title: Personal theories of substance use among middle-aged and older adults with bipolar disorder.
abstract: Most persons with bipolar disorder (BD) misuse alcohol and/or illicit drugs at some point, yet research specific to older adults with BD is nascent. The current study sought an in-depth understanding of the experiences and meanings of substance use in a sample of adults who self-reported substance misuse.
  
  
  
  Semi-structured interviews were conducted and thematically analyzed to understand the personal theories of substance use by 12 adults (9 women and 3 men; M = 49 years old) who self-reported diagnoses of BD and regular alcohol or illicit drug use.
  
  
  
  Findings provide an in-depth picture of the theories middle-aged and older adults with BD have developed to explain their substance use. Participants' theories suggest multiple reasons for substance use, including self-medication; increased confidence with substance use; rejection of prescribed medications; easy access to alcohol; early social exposure/use as facilitator; and living in a culture of substance use.
  
  
  
  Findings suggest multiple theories for the comorbid link between BD and substance use, primarily that persons with BD use drugs and/or alcohol to relieve stress or manage symptoms. It is clinically relevant to incorporate personal reasons for actively and regularly using substances as part of personalized substance treatment and BD symptom management.
authors.affiliation: a Gerontology Research Centre , Simon Fraser University , Vancouver , Canada.
authors.forename: Sarah L
authors.identifier: 0000-0002-0421-2612
authors.initials: SL
authors.lastname: Canham
authors.affiliation: b Department of Gerontology , Simon Fraser University , Vancouver , Canada.
authors.forename: Atiya
authors.initials: A
authors.lastname: Mahmood
authors.affiliation: c IRMACS Centre , Simon Fraser University , Burnaby , Canada.
authors.forename: Marissa N
authors.initials: MN
authors.lastname: Stalman
authors.affiliation: c IRMACS Centre , Simon Fraser University , Burnaby , Canada.
authors.forename: David
authors.initials: D
authors.lastname: King
authors.affiliation: d Department of Public Health and Center for Multidisciplinary Research in Aging , Ben-Gurion University of the Negev , Be'er Sheva , Israel.
authors.forename: Norm
authors.initials: N
authors.lastname: O'Rourke
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*
keywords: Bipolar disorder; comorbidity; drug and alcohol misuse; self-medication