Further, other SUD also occur more often in individuals with either CUD and BD. Approximately two-thirds of individuals with bipolar disorder and CUD report nicotine dependence and alcohol and drug use disorders. A meta-analysis reported that among SUDs seen in patients with BD, alcohol (42%) and cannabis (20%) were most prevalent, followed by other illicit substances (17%) [5,6]. Other studies confirm that BD with comorbid CU was associated with an increased frequency of SUDs [21]. This is a particularly relevant finding, since co-occurring alcohol and SUDs among individuals with bipolar disorder are negatively associated with on the 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].
