Linking Risks of Substance Use and Bipolar Disorders in Adolescents


Bipolar disorder is separate from the depressive disorders documented in DSM-5 due to there being a link between depressive disorders, schizophrenia spectrum disorders, and other psychotic disorders in terms of its symptoms, family history, and genetics (DSM-5). Four main types of bipolar disorders (Bipolar I, Bipolar II, Cyclothymic and other Related Disorders) fall under two core episodes: manic and depressive. A manic episode can be characterized as experiencing constantly elevated or irritable mood along with increased energy, all lasting for at least one week. Similarly, hypomanic episodes have the same symptoms, but individuals experience a shorter period of mood disturbance of about four consecutive days. On the contrary, major depressive episodes are characterized with symptoms such as depressed mood for most of the day, diminished interest, and feelings of worthlessness during a two-week period along with changes in everyday abilities such as being able to concentrate (DSM-5). It is also well known that bipolar episodes can be substance or medication-induced (DSM-5).    

Although we know that substance use or medication can stimulate bipolar episodes, many people have not considered adolescents as affected individuals. Evidence published in the Journal of Clinical Psychiatry shows that teenagers suffering from bipolar disorder are at greater risk of substance abuse and the development of substance use disorders later in life (Cara, 2016). From this article, we see that adolescents with bipolar disorder were remarkably more likely to have substance use disorder compared to adolescents without mood disorders. In particular, researchers observed that adolescents with comorbid conduct disorder, a psychiatric disorder characterized as having frequent behavioral patterns violating societal norms, dramatically increased the risk for substance use and cigarette smoking. Conduct disorder behaviors include being physically cruel to people or animals, forcing sexual activities and or deceitfulness and theft (DSM-IV). One study by Kovacs and Pollock concludes that comorbid conduct disorder may be more common in adolescents with bipolar disorder. They suggest that bipolar disorder, in relation to comorbid conduct disorder, should be examined further because the presence of comorbid conduct disorder might result in the failure to detect bipolar disorder (Kovacs & Pollock).  

A previous study published in June 2008, which understood the links between adolescent bipolar disorder with cigarette smoking and substance use disorder, followed up five years later in order to observe how time has affected adolescents diagnosed with bipolar disorder. Wilens and Massachusetts General Hospital investigators gathered evidence that the combination of bipolar disorder and comorbid conduct disorder results in a stronger influence on the risk of substance abuse and smoking (Science Daily, 2016).

Comparisons of study groups allowed investigators to see that those with bipolar disorder who had symptoms five years later were at higher risk for substance use disorder and cigarette smoking than those who experienced a reduction in symptoms and were in remission or had better control due to treatment (Science Daily, 2016). Those with active symptoms and reduced symptoms were both at greater risk in comparison to the control–adolescents with no mood disorders. When the presence of other disorders such as attention-deficit hyperactivity disorder (ADHD) were controlled for or not included in the statistics, the effect on the bipolar-associated risk was not significant. However, when those with conduct disorder and bipolar disorder were excluded from the statistics for comparison purposes, the increased levels of risk disappear or become less significant (EurekAlert, 2016). This observation suggests that the combination of conduct disorder with bipolar disorder plays a significant role in the risk of substance use and cigarette smoking associated with bipolar disorder. As an adolescent with bipolar disorder, the presence of conduct disorder seems to influence substance use disorders as individuals become young adults and develop into adulthood.

Wilens and Massachusetts General Hospital investigators recommend that clinicians monitor adolescents with bipolar disorder for activities such as cigarette smoking and substance use (Science Daily). Wilens and his colleagues plan to further investigate brain imaging to better understand the brain circuitry involved with these disorders. Others contend that the relationship between comorbid conduct disorder and bipolar disorder should be examined further to ensure they are not being misdiagnosed (Kovacs & Pollock).   

References:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994:78–85.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bipolar adolescents continue to have elevated substance use disorder risk as young adults. (2016, August 30). Retrieved October 11, 2016, from https://www.eurekalert.org/pub_releases/2016-08/mgh-bac082616.php

Cara, E. (2016, August 30). How Bipolar Disorder Increases Risk Of Substance Abuse. Retrieved October 10, 2016, from http://www.medicaldaily.com/bipolar-disorder-and-addiction-teens-mental-health-condition-increased-risk-396480

Kovacs, M., & Pollock, M. (1995). Bipolar disorder and comorbid conduct disorder in childhood and adolescence. Journal Of The American Academy Of Child And Adolescent Psychiatry, (6), 715.

Science Daily. (2016, August 30). Bipolar adolescents continue to have elevated substance use disorder risk as young adults: Follow up to earlier study finds co-occurrence of conduct disorder could make an important difference. ScienceDaily. Retrieved October 10, 2016 from www.sciencedaily.com/releases/2016/08/160830140736.htm

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