title: Patient characteristics and treatment implications of marijuana abuse among bipolar alcoholics: results from a double blind, placebo-controlled study.
abstract: OBJECTIVE
  Marijuana abuse, primarily a disorder of adolescents and young adults, is highly prevalent among patients with severely ill psychiatric population, especially those with bipolar disorder. Additional marijuana abuse may impact on the clinical presentation of bipolar illness and may potentially act as mediator of treatment response in this population. However, the characterization of bipolar disorder patients with additional marijuana abuse and the impact of such abuse on treatment outcome has been rarely examined. The aim of this study was to characterize bipolar alcoholic patients with comorbid marijuana abuse and test the impact of marijuana abuse on alcohol and mood outcome of patients with bipolar disorder and comorbid alcohol dependence.
  
  
  METHODS
  We conducted secondary analyses of a randomized, double blind, placebo-controlled trial testing valproate in 52 bipolar alcoholics. Subjects had a comprehensive assessment at baseline using structured diagnostic assessments, and they were then assessed every 2 weeks for 24 weeks.
  
  
  RESULTS
  Twenty-five subjects (48%) reported marijuana abuse. Those with co-occurring marijuana abuse were younger, had fewer years of education, and had significantly higher number of additional psychiatric comorbidity. They also had more severe alcohol and other drug use and were significantly more likely to present in the manic phase. The mixed model indicated that the placebo-treated marijuana abuse group had the worst alcohol use outcome.
  
  
  CONCLUSIONS
  Marijuana abuse among patients with bipolar disorder and alcohol dependence is associated with higher degree of severity of alcohol and other drugs of abuse and may negatively impact on alcohol treatment outcome.
authors.affiliation: Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. salloumim@upmc.edu
authors.forename: Ihsan M
authors.initials: IM
authors.lastname: Salloum
authors.forename: Jack R
authors.initials: JR
authors.lastname: Cornelius
authors.forename: Antoine
authors.initials: A
authors.lastname: Douaihy
authors.forename: Levant
authors.initials: L
authors.lastname: Kirisci
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Daley
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D000368:Aged; D000428:Alcohol Drinking / Q000523:psychology; D000437:Alcoholism / Q000523:psychology*; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology*; D017831:Diagnosis, Dual (Psychiatry); D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000523:psychology*; D008875:Middle Aged; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D018692:Antimanic Agents; D014635:Valproic Acid