title: Substance use disorders among adolescents with bipolar spectrum disorders.
abstract: OBJECTIVE
  We set out to examine the prevalence and correlates of substance use disorders (SUD) in a large sample of adolescents with bipolar disorder (BP).
  
  
  METHODS
  Subjects were 249 adolescents ages 12 to 17 years old who fulfilled DSM-IV criteria for bipolar I disorder [(BPI), n = 154], or bipolar II disorder [(BPII), n = 25], or operationalized criteria for BP not otherwise specified [(BP NOS), n = 70], via the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS). As part of the multi-site Course and Outcome of Bipolar Youth study, demographic, clinical, and family history variables were measured via intake clinical interview with the subject and a parent/guardian.
  
  
  RESULTS
  The lifetime prevalence of SUD among adolescents with BP was 16% (40/249). Results from univariate analyses indicated that subjects with, as compared to without, SUD were significantly less likely to be living with both biological parents, and that there was significantly greater lifetime prevalence of physical abuse, sexual abuse, suicide attempts, conduct disorder, and posttraumatic stress disorder among subjects with SUD. Subjects with SUD reported significantly greater 12-month prevalence of trouble with police, and females with SUD reported significantly greater 12-month prevalence of pregnancy and abortion. Significant predictors of SUD in a logistic regression model included living with both biological parents (lower prevalence), conduct disorder and suicide attempts (increased prevalence). In logistic regression analyses controlling for demographic differences and conduct disorder, SUD remained significantly associated with trouble with police, whereas the association of SUD with pregnancy and abortion was reduced to a statistical trend. The prevalence of SUD was not significantly different among child- versus adolescent-onset BP subjects.
  
  
  CONCLUSIONS
  SUD among adolescents with BP is associated with profound hazards including suicide attempts, trouble with police, and teenage pregnancy and abortion.
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. goldsteinbi@upmc.edu
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
authors.forename: Michael A
authors.initials: MA
authors.lastname: Strober
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: David A
authors.initials: DA
authors.lastname: Axelson
authors.forename: Christianne
authors.initials: C
authors.lastname: Esposito-Smythers
authors.forename: Tina R
authors.initials: TR
authors.lastname: Goldstein
authors.forename: Henrietta
authors.initials: H
authors.lastname: Leonard
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hunt
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Gill
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.forename: Colleen
authors.initials: C
authors.lastname: Grimm
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
authors.forename: Neal D
authors.initials: ND
authors.lastname: Ryan
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001714:Bipolar Disorder / Q000150:complications*; D002648:Child; D003710:Demography; D005192:Family Health; D005260:Female; D006801:Humans; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000209:etiology*