Does Recovery From Substance Use Disorder Matter in Patients With Bipolar Disorder?

Roger D. Weiss, M.D.; Michael J. Ostacher, M.D.; Michael W. Otto, Ph.D.; Joseph R. Calabrese, M.D.; Mark Fossey, M.D.; Stephen R. Wisniewski, Ph.D.; Charles L. Bowden, M.D.; Andrew A. Nierenberg, M.D.; Mark H. Pollack, M.D.; Ihsan M. Salloum, M.D., Ph.D.; Naomi M. Simon, M.D.; Michael E. Thase, M.D.; and Gary S. Sachs, M.D., for STEP-BD Investigators

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 measures.

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.

(J Clin Psychiatry 2005;66:730-735)

Received Sept. 21, 2004; accepted Jan. 10, 2005. From the Department of Psychiatry, Harvard Medical School, Boston (Drs. Weiss, Ostacher, Otto, Nierenberg, Pollack, Simon, and Sachs), McLean Hospital, Belmont (Dr. Weiss), and Massachusetts General Hospital, Boston (Drs. Ostacher, Otto, Nierenberg, Pollack, Simon, and Sachs), Mass.; Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio (Dr. Calabrese); Department of Psychiatry, University of Oklahoma, Tulsa (Dr. Fossey); Department of Psychiatry, University of Pittsburgh and Western Psychiatric Institute and Clinic, Pittsburgh, Pa. (Drs. Wisniewski, Salloum, and Thase); and Department of Psychiatry, University of Texas Health Science Center, San Antonio (Dr. Bowden).

This project has been funded in whole or in part with federal funds from the National Institute of Mental Health (NIMH), National Institutes of Health, under contract N01 MH80001. Dr. Weiss' work on this project was supported with grants K02 DA00326 and R01 DA15968 from the National Institute on Drug Abuse. Dr. Simon's work on this project was supported by Career Development Award MH01831 from the NIMH.

Financial disclosure appears at the end of this article.

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) sites and principal investigators are listed at the end of the article.

Any opinions, findings, and conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the NIMH. This article was approved by the publication committee of the STEP-BD.

Corresponding author and reprints: Roger D. Weiss, M.D., McLean Hospital, 115 Mill St., Belmont, MA 02478 (e-mail: rweiss@mclean.harvard.edu).