Substance Use Disorder Risks in Teens With Bipolar Disorder

Bipolar disorder is the common term for a group of mental illnesses that center on unusual, dysfunctional fluctuations in normal mood. The American Psychiatric Association currently recognizes three main forms of these illnesses, as well as several secondary forms. People affected by a bipolar disorder have increased chances of developing a substance use disorder (the term used to describe problems with substance abuse or substance dependence). In a new study published in August 2013 in the Journal of the American Academy of Child & Adolescent Psychiatry, a multi-institution research team examined the specific risks for substance use disorders in teenagers diagnosed with a bipolar condition.

Bipolar Disorder Basics

Most people probably view bipolar disorder as a single condition that produces periods of abnormal, highly energetic or agitated behavior (i.e., manic episodes), as well as periods of deeply “down” moods that are serious enough to qualify for a diagnosis of major depression. In reality, this basic set of symptoms only defines one subtype of bipolar disorder, called bipolar I disorder. Another subtype of the condition, called bipolar II disorder, produces periods of severe depression and a substantially milder form of mania (known as hypomania), while a third subtype—called cyclothymic disorder—produces periods of relatively subdued mania and relatively mild depression. Some people also develop unusual combinations of bipolar symptoms that don’t meet the definition for any of the named bipolar conditions. In addition, some people develop bipolar-like symptoms as a result of medication or drug side effects, or in connection with specific physical health problems.

Substance Use Disorder Basics

In 2013, the American Psychiatric Association (APA) introduced the diagnosis of substance use disorder as a replacement for the separate diagnoses of substance abuse (non-addicted, dysfunctional use of drugs or alcohol) and substance dependence (addicted, dysfunctional use of drugs or alcohol). This switch was made because abuse and dependence are highly intertwined issues, both in research terms and in the real-world treatment of substance-using patients. The APA specifically names some of the substances commonly involved in the onset of a substance use disorder, including cannabis (marijuana), alcohol, hallucinogens, inhalants, opioids, stimulants, tobacco and sedative-hypnotics (tranquilizers). The organization also gives doctors the freedom to diagnose the condition in people who develop abuse/dependence issues involving substances that aren’t specifically named.

Risks in Teens with Bipolar Disorder

In the study published in the Journal of the American Academy of Child & Adolescent Psychiatry, the multi-institution research team examined the risks for the initial development of a substance use disorder in a group of 167 children between the ages of 12 and 17, each of whom had been previously diagnosed with bipolar I disorder, bipolar II disorder or unspecified bipolar-related symptoms. On average, the researchers tracked each one of these children for a period of slightly longer than four years. None of the teen or preteen participants had a substance-related problem at the start of the study. Over the course of the study, 32 percent of the participants developed some form of substance use disorder. After analyzing their compiled data, the study’s authors concluded that six factors increase the risks for onset of such a disorder in bipolar teens. These factors are exploratory involvement in alcohol consumption, the presence of a mental health condition called panic disorder, the presence of a mental health condition called oppositional defiant disorder, lack of antidepressant treatment for bipolar symptoms, serious problems within the family unit and a history of substance use disorders within one’s family bloodline.


The authors of the study in the Journal of the American Academy of Child & Adolescent Psychiatry note that alcohol consumption boosts substance use disorder risks in bipolar teenagers more than any other single factor. They also note that any given bipolar teen’s chances of developing a substance use disorder rise sharply when he or she has three or more related risk factors. Teens with bipolar I disorder, bipolar II disorder and unspecified bipolar symptoms apparently all have baseline risks for developing a substance use disorder. However, the risks may increase when teens develop unusually severe forms of mania or hypomania. Conversely, teens who receive lithium as part of their treatment regimen for bipolar disorder typically experience a significant decline in their chances of developing serious substance-related issues. The study’s authors believe that knowledge of the primary risk factors for substance abuse/addiction in bipolar teens will lead to improved prevention as well as treatment efforts.

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