such as age of onset [10,18], overall illness severity [6,20,28], history of mixed episodes [27] and rapid cycling [6,17], history of early adversity or trauma [29], current psychotherapy and pharmacotherapy treatment history and adherence [8,9], as well as other relevant features such as obesity and body mass index [30]. Further, study analyses were cross-sectional, and we were therefore unable to evaluate directionality of associations between CUD comorbidity and clinical and demographic features in the study sample. Finally, the study sample was primarily White and non-Hispanic. Thus, generalizability to more diverse patient groups with BD requires further study. Generalizability to patients with bipolar II disorder also requires further study.
