Background: Substance abuse occurs at high rates in bipolar disorder. The r
easons for this co-occurrence are unknown. Alcohol use disorders have been
associated with both earlier and later age of onset of bipolar disorder, in
parr based on the temporal associations of the two conditions. Both drug a
nd alcohol use disorders are associated with impaired outcome of bipolar il
lness. This influence may involve both direct effects of alcohol or drugs o
n the initiation of affective symptoms and indirect effects on treatment co
mpliance. To extend these previous findings we examined the temporal associ
ations of substance abuse and affective symptoms in patients with new onset
bipolar disorder.
Methods: Associations between affective symptoms and alcohol and cannabis u
se disorder symptoms were evaluated using regression and time-series correl
ative methods in 50 new-onset bipolar patients.
Results: The duration of alcohol abuse during follow-up was associated with
the time patients experienced depression. The duration of cannabis abuse w
as associated with the duration of mania. Several subgroups could be identi
fied with different temporal relationships among these disorders.
Conclusions: Although the relationships among substance use and bipolar dis
orders are complex, systematic study of the courses of the disorders might
clarify how these conditions interact longitudinally. As the numbers of sub
jects in specific subgroups are relatively small in this study, these resul
ts should be considered preliminary. (C) 2000 Society of Biological Psychia
try.