title: Excessive substance use in bipolar disorder is associated with impaired functioning rather than clinical characteristics, a descriptive study.
abstract: BACKGROUND
  There is a strong association between bipolar disorder (BD) and substance use disorder (SUD). The clinical and functional correlates of SUD in BD are still unclear and little is known about the role of excessive substance use that does not meet SUD criteria. Thus, the aims of the current study were to investigate lifetime rates of illicit substance use in BD relative to the normal population and if there are differences in clinical and functional features between BD patients with and without excessive substance use.
  
  
  METHODS
  125 consecutively recruited BD in- and outpatients from the Oslo University Hospitals and 327 persons randomly drawn from the population in Oslo, Norway participated. Clinical and functional variables were assessed. Excessive substance use was defined as DSM-IV SUD and/or excessive use according to predefined criteria.
  
  
  RESULTS
  The rate of lifetime illicit substance use was significantly higher among patients compared to the reference population (OR = 3.03, CI = 1.9-4.8, p < .001). Patients with excessive substance use (45% of total) had poorer educational level, occupational status, GAF-scores and medication compliance, with a trend towards higher suicidality rates, compared to patients without. There were no significant group differences in current symptom levels or disease course between groups.
  
  
  CONCLUSIONS
  The percentage of patients with BD that had tried illicit substances was significantly higher than in the normal population. BD patients with excessive substance use clearly had impaired functioning, but not a worse course of illness compared to patients without excessive substance use. An assessment of substance use beyond SUD criteria in BD is clinically relevant.
authors.affiliation: Section for Psychosis Research, Oslo University Hospital, Bygg 49, Kirkevn, 166 N-0407 Oslo, Norway. t.v.lagerberg@medisin.uio.no
authors.forename: Trine V
authors.initials: TV
authors.lastname: Lagerberg
authors.forename: Ole A
authors.initials: OA
authors.lastname: Andreassen
authors.forename: Petter A
authors.initials: PA
authors.lastname: Ringen
authors.forename: Akiah O
authors.initials: AO
authors.lastname: Berg
authors.forename: Sara
authors.initials: S
authors.lastname: Larsson
authors.forename: Ingrid
authors.initials: I
authors.lastname: Agartz
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sundet
authors.forename: Ingrid
authors.initials: I
authors.lastname: Melle
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D013287:Illicit Drugs