Introduction to substance use often occurs during adolescence. Teens may be willing to take risks that adults are not, experimenting with substances that carry dangerous side effects. Some teens may go on to develop a substance abuse problem which may plague them into adulthood unless they seek quality addiction treatment. Identifying teens most at-risk is a critical focus of programs designed to reduce substance use. Experts know that the likelihood of a teenager developing a substance abuse problem is based on both environmental and biological factors, but each case is unique. A recent study identified bipolar teens as having a significantly increased risk of developing substance abuse. Published in the Journal of the American Academy of Child and Adolescent Psychiatry, the study finds that approximately one out of every three teens diagnosed with bipolar disorder also developed substance abuse issues. In addition, the researchers identified multiple factors that were reliable predictors for identifying bipolar disorder patients that were most likely to use substances. Led by Dr. Benjamin Goldstein, the study used data from the Course and Outcome of Bipolar Youth (COBY) which assessed 167 first-time substance users between the ages of 12 and 17 over a four year period. The participants were interviewed an average of seven times and assessed to determine their symptoms, stressors, functioning levels and treatment. The researchers used the information to measure frequency of use and note possible predictors of substance abuse initiation. The analysis showed that 32 percent of the teens involved in the COBY assessment developed an abuse problem within an average of 2.7 years after the study began. Participants that repeatedly experimented with alcohol at the beginning of the study were the most likely to abuse substances. Another strong predictor of later substance abuse was experimentation with cannabis. Additional factors that were useful predictors of later substance abuse were panic disorder, family history of substance abuse, oppositional defiant disorder, low family cohesiveness and a lack of treatment for depression. For teens with a combination of risk factors the likelihood of developing a substance abuse problem multiplied. Of those that had three or more risk factors, 54.7 percent developed substance abuse, compared to 14.1 percent of those with only two or fewer risk factors. The findings were the result of the largest longitudinal study of children and adolescents diagnosed with bipolar disorder, which was funded by the National Institute of Mental Health. The interviews were conducted with participants at Brown University, the University of Pittsburgh and at UCLA. COBY continues to follow the participants as they age into their 20s and 30s. Goldstein warns that with teens diagnosed with bipolar disorder even experimental drug use can be taking a major risk. He likened it to playing with fire. But he also says there\u2019s a two to three year window wherein prevention can be effective. Prevention and early intervention is the most effective way to reduce substance abuse among teens with bipolar disorder. Parents of teens with bipolar disorder can be encouraged that they can have a significant impact in helping their child avoid substance abuse. Conversations about risks, rules and consequences related to substance use can help teens make informed decisions.