Comorbid substance use disorder (BD-SUD) is common among individuals with bipolar disorder (BD) and is associated with worse clinical outcomes. This study compares differences in medication adherence, adherence barriers, and symptom severity of individuals with BD-SUD based on diagnostic status (current, past, or none).
Methods
This interim analysis utilized screening and baseline data from a 12-month randomized controlled trial comparing adherence interventions among poorly adherent individuals with BD. Patients were recruited from public mental health settings and met strict diagnostic and symptom criteria.
Results
From the study sample (N = 129; Mage = 42.18; SDage = 13.04), no significant sociodemographic differences were found. Individuals with BD and current substance use disorder reported significantly higher rates of problematic substance use and motivation to reduce such use compared to the other groups. No other differences were found.
Conclusions
Comorbid substance use disorder is common among individuals with bipolar disorder and often associated with poor outcomes. In this baseline, cross-sectional analysis, minimal differences were observed across varying BD-SUD status. Longitudinal analyses will be important for clarifying whether adherence and related outcomes differ over time across BD-SUD groups.
NierenbergAAAgustiniBKöhler-ForsbergO, et al.Diagnosis and treatment of bipolar disorder: a review. JAMA. 2023;330(14):1370-1380. doi:10.1001/jama.2023.18588
2.
AgugliaANataleAFusar-PoliL, et al.Bipolar disorder and polysubstance use disorder: sociodemographic and clinical correlates. Front Psychiatr. 2022;13:913965. doi:10.3389/fpsyt.2022.913965
3.
AnugwomGOOladunjoyeAOBasiruTO, et al.Does cocaine use increase medication noncompliance in bipolar disorders? A United states nationwide inpatient cross-sectional study. Cureus. 2021;13(7):e16696. doi:10.7759/cureus.16696
4.
ManwaniSGSzilagyiKAZablotskyBHennenJGriffinMLWeissRD. Adherence to pharmacotherapy in bipolar disorder patients with and without co-occurring substance use disorders. J Clin Psychiatry. 2007;68(8):1172-1176. doi:10.4088/jcp.v68n0802
5.
MeenaGKYadavASahaR. Comparison of personality factors, adherence to medication and quality of life in bipolar disorder-I patients with or without substance use disorder. J Affect Disorders Rep. 2024;16:100777.
6.
MenculiniGSteardoLVerdoliniNCirimbilliFMorettiPTortorellaA. Substance use disorders in bipolar disorders: clinical correlates and treatment response to mood stabilizers. J Affect Disord. 2022;300:326-333. doi:10.1016/j.jad.2022.01.001
7.
OladunjoyeAFKaleemSZSureshA, et al.Cannabis use and medication nonadherence in bipolar disorder: a nationwide inpatient sample database analysis. J Affect Disord. 2022;299:174-179. doi:10.1016/j.jad.2021.11.067
8.
SajatovicMValensteinMBlowFCGanoczyDIgnacioRV. Treatment adherence with antipsychotic medications in bipolar disorder. Bipolar Disord. 2006;8(3):232-241. doi:10.1111/j.1399-5618.2006.00314.x
9.
SajatovicMBauerMSKilbourneAMVertreesJEWillifordW. Self-reported medication treatment adherence among veterans with bipolar disorder. Psychiatr Serv. 2006;57(1):56-62. doi:10.1176/appi.ps.57.1.56
10.
TeterCJFaloneAEBakaianAMTuCOngürDWeissRD. Medication adherence and attitudes in patients with bipolar disorder and current versus past substance use disorder. Psychiatry Res. 2011;190(2-3):253-258. doi:10.1016/j.psychres.2011.05.042
11.
WeinstockLMGaudianoBAWenzeSJEpstein-LubowGMillerIW. Demographic and clinical characteristics associated with comorbid cannabis use disorders (CUDs) in hospitalized patients with bipolar I disorder. Compr Psychiatry. 2016;65:57-62. doi:10.1016/j.comppsych.2015.10.003
12.
LagerbergTVAndreassenOARingenPA, et al.Excessive substance use in bipolar disorder is associated with impaired functioning rather than clinical characteristics, a descriptive study. BMC Psychiatry. 2010;10:1-9.
