Bipolar disorder is a disabling psychiatric disorder that presents in approximately 1.5% to 2.5% of the population.1 It is characterized by mood instability (hypomania/mania), depression, or mixed manic and depressive episodes. Fluctuations in mood are frequently accompanied by changes in energy levels and sleep patterns.
Substance use disorders (SUDs) are common among individuals with BD. Findings from a large meta-analysis indicate that the lifetime prevalence of alcohol and cannabis use disorders in BD is 42% and 20%, respectively.2 The lifetime prevalence of tobacco smoking in BD is as high as 60% to 80% compared with approximately 15% in the general US population.3,4 Co-occurring substance use is associated with earlier illness onset, suicidality, rapid cycling and mixed features, and more severe symptoms.5-7 Furthermore, there can be serious societal and economic consequences, including higher rates of violence, crime, homelessness, and health care costs. A better understanding of this comorbidity is important for diagnosing and treating these dual diagnosis patients.
John is a 22-year-old white single male with a history of bipolar I disorder. He was a student at a local community college until a month ago when he dropped out abruptly. Since age 16, he has been taking valproate sodium (1000 mg daily) and sertraline (100 mg daily), but he is only partially responsive to these medications (frequent mood instability, currently experiencing depressed mood). Over the past year, he admits to regularly drinking beer (3-4 times per week, 2-3 standard drinks per session). Although he rarely drinks to intoxication, his parents and friends consider him increasingly unreliable. He has also been smoking cannabis and crack cocaine in the past 6 weeks and says that he has “never felt better.” He thinks that he has no real drug problems and regards drinking as his way of coping.
Ms Ma is an undergraduate student in psychology at the University of Toronto; Ms Coles is research coordination in the Biobehavioral Addictions and Mental Health Laboratory, Addictions Division, Centre for Addiction and Mental Health; Dr George is Professor, Department of Psychiatry, University of Toronto and Chief, Addictions Division, Centre for Addiction and Mental Health.
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