Elsevier

Psychiatry Research

Volume 209, Issue 3, 30 October 2013, Pages 459-465
Psychiatry Research

Bipolar disorder and co-occurring cannabis use disorders: Characteristics, co-morbidities and clinical correlates

https://doi.org/10.1016/j.psychres.2012.12.014Get rights and content

Abstract

This study examines rates of co-morbid mental disorders and indicators of the course of illness among individuals with bipolar disorder and cannabis use disorders (CUD). Data were drawn from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC Wave 1, 2001–2002), a nationally representative sample of adults living in the United States. Among individuals with lifetime prevalence of bipolar disorder (N=1905) rates of CUD in the past 12 months were 7.2%, compared to 1.2% in the general population. Logistic regression models adjusting for sociodemographic variables indicated that individuals with bipolar disorder and co-occurring CUD were at increased risk for nicotine dependence (Adjusted Odds Ratio (AOR)=3.8), alcohol (AOR=6.6) and drug (AOR=11.9) use disorders, as well as antisocial personality disorder (AOR=2.8) compared to those without CUD. Among individuals with co-occurring CUD, age of onset of bipolar disorder was significantly lower and median number of manic, hypomanic and depressive episodes per year was significantly greater compared to individuals without CUD. Co-occurring CUD is associated with significant co-morbidities and a more severe course of illness among individuals with bipolar disorder. Comprehensive evaluation of patients with bipolar disorder should include a systematic assessment of CUD.

Highlights

► We examine rates of co-morbid mental disorders and indicators of the course of illness among individuals with bipolar disorder and cannabis use disorders (CUD). ► Among individuals with bipolar disorder, concurrent CUD were associated with increased risk for nicotine, alcohol and drug use disorders. ► Among individuals with bipolar disorder, concurrent CUD were associated with earlier age of onset and greater annual number of bipolar episodes. ► Co-occurring CUD are associated with significant co-morbidities and a more severe course of illness among individuals with bipolar disorder.

Introduction

Bipolar I and II disorders are serious mental illnesses that have been reported to occur in approximately 1–3% (Narrow et al., 2002, Grant et al., 2005) and 3–5% (Berk and Dodd, 2005, Cerullo and Strakowski, 2007) of the population, respectively. They are, globally, the sixth leading cause of disability (Woods, 2000). Bipolar disorders are often complicated by co-occurring substance use disorders, which are associated with increased co-morbidities (Gao et al., 2008). Cannabis is the most common illicit substance used among individuals with bipolar disorder (Cerullo and Strakowski, 2007) and up to 38% of individuals with bipolar disorder misuse cannabis (Etain et al., 2012). Cannabis abuse has particularly been reported to be high among young bipolar patients (Dell'Osso et al., 2011), and chronic cannabis use is associated with higher severity of illness and greater treatment non-compliance among individuals with bipolar disorder (van Rossum et al., 2009).

Despite numerous reports on co-occurrence between bipolar disorder and substance use disorders (see for example review by Cerullo and Strakowski (2007)), few studies have focused particularly on the relationship between CUD and bipolar disorder. In a longitudinal study by Strakowski et al. (2007), co-occurring CUD was found to be associated with more overall time in affective episodes and with more rapid cycling. Baethge et al. (2005) reported that in a prospective study on a clinical sample of bipolar patients, cannabis dependence was particularly associated with more manic episodes. Agrawal et al. (2011) reported results from a case-control study showing that co-occurring CUD was associated with increased suicide attempts, mixed episodes and disability.

Nevertheless, data pertaining to characteristics and co-occurrence of cannabis use disorders (CUD) among individuals with bipolar disorder are still scarce. The aim of this study is to (a) report on characteristics of bipolar disorder and co-occurring CUD; (b) examine rates of co-morbid mental disorders among individuals with bipolar disorder and CUD; (c) examine bipolar-related indicators of course of illness among individuals with bipolar disorder and CUD. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine the relationship between bipolar disorder and CUD. The NESARC is the largest epidemiological survey to-date on mental illness and substance abuse. In addition, it uses assessment tools which clearly differentiate primary mental disorders and substance-induced disorders. This is particularly important when exploring the association between bipolar disorder and CUD, as it is the only way to conclude whether CUD among individuals with bipolar disorder are associated with specific co-occurring mental disorders even when cannabis-induced mental disorders are ruled out.