13.
OquendoMACurrierDLiuS-MHasinDSGrantBFBlancoC. Increased risk for suicidal behavior in comorbid bipolar disorder and alcohol use disorders: results from the national epidemiologic survey on alcohol and related conditions (NESARC). J Clin Psychiatry. 2010;71(7):8966.
14.
O’RourkeNHeiselMJCanhamSLSixsmithATeamBS. Predictors of suicide ideation among older adults with bipolar disorder. PLoS One. 2017;12(11):e0187632.
15.
RakofskyJJDunlopBW. Do alcohol use disorders destabilize the course of bipolar disorder?J Affect Disord. 2013;145(1):1-10.
16.
ShabaniAJolfaeiAGVazmalaeiHAEbrahimiAANaserbakhtM. Clinical and course indicators of bipolar disorder type I with and without opioid dependence. J Res Med Sci: Official J Isfahan University Medical Sci. 2010;15(1):20-26.
17.
WeissRDOstacherMJOttoMW, et al.Does recovery from substance use disorder matter in patients with bipolar disorder?J Clin Psychiatr. 2005;66(6):730-735.
18.
MesserTLammersGMüller-SiechenederFSchmidtR-FLatifiS. Substance abuse in patients with bipolar disorder: a systematic review and meta-analysis. Psychiatry Res. 2017;253:338-350.
19.
GarcíaSMartínez-CengotitabengoaMLópez-ZurbanoS, et al.Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: a systematic review. J Clin Psychopharmacol. 2016;36(4):355-371.
20.
Gonzalez-PintoAReedCNovickDBertschJHaroJ. Assessment of medication adherence in a cohort of patients with bipolar disorder. Pharmacopsychiatry. 2010;43(07):263-270.
21.
JawadIWatsonSHaddadPMTalbotPSMcAllister-WilliamsRH. Medication nonadherence in bipolar disorder: a narrative review. Therapeutic Adv Psychopharmacol. 2018;8(12):349-363.
22.
McVoyMLevinJB. Updated strategies for the management of poor medication adherence in patients with bipolar disorder. Expert Rev Neurother. 2023;23(4):365-376. doi:10.1080/14737175.2023.2198704
23.
GogiaMShahAQKapczinskiFde Azevedo CardosoT. The impact of substance use disorder comorbidity on cognition of individuals with bipolar disorder: a systematic review. Psychiatry Res. 2022;311:114525.
24.
MazzaMMandelliLDi NicolaM, et al.Clinical features, response to treatment and functional outcome of bipolar disorder patients with and without co-occurring substance use disorder: 1-year follow-up. J Affect Disord. 2009;115(1-2):27-35.
25.
LevyBMonzaniBAStephanskyMRWeissRD. Neurocognitive impairment in patients with co-occurring bipolar disorder and alcohol dependence upon discharge from inpatient care. Psychiatry Res. 2008;161(1):28-35.
26.
LevinJBBriggsFBlixenC, et al.A randomized controlled trial of customized adherence enhancement (CAE-E): study protocol for a hybrid effectiveness-implementation project. Trials. 2022;23(1):634.
27.
FirstMWilliamsJKargRSpitzerR. Structured Clinical Interview for DSM-5—Research Version (SCID-5 for DSM-5, Research Version; SCID-5-RV). Arlington, VA: American Psychiatric Association; 2015.
28.
SajatovicMLevinJBSamsJ, et al.Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder. Bipolar Disord. 2015;17(6):653-661. doi:10.1111/bdi.12326
29.
PeetMHarveyNS. Lithium maintenance: 1. A standard education programme for patients. Br J Psychiatry. 1991;158:197-200. doi:10.1192/bjp.158.2.197
30.
MontgomerySAAsbergM. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382-389. doi:10.1192/bjp.134.4.382
31.
YoungRCBiggsJTZieglerVEMeyerDA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429-435. doi:10.1192/bjp.133.5.429
32.
OverallJEGorhamDR. The brief psychiatric rating scale (BPRS): recent developments in ascertainment and scaling. Psychopharmacol Bull. 1988;24:97-99.
