Impact of substance abuse on the course and treatment of bipolar disorder

Objectives: The objectives of this article are to review the prevalence nat ural history, pathophysiology, and treatment of comorbid bipolar disorder w ith alcoholism and other psychoactive substance use disorders (PSUDs). Methods: All identified bibliographies through a literature search of all M edline files and bibliographies of selected articles focusing on the preval ence, natural history, course, prognosis, inter-relationship, and treatment of bipolar disorder with comorbid alcoholism and other PSUDs were reviewed . Results and conclusions: Comorbidity of bipolar disorder and alcoholism and other PSUDs is highly prevalent. The presence of this so called 'dual diag noses' creates a serious challenge in terms of establishing nn accurate dia gnosis and providing appropriate treatment interventions. The inter-relatio nship between these disorders appears to be mutually detrimental, The cours e, manifestation, and treatment of each condition are significantly compoun ded bg the presence of the other condition. Substance abuse and alcoholism appear to significantly complicate the course and prognosis of bipolar diso rder resulting in increased suffering, disability, and costs. On the other hand, bipolar disorder may be a risk factor for developing PSUDs. Although, there are a number of hypotheses explaining the pathophysiological mechani sm involved in such comorbidities, our understanding of the exact nature of such neurobiological mechanisms is still limited. While the antikindling a gents and targeted psychotherapeutic techniques may be useful intervention strategies, there is still a significant lack of empirically based treatmen t options for these patients.