Current Substance Use Tripled Violence Risk in Male Bipolar Patients

What the researchers found

Researchers evaluated 100 male inpatients with bipolar disorder type I during mood episodes to identify factors associated with violent behavior (defined as physical aggression against others).

Current substance use, rather than lifetime history of substance use disorder, was the key predictor: it was associated with a threefold increase in violence risk. The lifetime rate of substance use disorder in this population was 59%, and 39% were currently using substances.

Cannabis and alcohol were the most commonly used substances in both lifetime and current use groups, followed by synthetic cannabinoids. Patients who used any substance were more likely to have criminal records and prior incarceration. A previous history of violent behavior was another significant risk factor.

Why it matters

Understanding that current substance use, not just lifetime history, drives violence risk in bipolar disorder has practical implications for clinical management. It suggests that addressing active substance use could reduce violent behavior in this population.

The numbers in context

100 male inpatients studied. 59% had lifetime substance use disorder. 39% had current substance use. Current use associated with 3x increased violence risk. Cannabis and alcohol were the most commonly used substances.

How the study worked

One hundred male inpatients diagnosed with bipolar disorder type I were assessed during a current mood episode using validated scales including the Young Mania Rating Scale, Hamilton Depression Rating Scale, Barratt Impulsivity Scale, and Overt Aggression Scale. Logistic regression was used to predict violent behavior.

What this study cannot tell us

The sample was limited to male inpatients, so findings may not apply to female patients or outpatients. Self-reported substance use may be inaccurate. Synthetic cannabinoid use relied on patient and family reports due to lack of laboratory detection. The cross-sectional design cannot establish causation.

How to read the evidence

This is a small cross-sectional study of 100 male inpatients at a single center. The findings are preliminary and cannot establish causation.

When this study was published

Published in 2016. Research on the bipolar-substance use relationship has continued to develop.

The bigger picture

The co-occurrence of substance use and bipolar disorder is common and complicates treatment. This study adds to evidence that active substance use, particularly cannabis and alcohol, is associated with worse behavioral outcomes during mood episodes.

Questions still open

• Would treating active substance use in bipolar patients reduce violent incidents? Do different substances carry different levels of violence risk in bipolar disorder?

Common questions

Read the original research

Substance use is a risk factor for violent behavior in male patients with bipolar disorder.

Journal of affective disorders, 193, 89-93

Citation

Alnıak, İzgi; Erkıran, Murat; Mutlu, Elif. (2016). Substance use is a risk factor for violent behavior in male patients with bipolar disorder.. Journal of affective disorders, 193, 89-93. https://doi.org/10.1016/j.jad.2015.12.059

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