33.
SpearingMKPostRMLeverichGSBrandtDNolenW. Modification of the clinical global impressions (CGI) scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res. 1997;73(3):159-171.
34.
JonesSHThornicroftGCoffeyMDunnG. A brief mental health outcome scale-reliability and validity of the global assessment of functioning (GAF). Br J Psychiatry: J Mental Sci. 1995;166(5):654-659.
35.
DingemansPMLinszenDHLeniorMESmeetsRM. Component structure of the expanded brief psychiatric rating scale (BPRS-E). Psychopharmacology (Berl). 1995;122(3):263-267. doi:10.1007/BF02246547
36.
MohammadiZPourshahbazAPoshtmashhadiMDolatshahiBBaratiFZareiM. Psychometric properties of the young mania rating scale as a mania severity measure in patients with bipolar I disorder. Pract Clinic Psychol. 2018;6(3):175-182.
OrganizationWHBaborTFHiggins-BiddleJCSaundersJBMonteiroMG. AUDIT: the alcohol use disorders identification test: guidelines for use in primary health care, 2nd ed. World Health Organization. 2001.
39.
SaundersJBAaslandOGBaborTFde la FuenteJRGrantM. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol Consumption--II. Addiction. 1993;88(6):791-804.
40.
MaistoSACareyMPCareyKBGordonCMGleasonJR. Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychol Assess. 2000;12(2):186-192.
41.
CoccoKMCareyKB. Psychometric properties of the drug abuse screening test in psychiatric outpatients. Psychol Assess. 1998;10(4):408-414.
42.
BilderbeckACAtkinsonLZMcMahonHC, et al.Psychoeducation and online mood tracking for patients with bipolar disorder: a randomised controlled trial. J Affect Disord. 2016;205:245-251. doi:10.1016/j.jad.2016.06.064
43.
JidongDEHusainMIIkeTJ, et al.Bipolar disorders in Nigeria: a mixed-methods study of patients, family caregivers, Clinicians, and the community members’ perspectives. Int J Bipolar Disord. 2023;11(1):2. doi:10.1186/s40345-022-00276-2
44.
KleinPJAebiMESajatovicM, et al.Differential medication attitudes to antihypertensive and mood stabilizing agents in response to an automated text-messaging adherence enhancement intervention. Journal of behavioral and cognitive therapy. 2020;30(1):57-64.
45.
LevinJBAebiMEHowlandM, et al.The relationship between medication attitudes and medication adherence behavior in adults with bipolar disorder. J Nerv Ment Dis. 2020;208(2):87-93. doi:10.1097/NMD.0000000000001083
46.
WeidenPRapkinBMottT, et al.Rating of medication influences (ROMI) scale in schizophrenia. Schizophr Bull. 1994;20(2):297-310. doi:10.1093/schbul/20.2.297
47.
VerplankenBOrbellS. Reflections on past behavior: a self‐report index of habit strength 1. J Appl Soc Psychol. 2003;33(6):1313-1330.
48.
MillerWRToniganJS. Assessing Drinkers' Motivation for Change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). American Psychological Association; 1997.
49.
BultmanDCSvarstadBL. Effects of physician communication style on client medication beliefs and adherence with antidepressant treatment. Patient Educ Counsel. 2000;40(2):173-185.
50.
HarrisPATaylorRThielkeRPayneJGonzalezNCondeJG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010
51.
ZorrillaIAguadoJHaroJ, et al.Cannabis and bipolar disorder: does quitting cannabis use during manic/mixed episode improve clinical/functional outcomes?Acta Psychiatr Scand. 2015;131(2):100-110.
52.
ConsoloniJLM'BailaraKPerchecC, et al.Trajectories of medication adherence in patients with bipolar disorder along 2 years-follow-up. J Affect Disord. 2021;282:812-819. doi:10.1016/j.jad.2020.12.192
53.
ThompsonAEAnisimowiczYMiedemaBHoggWWodchisWPAubrey-BasslerK. The influence of gender and other patient characteristics on health care-seeking behaviour: a qualicopc study. BMC Fam Pract. 2016;17(1):38.
