Other studies confirm that BD with comorbid CU is related with increased frequency of SUDs [21,32]. This is a particularly relevant finding, as co-occurring alcohol- and SUDs among individuals with bipolar disorder are associated with negative effects on course of illness (even after adjusting for non-compliance) including a delayed onset of symptomatic recovery when treated [24,25]. The significance of these findings is underscored when considering the heavy burden of disease already associated with bipolar disorder [26,27].
