Does Recovery From Substance Use Disorder Matter in Patients With Bipolar Disorder?
J Clin Psychiatry 2005;66(6):730-735
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: To examine the potential impact of
recovery from substance use disorder (SUD) on the course of
bipolar disorder among patients diagnosed with both bipolar and
substance use disorders according to DSM-IV criteria.
Method: As part of the multicenter Systematic
Treatment Enhancement Program for Bipolar Disorder (STEP-BD), we
examined bipolar disorder status (i.e., whether the patient is
recovering or recovered), role functioning, and quality of life
in the first 1000 patients to enter the STEP-BD study. We
compared patients with no history of SUD, current SUD, and past
SUD (i.e., lifetime SUD, but no current SUD) on these parameters.
Data were collected between November 1999 and April 2001.
Results: A current clinical status of recovering
or recovered from bipolar disorder was less likely among patients
with current or past SUD compared to patients with no SUD
(p < .002). Recovering/recovered status did not differ
significantly between patients with current SUD versus past SUD.
All 3 groups differed significantly on measures of role
functioning as assessed by the Longitudinal Interval Follow-Up
Evaluation-Range of Impaired Functioning Tool (LIFE-RIFT), with
poorest role functioning among patients with current SUD,
followed by patients with past SUD (p = .0002). Patients with
current or past SUD reported significantly lower quality of life
as measured by the LIFE-RIFT and the Quality of Life Enjoyment
and Satisfaction Questionnaire and more lifetime suicide attempts
(p < .001) than patients without an SUD; patients with past
versus current SUD did not differ significantly on these
Conclusion: The results suggest that patients
with bipolar disorder who experience sustained remission from an
SUD fare better than patients with current SUD, but not as well
as subjects with no history of SUD; differences among the 3
groups appear greatest in the area of role functioning.