Is bipolar disorder a risk for cigarette smoking in ADHD youth?

Despite emerging literature linking juvenile bipolar disorder (BPD) and sub stance abuse, little is known about a link between BPD and cigarette smokin g. To this end we evaluated the association between BPD and cigarette smoki ng in youth. Subjects were 31 bipolar adolescents derived from a cohort of boys with DSM-III-R ADHD (N = 128) and non-ADHD comparisons (N = 109) follo wed prospectively for 4 years into mid-adolescence. Information on cigarett e smoking was obtained in a standardized manner blind to the proband's clin ical status. Logistic regression models were used to determine risk far smo king at follow-up. BPD was associated with a higher risk for cigarette smok ing in mid-adolescence, which was largely accounted for by, conduct disorde r. The developmental onset of BPD in adolescence (age 13-18 years) conferre d a greater risk for cigarette smoking compared to those youths with the on set of their BPD prepubertally ( less than or equal to 12 years; odds ratio = 10.8, p < 0.01), even after controlling for conduct disorder and other c onfounds. The naturalistic treatment of BPD with combined counseling and ph armacotherapy appeared to reduce the risk for cigarette smoking. BPD, parti cularly when it onsets in adolescence, is a significant risk factor for the early initiation of cigarette smoking in these A DHD youths. These data co upled with the literature strongly suggest that juveniles with BPD need to be carefully monitored for the early initiation of cigarette smoking and su bstance abuse.