Risk for substance use disorders in youths with child- and adolescent-onset bipolar disorder

Objective: Previous work in adults has suggested that early-onset bipolar d isorder (BPD) is associated with an elevated risk for substance use disorde rs (SUD). To this end, the authors assessed the risk for SUD in child-versu s adolescent-onset BPD with attention to comorbid psychopathology. Method: All youths (aged 13-18 years) with available structured psychiatric intervi ews were studied systematically. From clinic subjects (N = 333), 86 subject s with DSM-III-R BPD were identified. To evaluate the risk for SUD and BPD while attending to developmental issues, the authors stratified the BPD sam ple into those with child-onset BPD (less than or equal to 12 years of age, n = 50) and those with adolescent-onset BPD (13-18 years of age, n = 36). Results: In mid-adolescence, youths with adolescent-onset BPD were at signi ficantly increased risk for SUD relative to those with child-onset BPD (39% versus 8%; p =.001). Compared with those with child-onset BPD, those with adolescent-onset BPD had 8.8 times the risk for SUD (95% confidence interva l = 2.2-34.7; chi(7)(2) = 9.7, p = 002). The presence of conduct disorder o r other comorbid psychopathology within BPD did not account for the risk fo r SUD. Conclusions: Adolescent-onset BPD is associated with a much higher r isk for SUD than child-onset BPD, which was not accounted for by conduct di sorder or other comorbid psychopathology. Youths with adolescent-onset BPD should be monitored and educated about SUD risk. The identification and tre atment of manic symptomatology may offer therapeutic opportunities to decre ase the risk for SUD in these high-risk youths.