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Cited by 65Bipolar Disorder and TreatmentSubstance Abuse Treatment and OutcomesPersonality Disorders and Psychopathology

Predictors of First-Onset Substance Use Disorders During the Prospective Course of Bipolar Spectrum Disorders in Adolescents

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Goldstein, Benjamin I., Strober, Michael, Axelson, David, Goldstein, Tina R., Gill, Mary Kay, Hower, Heather, Dickstein, Daniel, Hunt, Jeffrey +9 more·2013·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2013.07.009PMC PMC3787940
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Abstract

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. Method 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.

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  • Three studies examined antipsychotic medication, including lithium.

    “Three studies examined antipsychotic medication, including lithium (Petersen et al. 2007; Turner et al. 2009; Goldstein et al. 2013).”

    From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Goldstein et al. 2013

    The Method (Procedures) says the study examined medication exposure, including lithium and second-generation antipsychotics. It lists lithium separately from antipsychotics, however, so the source does not support classifying lithium as an antipsychotic. The Results (Follow-Up Variables) also report an association between lithium exposure and first-onset substance use disorder. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • In a detailed analysis of treatment episodes in bipolar disorder, pharmacotherapy with lithium reduced the subsequent development of SUD.

    “For example, in a detailed analysis of treatment episodes in bipolar disorder, pharmacotherapy with lithium reduced the subsequent development of SUD (Goldstein et al. 2013).”

    From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Goldstein et al. 2013

    The Results report that greater lithium exposure in the preceding 12 weeks predicted a lower likelihood of first-onset SUD among adolescents with bipolar spectrum disorders. The Discussion cautions that this observational association may be confounded and cannot establish that lithium prevented SUD; the claim's causal wording and unqualified reference to bipolar disorder overstate the finding. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Data from within-group designs support that unmedicated treatment periods were related to an almost 30% increase in the likelihood to develop SUD compared to medicated times.

    “Data from within-group designs support that unmedicated treatment periods were related to an almost 30% increase in the likelihood to develop SUD compared to medicated times (Goldstein et al. 2013; Quinn et al. 2017).”

    From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Goldstein et al. 2013

    The Results (Follow-Up Variables Associated With First-Onset Substance Use Disorders; page unavailable) associate less medication exposure, particularly lithium, in the preceding 12 weeks with greater risk of first-onset SUD. But the paper does not report an almost 30% increase for unmedicated versus medicated periods or describe its analysis as a within-group comparison; the Methods (Statistical Analyses; page unavailable) instead give hazard ratios per percentage-point increase in weeks of exposure. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Two studies examined the impact of antidepressants.

    “Two studies examined the impact of antidepressants (Curry et al. 2012; Goldstein et al. 2013).”

    From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Goldstein et al. 2013

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Research works printed but not linked: 49

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Authors
Goldstein, B. I., Strober, M., Axelson, D., Goldstein, T. R., Gill, M. K., Hower, H., Dickstein, D., Hunt, J., Yen, S., Kim, E., Ha, W., Liao, F., Fan, J., Iyengar, S., Ryan, N. D., Keller, M. B., & Birmaher, B.
Affiliations
  • Sunnybrook Health Science Centre (CA)
  • University of California, Los Angeles (US)
  • University of Pittsburgh (US)
  • Brown University (US)
Corresponding author
Goldstein, Benjamin I.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2013-10
Volume
52
Issue
10
Pages
1026-1037
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2013.07.009
PMC
PMC3787940
OpenAlex
W2132312616
Cited by
65
References
58
Citations by year
2026: 4 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 6 · 2020: 7 · 2019: 4 · 2018: 4 · 2017: 7 · 2016: 5 · 2015: 2 · 2014: 8 · 2013: 1
FWCI
3.79
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH059929, K23MH074581, MH59691, R01MH059977, R01MH112543, R01MH059691, MH074581, K23MH069904, MH59977, MH74945, MH-59929, K22MH074945, MH69904)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
substance use disorders, bipolar disorder, adolescents, risk factors, alcohol experimentation, oppositional defiant disorder, panic disorder, family history of substance use, family cohesion, antidepressant treatment, lithium, preventive interventions, bipolar spectrum disorders
MeSH terms
Adolescent, Bipolar Disorder, Child, Family Relations, Female, Humans, Lithium, Male, Predictive Value of Tests, Prospective Studies, Risk Factors, Severity of Illness Index, Comorbidity, Panic Disorder, Age of Onset, Attention Deficit and Disruptive Behavior Disorders, Substance-Related Disorders

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