The severe shifts in mood and energy that define bipolar disorder can impact an affected individual’s behavior in significant ways, and researchers have long noted that individuals with this debilitating mood disorder often smoke, drink, or use drugs. In a new study from the June issue of Drug and Alcohol Dependence, researchers from Massachusetts General Hospital expand upon our understanding of this risk associated with bipolar disorder. They report a clear connection between bipolar disorder and smoking or substance use in teens, demonstrating that this link exists even in the presence of other mental health conditions that can contribute to a higher likelihood of these behaviors.

The researchers interviewed 105 bipolar teens and children, with 14 being the average age at the study’s onset, and 98 control subjects matched for age. Using family histories and information gained from the subjects’ physicians, the researchers examined many factors, focusing specifically on the prevalence of smoking, drinking, and drug use among their subjects. While 34 percent of subjects with bipolar disorder smoked or used illicit substances, only four percent of control subjects engaged in these behaviors. The researchers then controlled for other psychiatric conditions associated with an increased risk of smoking and substance use and that often develop alongside bipolar disorder, including attention deficit hyperactivity disorder, anxiety disorders, and conduct disorder. Their findings revealed that the risk associated with bipolar disorder occurred independently of these other risks.

Continued evaluation further illuminated the link between substance abuse and bipolar disorder in teens. Bipolar subjects who smoked, drank, or used drugs tended to engage in these behaviors after the symptoms of bipolar disorder had already appeared, and teens with the disorder were more likely to use these substances than their younger counterparts. A genetic predisposition for both bipolar disorder and smoking or substance use could explain these correlations, but the researchers also suggest that a propensity for risk-taking behavior may be at play. Individuals with bipolar disorder can act in a risky manner, especially during manic episodes, and adolescents are also likely to demonstrate poor judgement and take unnecessary chances. For teens with bipolar disorder, this combination of factors may up their likelihood of disregarding healthy behaviors for the immediate effects of smoking, drinking, or drug use. Moreover, they may use these substances despite the dangers associated with them as a way to self-medicate the highs and lows of bipolar disorder.

While bipolar disorder may put teens at risk for these behaviors, the researchers stress that smoking and substance abuse could also be viewed as warning signs that an individual may be experiencing mental health problems. Smoking and substance use are common among individuals with mental illness, and it’s important that we take steps to address this common problem. By helping someone with bipolar disorder, schizophrenia, depression, or other mental illness to quit smoking, stop drinking, or overcome a drug addiction, we can help them to improve the overall quality of their health, which will greatly impact their ability to function on a daily basis.