Substance abuse in bipolar disorder

Background. High rates of substance abuse have been reported in the general population, with males more often affected than females. Although high rat es of substance abuse have also been reported in bipolar patients, the rela tionship between substance abuse and bipolar disorder has not been well cha racterized. Methods: Substance abuse histories were obtained in 392 patients hospitaliz ed for manic or mixed episodes of bipolar disorder and rates of current and lifetime abuse calculated. Analyses comparing sex, subtype (manic vs. mixe d) and clinical history variables were conducted. Results: Rates of lifetime substance abuse were high for both alcohol (48.5 %) and drugs (43.9%). Nearly 60% of the cohort had a history of some lifeti me substance abuse. Males had higher rates of abuse than females, but no di fferences in substance abuse were observed between subjects in manic and mi xed bipolar states. Rates of active substance abuse were lower in older age cohorts. Subjects with a comorbid diagnosis of lifetime substance abuse ha d more psychiatric hospitalizations. Conclusions: Substance abuse is a major comorbidity in bipolar patients. Al though rates decrease in older age groups, substance abuse is still present at clinically important rates in the elderly. Bipolar patients with comorb id substance abuse may have a more severe course. These data underscore the significance of recognition and treatment of substance abuse in bipolar di sorder patients.