In another study, 77 bipolar patients were prospectively investigated over 12 months to assess the associations between alcohol use and bipolar disorders after a first hospitalization of mania (33). Most alcohol-dependent bipolar subjects developed an additional affective episode during follow-up in the absence of ongoing alcohol or drug abuse. The authors concluded that patients whose bipolar illness co-occurs with alcohol or substance use disorders do not necessarily require ongoing alcohol or substance abuse to initiate new affective episodes. But when present, high alcohol use or use disorders were associated with affective symptoms. In the current analyses, while not statistically significant, the number of affective symptoms in the comorbid bipolar I group worsened during the follow-up.
