OBJECTIVE: Substance use disorders (SUD) are common and problematic in bipolar disorder (BP). We prospectively examined predictors of first-onset SUD among adolescents with BP. METHOD: Adolescents (12-17 years old; N = 167) in the Course and Outcome of Bipolar Youth (COBY) study fulfilling criteria for BP-I, BP-II, or operationalized BP not otherwise specified, without SUD at intake, were included. Baseline demographic, clinical, and family history variables, and clinical variables assessed during follow-up, were examined in relation to first-onset SUD. Participants were prospectively interviewed every 38.5 ± 22.2 weeks for an average of 4.25 ± 2.11 years. RESULTS: First-onset SUD developed among 32% of subjects, after a mean of 2.7 ± 2.0 years from intake. Lifetime alcohol experimentation at intake most robustly predicted first-onset SUD. Lifetime oppositional defiant disorder and panic disorder, family history of SUD, low family cohesiveness, and absence of antidepressant treatment at intake were also associated with increased risk of SUD, whereas BP subtype was not. Risk of SUD increased with increasing number of these 6 predictors: 54.7% of subjects with 3 or more predictors developed SUD vs. 14.1% of those with fewer than 3 predictors (hazard ratio = 5.41 95% confidence interval = 2.7-11.0 p < .0001). Greater hypo/manic symptom severity in the preceding 12 weeks predicted greater likelihood of SUD onset. Lithium exposure in the preceding 12 weeks predicted lower likelihood of SUD. CONCLUSIONS: This study identifies several predictors of first-onset SUD in the COBY sample that, if replicated, may suggest targets for preventive interventions for SUD among youth with BP. Treatment-related findings are inconclusive and must be interpreted tentatively, given the limitations of observational naturalistic treatment data. There is a substantial window of opportunity between BP and SUD onset during which preventive strategies may be used.
OBJECTIVE: Substance use disorders (SUD) are common and problematic in bipolar disorder (BP). We prospectively examined predictors of first-onset SUD among adolescents with BP. METHOD: Adolescents (12-17 years old; N = 167) in the Course and Outcome of Bipolar Youth (COBY) study fulfilling criteria for BP-I, BP-II, or operationalized BP not otherwise specified, without SUD at intake, were included. Baseline demographic, clinical, and family history variables, and clinical variables assessed during follow-up, were examined in relation to first-onset SUD. Participants were prospectively interviewed every 38.5 ± 22.2 weeks for an average of 4.25 ± 2.11 years. RESULTS: First-onset SUD developed among 32% of subjects, after a mean of 2.7 ± 2.0 years from intake. Lifetime alcohol experimentation at intake most robustly predicted first-onset SUD. Lifetime oppositional defiant disorder and panic disorder, family history of SUD, low family cohesiveness, and absence of antidepressant treatment at intake were also associated with increased risk of SUD, whereas BP subtype was not. Risk of SUD increased with increasing number of these 6 predictors: 54.7% of subjects with 3 or more predictors developed SUD vs. 14.1% of those with fewer than 3 predictors (hazard ratio = 5.41 95% confidence interval = 2.7-11.0 p < .0001). Greater hypo/manic symptom severity in the preceding 12 weeks predicted greater likelihood of SUD onset. Lithium exposure in the preceding 12 weeks predicted lower likelihood of SUD. CONCLUSIONS: This study identifies several predictors of first-onset SUD in the COBY sample that, if replicated, may suggest targets for preventive interventions for SUD among youth with BP. Treatment-related findings are inconclusive and must be interpreted tentatively, given the limitations of observational naturalistic treatment data. There is a substantial window of opportunity between BP and SUD onset during which preventive strategies may be used.
