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Does Conduct Disorder Mediate the Development of Substance Use Disorders in Adolescents With Bipolar Disorder? A Case-Control Family Study

Timothy E. Wilens, M.D.; MaryKate Martelon, M.P.H.; Markus J. P. Kruesi, M.D.; Tiffany Parcell, B.S.; Diana Westerberg, B.A.; Mary Schillinger, B.A.; Martin Gignac, M.D.; and Joseph Biederman, M.D.

Background: Recent work has highlighted important relationships among conduct disorder (CD), substance use disorders (SUD), and bipolar disorder in youth. However, because bipolar disorder and CD are frequently comorbid in the young, the impact of CD in mediating SUD in bipolar disorder youth remains unclear.

Method: 105 adolescents with DSM-IV bipolar disorder (mean ± SD age = 13.6 ± 2.50 years) and 98 controls (mean ± SD age = 13.7 ± 2.10 years) were comprehensively assessed with a structured psychiatric diagnostic interview for psychopathology and SUD. The study was conducted from January 2000 through December 2004.

Results: Among bipolar disorder youth, those with CD were more likely to report cigarette smoking and/or SUD than youth without CD. However, CD preceding SUD or cigarette smoking did not significantly increase the subsequent risk of SUD or cigarette smoking. Adolescents with bipolar disorder and CD were significantly more likely to manifest a combined alcohol plus drug use disorder compared to subjects with bipolar disorder without CD (chi2 = 11.99, p <.001).

Conclusion: While bipolar disorder is a risk factor for SUD and cigarette smoking in a sample of adolescents, comorbidity with preexisting CD does not increase the risk for SUD. Further follow-up of this sample through the full risk of SUD into adulthood is necessary to confirm these findings.


(J Clin Psychiatry 2009;70(2):259-265. Online Ahead of Print February 10, 2009. doi:10.4088/JCP.08m04438)

Received May 29, 2008; accepted Sept. 26, 2008. From the Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, and Department of Psychiatry, Harvard Medical School, Cambridge, Mass. (Drs. Wilens and Biederman and Mss. Martelon, Parcell, Westerberg, and Schillinger); the Division of Child Psychiatry, Medical University of South Carolina, Charleston (Dr. Kruesi); and the Institute Philippe Pinel, Université de Montréal, Quebec, Canada (Dr. Gignac).

Supported by National Institutes of Health grants RO1 DA12945 and K24 DA016264 (Dr. Wilens).

Presented at the Pediatric Bipolar Conference, March 28-29, 2008, Boston, Mass.

Financial disclosure appears at the end of this article.

Corresponding author and reprints: Timothy E. Wilens, M.D., Massachusetts General Hospital, Pediatric Psychopharmacology Unit, 55 Parkman St., YAW 6A, Boston, MA 02114 (e-mail: