Alcoholism and drug abuse in three groups - bipolar I, unipolars and theiracquaintances

Objective: Previous work has shown that manic-depressive illness and alcoho l abuse are linked. This study further explores the relationship of alcohol and drug abuse in bipolar I patients and unipolar depressives and a compar ison group obtained through the acquaintance method. Method: Diagnosis was accomplished according to Research Diagnostic Criteria (RDC): controls =469 ; bipolars = 277; unipolar depressives = 678. Systematic data were gathered using the SADS on lifetime and current drug abuse and alcoholism. Both pat ients and comparison subjects were then followed prospectively for 10 years . First degree family members were interviewed using the RDC family history method. Results: The group of bipolar patients and the group of unipolar p atients had higher rates of drug and alcohol abuse than the comparison grou p when primary and secondary affective disorder patients were combined. How ever, primary unipolar patients did not have higher rates of alcohol or dru g abuse than the comparison group. In contrast, primary bipolar patients ha d higher rates of alcoholism, stimulant abuse, and ever having abused a dru g than the primary unipolar group and the control group. In an evaluation o f the bipolar patients, drug abusers were significantly younger at intake a nd had a significantly younger age of onset of bipolar disorder. There was a significant increase in family history of mania or schizoaffective mania in the drug-abusing bipolar patients as compared to the non-abusing bipolar patients. Limitation: As in all adult samples of patients with affective i llness, the chronology of alcohol and substance problems vis-a-vis the onse t of illness was determined retrospectively. Conclusions: (1) Alcoholism an d drug abuse are more frequent in bipolar than unipolar patients. (2) The d rug abuse of bipolar patients tends toward the abuse of stimulant drugs. (3 ) In a bipolar patient, familial diathesis for mania is significantly assoc iated with the abuse of alcohol and drugs. (4) More provocatively, these fi ndings suggest the hypothesis of a common familial-genetic diathesis for a subtype of bipolar I, alcohol and stimulant abuse. Clinical implications: T he present analyses, coupled with two previous ones from the CDS, suggest t hat drug abuse may precipitate an earlier onset of bipolar I disorder in th ose who already have a familial predisposition for mania. Furthermore, in d ually diagnosed patients with manic-depressive and alcohol/stimulant abuse history, mood stabilization of the bipolar disorder represents a rational a pproach to control concurrent alcohol and drug problems, and should be stud ied in systematic controlled trials. (C) 1998 Elsevier Science B.V. All rig hts reserved.