title: A gender-focused perspective on health service utilization in comorbid bipolar I disorder and alcohol use disorders: results from the national epidemiologic survey on alcohol and related conditions.
abstract: OBJECTIVE
  This study compares health service utilization by individuals with comorbid lifetime bipolar I disorder and lifetime alcohol use disorders (AUD) to that of individuals with either diagnosis alone, using nationally representative data.
  
  
  METHODS
  The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with bipolar I disorder only (BD-only; N = 636), AUD only (N = 11,068), and comorbid bipolar I disorder and AUD (BD-AUD; N = 775). Diagnoses were generated using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. The 3 groups were compared with respect to self-reported health service utilization.
  
  
  RESULTS
  For both men and women, respondents in the BD-AUD group were significantly more likely than AUD-only respondents to report any alcohol-related service utilization (p < .001). BD-AUD respondents were significantly more likely to report bipolar disorder-related hospital admissions as compared with BD-only respondents among males only (p = .009). Within the BD-AUD group, males reported significantly greater utilization of AUD treatment only (p < .001), and females reported significantly greater utilization of bipolar disorder treatment only (p < .001) and significantly greater likelihood of utilizing mental health services overall (p < .001). There was no gender difference in the proportion of respondents who utilized both AUD and bipolar disorder services.
  
  
  CONCLUSIONS
  As expected, individuals with comorbid bipolar I disorder and AUD utilize significantly more mental health services than individuals with either disorder alone. The primary original finding is that among those with comorbid bipolar I disorder and AUD, bipolar I disorder is more likely to go untreated among males and AUD is more likely to go untreated among females. Gender may be an important factor to consider in future health service planning for comorbid bipolar I disorder and AUD.
authors.affiliation: Mood Disorders Program, Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. benjamin.goldstein@utoronto.ca
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Levitt
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000628:therapy*; D001714:Bipolar Disorder / Q000453:epidemiology / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014481:United States / Q000453:epidemiology