Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: A controlled study

Wilens, Timothy E.; Biederman, Joseph; Adamson, Joel J.; Henin, Aude; Sgambati, Stephanie; Gignac, Martin; Sawtelle, Robert; Santry, Alison; Monuteaux, Michael C.

doi:10.1016/j.drugalcdep.2007.12.016

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Volume 95, Issue 3 , Pages 188-198, 1 June 2008

Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: A controlled study☆

Timothy E. Wilens
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
- Harvard Medical School, Department of Psychiatry, Cambridge, MA 02115, USA
- Corresponding author at: Massachusetts General Hospital, Pediatric Psychopharmacology Unit, 32 Fruit Street, YAW 6A, Boston, MA 02114, USA. Tel.: +1 617 726 1731; fax: +1 617 724 3742.
Joseph Biederman
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
- Harvard Medical School, Department of Psychiatry, Cambridge, MA 02115, USA
Joel J. Adamson
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
Aude Henin
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
Stephanie Sgambati
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
Martin Gignac
- Institute Philippe Pinel, Université de Montréal, Montréal, Qc H3C 3J7, Canada
Robert Sawtelle
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
Alison Santry
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
Michael C. Monuteaux
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02114, USA
- Harvard Medical School, Department of Psychiatry, Cambridge, MA 02115, USA

Received 5 July 2007; received in revised form 20 November 2007; accepted 26 December 2007.

Abstract

Although previous work suggests that juvenile onset bipolar disorder increases risk for substance use disorders and cigarette smoking, the literature on the subject is limited. We evaluated the association of risk for substance use disorders and cigarette smoking with bipolar disorder in adolescents in a case–control study of adolescents with bipolar disorder (n=105, age 13.6±2.5 years [mean]; 70% male) and without bipolar disorder (“controls”; n=98, age 13.7±2.1 years; 60% male). Rates of substance use and other disorders were assessed with structured interviews (KSADS-E for subjects younger than 18, SCID for 18-year-old subjects). Bipolar disorder was associated with a significant age-adjusted risk for any substance use disorder (hazard ratio[95% confidence interval]=8.68[3.02 25.0], χ²=16.06, p<0.001, df=1), alcohol abuse (7.66 [2.20 26.7], χ²=10.2, p=0.001, df=1), drug abuse (18.5 [2.46 139.10], χ²=8.03, p=0.005, df=1) and dependence (12.1 [1.54 95.50], χ²=5.61, p=0.02, df=1), and cigarette smoking (12.3 [2.83 53.69], χ²=11.2, p<0.001, df=1), independently of attention deficit/hyperactivity disorder, multiple anxiety, and conduct disorder (CD). The primary predictor of substance use disorders in bipolar youth was older age (BPD−SUD versus BPD+SUD, logistic regression: χ²=89.37, p<0.001). Adolescent bipolar disorder is a significant risk factor for substance use disorders and cigarette smoking, independent of psychiatric comorbidity. Clinicians should carefully screen adolescents with bipolar disorder for substance and cigarette use.