Authors: Jie Guo; Karl G Hill; J David Hawkins; Richard F Catalano; Robert D Abbott Journal: J Am Acad Child Adolesc Psychiatry Date: 2002-07 Impact factor: 8.829
Authors: Ronald C Kessler; Patricia Berglund; Olga Demler; Robert Jin; Kathleen R Merikangas; Ellen E Walters Journal: Arch Gen Psychiatry Date: 2005-06
Authors: David A Axelson; Boris Birmaher; Michael A Strober; Benjamin I Goldstein; Wonho Ha; Mary Kay Gill; Tina R Goldstein; Shirley Yen; Heather Hower; Jeffrey I Hunt; Fangzi Liao; Satish Iyengar; Daniel Dickstein; Eunice Kim; Neal D Ryan; Erica Frankel; Martin B Keller Journal: J Am Acad Child Adolesc Psychiatry Date: 2011-09-08 Impact factor: 8.829
Authors: John Curry; Susan Silva; Paul Rohde; Golda Ginsburg; Betsy Kennard; Christopher Kratochvil; Anne Simons; Jerry Kirchner; Diane May; Taryn Mayes; Norah Feeny; Anne Marie Albano; Sarah Lavanier; Mark Reinecke; Rachel Jacobs; Emily Becker-Weidman; Elizabeth Weller; Graham Emslie; John Walkup; Elizabeth Kastelic; Barbara Burns; Karen Wells; John March Journal: J Consult Clin Psychol Date: 2012-01-16
Authors: Danella M Hafeman; Brian Rooks; John Merranko; Fangzi Liao; Mary Kay Gill; Tina R Goldstein; Rasim Diler; Neal Ryan; Benjamin I Goldstein; David A Axelson; Michael Strober; Martin Keller; Jeffrey Hunt; Heather Hower; Lauren M Weinstock; Shirley Yen; Boris Birmaher Journal: J Am Acad Child Adolesc Psychiatry Date: 2019-07-29 Impact factor: 8.829
Authors: Jacob R Stephens; Jaimee L Heffner; Caleb M Adler; Thomas J Blom; Robert M Anthenelli; David E Fleck; Jeffrey A Welge; Stephen M Strakowski; Melissa P DelBello Journal: J Am Acad Child Adolesc Psychiatry Date: 2014-05-10 Impact factor: 8.829
Authors: Marc J Weintraub; Christopher D Schneck; Patricia D Walshaw; Kiki D Chang; Manpreet K Singh; David A Axelson; Boris Birmaher; David J Miklowitz Journal: J Psychiatr Res Date: 2020-01-25 Impact factor: 4.791
Authors: Timothy E Wilens; Diana W Woodward; Je Deuk Ko; Amy F Berger; Colin Burke; Amy M Yule Journal: J Child Adolesc Psychopharmacol Date: 2022-05-04 Impact factor: 3.031
Authors: Timothy E Wilens; Joseph Biederman; MaryKate Martelon; Courtney Zulauf; Jesse P Anderson; Nicholas W Carrellas; Amy Yule; Janet Wozniak; Ronna Fried; Stephen V Faraone Journal: J Clin Psychiatry Date: 2016-10 Impact factor: 4.384
Authors: Boris Birmaher; Mary Kay Gill; David A Axelson; Benjamin I Goldstein; Tina R Goldstein; Haifeng Yu; Fangzi Liao; Satish Iyengar; Rasim S Diler; Michael Strober; Heather Hower; Shirley Yen; Jeffrey Hunt; John A Merranko; Neal D Ryan; Martin B Keller Journal: Am J Psychiatry Date: 2014-09 Impact factor: 18.112
Authors: Boris Birmaher; John Merranko; Danella Hafeman; Benjamin I Goldstein; Rasim Diler; Jessica C Levenson; Kelly Monk; Satish Iyengar; Mary Beth Hickey; Dara Sakolsky; David Axelson; Tina Goldstein Journal: J Am Acad Child Adolesc Psychiatry Date: 2021-03-27 Impact factor: 8.829
Authors: Julia Martini; Karolina Leopold; Steffi Pfeiffer; Christina Berndt; Anne Boehme; Veit Roessner; Paolo Fusar-Poli; Allan H Young; Christoph U Correll; Michael Bauer; Andrea Pfennig Journal: Int J Bipolar Disord Date: 2021-07-02