse of different substances after treatment initiation is not well-studied. Also, knowledge on how substance misuse trajectories influence the early course of bipolar disorder is limited. We recruited 220 individuals in first treatment of bipolar disorder of which 112 participated in a 1-year follow-up study at the NORMENT center in Oslo, Norway. Misuse was defined as having scores above cut-off for harmful use on the Alcohol or Drug Use Disorders Identification Tests (AUDIT or DUDIT). We investigated rates of stopping and continuing misuse of alcohol, cannabis and other illicit substances and daily nicotine use over the follow-up period, and whether such misuse trajectories predicted the risk for affective relapse. The prevalence of cannabis misuse was reduced from 29 to 15% and alcohol misuse was reduced from 39 to 21% during follow-up. Continuing alcohol misuse significantly and independently predicted affective relapse, whereas there was no difference in relapse risk between individuals stopping alcohol misuse and never misusing alcohol. Cannabis misuse trajectories did not significantly predict relapse risk although we cannot exclude interactions with alcohol misuse. In conclusion, substance misuse decreased in the early phase of bipolar disorder treatment but should be further reduced with interventions specifically addressing substance misuse. Stopping alcohol misuse is likely to yield substantial benefit on the clinical course of bipolar disorder.
Highlights
Around half of individuals with bipolar disorder (BD) develop cannabis, alcohol, or other substance use disorders during their lifetime (1–3)
In one of the few longitudinal studies on first episode mania to date, both the time in active cannabis misuse and the time in active alcohol misuse was associated with the time in affective episodes over the 5-year follow-up period (10, 11). In another longitudinal study of a first-treatment mania sample partly overlapping with the current study sample, we found that continued cannabis use was associated with higher levels of current manic symptoms and lower levels of current global functioning at 1-year follow-up compared to no use or stopped use (12)
In the multivariate analysis controlling for the potential confounders; other substance misuse and daily nicotine use at follow-up, alcohol misuse trajectory was independently associated with “any relapse” with a significantly higher relapse risk in the CONT group compared to the NO group (Table 5)
Summary
Around half of individuals with bipolar disorder (BD) develop cannabis-, alcohol-, or other substance use disorders during their lifetime (1–3). In a recent first episode mania study, lifetime cannabis use disorder (CUD) was found in 34%, alcohol use disorder (AUD) in 15%, and other illicit substance use disorders (other SUD) in 11% of the participants (5) It is not wellknown whether the rates of substance misuse decrease, increase or is stable during the early phases of BD. We have expanded our first treatment BD sample, including participants with bipolar II disorder (BD II) and BD not otherwise specified (BD NOS) This enables a more detailed investigation of the trajectories of misuse of alcohol, cannabis and other illicit substances during the first year of treatment and their relationship to the risk of early relapse. We hypothesized that individuals with continued misuse of cannabis and/or alcohol would have significantly higher risk for relapse than patients without misuse, with intermediate risk in individuals who stopped their misuse
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