Predictors of first-onset substance use disorders during the prospective course of bipolar spectrum disorders in adolescents.
OBJECTIVE
Substance use disorders (SUD) are common and problematic in bipolar disorder (BP). We prospectively examined predictors of first-onset SUD among adolescents with BP.


METHODS
Adolescents (12-17 years old; N = 167) in the Course and Outcome of Bipolar Youth (COBY) study fulfilling criteria for BP-I, BP-II, or operationalized BP not otherwise specified, without SUD at intake, were included. Baseline demographic, clinical, and family history variables, and clinical variables assessed during follow-up, were examined in relation to first-onset SUD. Participants were prospectively interviewed every 38.5 ± 22.2 weeks for an average of 4.25 ± 2.11 years.


RESULTS
First-onset SUD developed among 32% of subjects, after a mean of 2.7 ± 2.0 years from intake. Lifetime alcohol experimentation at intake most robustly predicted first-onset SUD. Lifetime oppositional defiant disorder and panic disorder, family history of SUD, low family cohesiveness, and absence of antidepressant treatment at intake were also associated with increased risk of SUD, whereas BP subtype was not. Risk of SUD increased with increasing number of these 6 predictors: 54.7% of subjects with 3 or more predictors developed SUD vs. 14.1% of those with fewer than 3 predictors (hazard ratio = 5.41 95% confidence interval = 2.7-11.0 p < .0001). Greater hypo/manic symptom severity in the preceding 12 weeks predicted greater likelihood of SUD onset. Lithium exposure in the preceding 12 weeks predicted lower likelihood of SUD.


CONCLUSIONS
This study identifies several predictors of first-onset SUD in the COBY sample that, if replicated, may suggest targets for preventive interventions for SUD among youth with BP. Treatment-related findings are inconclusive and must be interpreted tentatively, given the limitations of observational naturalistic treatment data. There is a substantial window of opportunity between BP and SUD onset during which preventive strategies may be used.
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine; Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, University of Toronto. Electronic address: benjamin.goldstein@sunnybrook.ca.
Benjamin I
BI
Goldstein
Michael
M
Strober
David
D
Axelson
Tina R
TR
Goldstein
Mary Kay
MK
Gill
Heather
H
Hower
Daniel
D
Dickstein
Jeffrey
J
Hunt
Shirley
S
Yen
Eunice
E
Kim
Wonho
W
Ha
Fangzi
F
Liao
Jieyu
J
Fan
Satish
S
Iyengar
Neal D
ND
Ryan
Martin B
MB
Keller
Boris
B
Birmaher
D000293:Adolescent; D017668:Age of Onset; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000453:epidemiology; D001714:Bipolar Disorder / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D005195:Family Relations; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D016584:Panic Disorder / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology*
D008094:Lithium
bipolar; predictors; prevention; prospective; substance use disorder