Bipolar and Substance Use Disorders Comorbidity: Commonality and Risk Factors

Having bipolar disorder and substance use disorder co-occurring in patients can be common—40% to 60% of patients have this comorbidity. Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, clinical professor at the University of Illinois at Chicago, and Arwen Podesta, MD, ABPN, FASAM, ABIHM, a psychiatrist at Podesta Psychiatry LLC, discussed the commonality of this comorbidity at the first annual NP Institute in Boston, Massachusetts, as well as how they recommend professionals approach treatment. 

Save the date for NP Institute In-Person, March 20-23, 2024 in San Diego, California! For more information, visit the meeting website.

Read the Transcript: 

Julie Carbray, PhD: I'm Julie Carbray, clinical professor of nursing and psychiatry at the University of Illinois at Chicago, also the director of our mood disorder clinic and nursing faculty.

Arwen Podesta, MD: I'm a psychiatrist in New Orleans, Louisiana. I specialize in addiction medicine and holistic and integrative psychiatry and also in forensic psychiatry.

Psych Congress Network: How common is bipolar disorder and SUD comorbidity? What major factors lead to patients with BD developing SUD?

Dr Carbray: As you know, Arwen, comorbidity of substance use disorders is very common with bipolar disorder. Anywhere from 40 to 60% of persons with bipolar illness will also struggle with substance use disorders of some form.

Dr Podesta: And oftentimes you can't really tell whether it's the chicken or the egg, right, which comes first. But what we know very well is that those who have a genetic heritable, bipolar predilection will often, 40 to 60% will jump into substance use at an early age, which can sometimes even worsen the disease.

Dr Carbray: Absolutely. And sometimes we do have to keep track of when you first had a point of illness symptoms and when substance use began. Sometimes, as you said, it's the chicken, sometimes it's the egg. And what really helps us to determine that, can be a timeline of use behaviors as well as symptoms and then really trying to tease that apart.

Dr Podesta: And that chronology is so important. And it's very hard for the individual to identify sometimes, especially when they're not mentally well because of their illness. And so having the family involved or having other people and teachers and everything involved, that's how I do my chronologies as well.

Dr Carbray: Exactly. Having that collateral information about when symptoms started to appear, what that trajectory looked like for that person at that place and time and when use was really rolling in and was used around managing symptoms or not.

Dr Podesta: That's right.

Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, is a clinical professor of psychiatry and nursing at the University of Illinois at Chicago. Dr Carbray holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago, and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana. Dr Carbray was recognized by the UIC community in 2008 by receiving the Karen Gousman Excellence in Nursing Award and the American Psychiatric Nurses Association’s (APNA) Best Practices in Outpatient Mental Health Nursing Award. In 2012, Dr Carbray was awarded the University of Illinois at Chicago’s Inspire award for her long-standing commitment to UIC values and her inspiration of others in her work, and in 2016, Dr Carbray was awarded the Distinguished Service Award by APNA for her service to the profession of psychiatric nursing.

Arwen Podesta, MD, ABPN, FASAM, ABIHM, is a board-certified adult psychiatrist with sub-specializations in addiction medicine, forensic psychiatry, and integrative medicine. A graduate of the University of Southern California Keck School of Medicine, Dr Podesta completed her psychiatry residency in at Louisiana State University before pursuing a fellowship in forensic psychiatry at Tulane University.