Section snippets

Sample

We analyzed cross-sectional data from a population-based national representative sample, the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) study (Wave 1, 2001–2002) (Grant et al., 2003b) conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The interview was developed to advance measurement of substance use and mental disorders in large-scale surveys. Face-to-face interviews were conducted with 43,093 adults (response rate, 81%), aged 18 years

Results

Rates of 12-month CUD among individuals with lifetime bipolar disorder were 7.2% (CI=5.8–9.0), compared to 1.2% (CI=1.1–1.3) in the general population. Among individuals with CUD, no differences were found in the mean age of first use of cannabis (16.0 (±0.47) vs. 16.0 (±0.22); p=0.95), mean number of days of cannabis used in the last 12 months (192.1 (±16.9) vs. 161.1 (±7.0); p=0.09) and mean number of joints consumed on days when cannabis was used (3.2 (±0.41) vs. 2.6 (±0.17); p=0.13) among

Discussion

Cannabis use disorders are more prevalent among individuals with bipolar disorder compared to the general population. Results of this study show that among individuals with bipolar disorder, co-occurring CUD is associated with significant co-morbidities, particularly co-morbid substance use disorders. CUD among individuals with bipolar disorder was also found be associated with a more severe course of illness.

The general sociodemographic characteristics of individuals with CUD among respondents

Acknowledgments

This research was supported by a strategic training grant (Grant number TUF 96115) from the Canadian Institute of Health Research provided for the Social Aetiology of Mental Ilness Training Program.

References (56)

  • S.M. Strakowski et al.

    The impact of substance abuse on the course of bipolar disorder

    Biological Psychiatry

    (2000)
  • Diagnostic and Statistical Manual of Mental Disorders

    (2000)
  • C. Baethge et al.

    Substance abuse in first-episode bipolar I disorder: indications for early intervention

    American Journal of Psychiatry

    (2005)
  • C.E. Begley et al.

    The lifetime cost of bipolar disorder in the US: an estimate for new cases in 1998

    Pharmacoeconomics

    (2001)
  • M. Berk et al.

    Bipolar II disorder: a review

    Bipolar Disorders

    (2005)
  • T.S. Brugha et al.

    A difference that matters: comparisons of structured and semi-structured psychiatric diagnostic interviews in the general population

    Psychological Medicine

    (1999)
  • T.D. Carter et al.

    Early age at onset as a risk factor for poor outcome of bipolar disorder

    Journal of Psychiatric Research

    (2003)
  • M.A. Cerullo et al.

    The prevalence and significance of substance use disorders in bipolar type I and II disorder

    Substance Abuse Treatment, Prevention and Policy

    (2007)
  • W.M. Compton et al.

    Prevalence of marijuana use disorders in the United States: 1991–1992 and 2001–2002

    Journal of the American Medical Association

    (2004)
  • E. Dunayevich et al.

    Twelve-month outcome in bipolar patients with and without personality disorders

    Journal of Clinical Psychiatry

    (2000)
  • B. Etain et al.

    Clinical expression of bipolar disorder type I as a function of age and polarity at onset: convergent findings in samples from France and the United States

    Journal of Clinical Psychiatry

    (2012)
  • M.D. Fossey et al.

    Validity of the distinction between primary and secondary substance use disorder in patients with bipolar disorder: data from the first 1000 STEP-BD participants

    American Journal on Addictions

    (2006)
  • J.L. Garno et al.

    Bipolar disorder with comorbid cluster B personality disorder features: impact on suicidality

    Journal of Clinical Psychiatry

    (2005)
  • Grant, B.F., Moore, T.C., Kaplan, K., 2003b. Source and Accuracy Statement: Wave 1 National Epidemiologic Survey on...
  • B.F. Grant et al.

    Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    Archives of General Psychiatry

    (2004)
  • B.F. Grant et al.

    Prevalence, correlates, and comorbidity of bipolar I disorder and axis I and II disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    Journal of Clinical Psychiatry

    (2005)
  • R.A. Grucza et al.

    Discrepancies in estimates of prevalence and correlates of substance use and disorders between two national surveys

    Addiction

    (2007)
  • J.G. Gunderson et al.

    Descriptive and longitudinal observations on the relationship of borderline personality disorder and bipolar disorder

    American Journal of Psychiatry

    (2006)
  • Cited by (0)

    View full text