Diagnostic and Treatment Considerations: Bipolar Patients with Comorbid Substance Use Disorders

By Ihsan Salloum, MD, MPH; Antoine Douaihy, MD; Lauren Williams, MD

Diagnostic and Treatment Considerations: Bipolar Patients with Comorbid Substance Use Disorders

Comorbidity of bipolar disorder (BD) and alcoholism and substance use disorders (SUDs) represents a serious public health problem and a major challenge to treatment systems. Bipolar disorder is among the top causes of disabilities worldwide, and reportedly the fourth leading mental illness as a source of disease burden in established market economies. Large epidemiologic surveys in the United States have consistently confirmed a high association between bipolar disorder and SUDs. The Epidemiological Catchments Area Study reported bipolar I and bipolar II disorders as having the highest association with SUDs when compared with any other major psychiatric disorder. The prevalence of lifetime alcohol abuse or dependence in persons with bipolar I disorder and bipolar II disorders were found to be 46%, and 39.2% respectively. Similarly, the National Comorbidity Survey reported respondents with mania to be 8 to 9 times more likely to have an additional lifetime disorder of drug or alcohol dependence compared with the general population. The most recent and largest epidemiologic survey of more than 42,000 respondents in the United States, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), reported that mania and hypomania were associated with very high rates of SUDs. Those with mania were 6 times more likely to have alcohol dependence and 14 times more likely to have drug dependence over the past 12 months.

ABOUT THE AUTHORS

Ihsan Salloum, MD, MPH; and Lauren Williams, MD, are with the Department of Psychiatry and Behavioral Science, University of Miami Miller School of Medicine. Antoine Douaihy, MD, is with the Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.

Address correspondence to: Ihsan M. Salloum, MD, MPH, 1120 NW 14th Street, Miami, FL 33136; fax 305-243-1682; or e-mail isalloum@med.miami.edu.

Dr. Salloum and Dr. Williams have disclosed no relevant financial relationships. Dr. Douaihy has disclosed the following relevant financial relationship: AstraZeneca: Research grant recipient.

EDUCATIONAL OBJECTIVES

1. Develop knowledge about the frequency and clinical significance of bipolar disorder and substance use disorders comorbidity.
2. Demonstrate the diagnostic considerations in patients with co-occurring bipolar disorder and substance use disorder
3. Identify the latest research-based psychotherapy and pharmacotherapy treatments for this comorbidity.