Although previous research suggests that juvenile-onset bipolar disorder (BPD) increases the risk for cigarette smoking and other substance use disorders (SUDs), the literature on this subject is limited. To examine whether an association exists, researchers compared 105 youths with BPD to 98 youths without BPD (controls).

• Youths with BPD were significantly more likely to have an SUD (34%) compared with controls (4%).
• Youths with BPD were also more likely than controls to have alcohol abuse (23% versus 3%), alcohol dependence (6% versus 0%), drug abuse (22% versus 1%), drug dependence (14% versus 1%), and cigarette smoking (22% versus 4%) than controls.
• The increased risk for an SUD was independent of conduct disorder, attention deficit/hyperactivity disorder (ADHD), or multiple anxiety disorders.
• The onset of mood disorders (e.g., depression or mania) during adolescence was specifically associated with elevated risk for an SUD compared with mood disorders that began prior to puberty.
• Of the 33 subjects with both an SUD and BPD, 22 (67%) experienced the onset of BPD prior to the onset of their SUD, 8 (24%) experienced the onset of BPD and their SUD within the same year, and 3 (9%) experienced the onset of BPD after the onset of their SUD.

Comments by Michael Levy, PhD
These results clearly demonstrate that adolescent BPD is a significant risk factor for SUDs and cigarette smoking, independent of psychiatric comorbidity. This was particularly evident among youth who first experienced BPD symptoms during adolescence. In light of these findings, it is important for clinicians to screen youth with BPD for cigarette and other substance use.