Impulsivity in Bipolar Disorder Was Linked to Cannabis and Alcohol Misuse but Not Suicide Attempts | Research

The takeaway

Among 385 euthymic bipolar patients, trait impulsivity was significantly associated with cannabis and alcohol misuse and with more severe illness course, but not with suicide attempt history.

Read this if you have bipolar disorder and notice patterns of impulsive behavior including substance use.

Cannabis misuse had the strongest association with impulsivity (p<0.0001)

What the researchers found

Researchers compared impulsivity scores between 385 stable (euthymic) bipolar patients and 185 healthy controls. Bipolar patients scored significantly higher on all impulsivity measures (motor, attentional, non-planning) than controls.

Higher impulsivity was associated with alcohol misuse (p=0.005), cannabis misuse (p<0.0001), rapid cycling (p=0.006), and mixed episodes (p=0.002), with additive effects when multiple factors were present. Contrary to expectations, impulsivity was not associated with suicide attempts. Cannabis misuse showed the strongest individual association with impulsivity.

Why it matters

Understanding that impulsivity in bipolar disorder links specifically to substance misuse and a more severe illness course (rather than to suicide) helps clinicians know what to watch for. Highly impulsive bipolar patients may benefit most from substance use screening and prevention.

The numbers in context

385 bipolar patients, 185 controls. All impulsivity subscores significantly higher in patients (p<0.0001). Cannabis misuse: p<0.0001 with impulsivity. Alcohol misuse: p=0.005. Rapid cycling: p=0.006. Mixed episodes: p=0.002. No association with suicide attempts.

How the study worked

Cross-sectional comparison of BIS-10 impulsivity scores between 385 euthymic bipolar patients and 185 healthy controls. Associations between impulsivity and clinical features (suicide attempts, substance misuse, rapid cycling, mixed episodes) were examined.

What this study cannot tell us

Cross-sectional design cannot establish whether impulsivity drives substance misuse or vice versa. Only one measure of impulsivity was used (BIS-10). Patients were euthymic at assessment, so impulsivity levels during mood episodes may differ. No cognitive assessment of impulsivity was performed.

How to read the evidence

Well-powered cross-sectional study with appropriate controls; moderate evidence for impulsivity-substance use link.

When this study was published

Published in 2013. The relationship between bipolar disorder, impulsivity, and substance use continues to be studied.

The bigger picture

This study positions impulsivity as a dimensional feature of bipolar disorder that predicts specific clinical outcomes. Rather than being a random trait, impulsivity appears to channel toward substance misuse and more chaotic illness patterns, making it a potential target for intervention.

Questions still open

Would treating impulsivity directly reduce substance misuse in bipolar patients? Is the cannabis-impulsivity association bidirectional? Could impulsivity measures predict which bipolar patients will develop substance use problems?

Common questions

Why do people with bipolar disorder use more cannabis?

This study suggests impulsivity may be a key driver. Bipolar patients with higher trait impulsivity were more likely to misuse cannabis, and this association was the strongest of all the clinical features examined. Impulsive individuals may be more likely to use substances without considering consequences.

Does impulsivity cause suicide in bipolar disorder?

Surprisingly, this study found no association between impulsivity scores and suicide attempt history, including number of attempts, age at first attempt, or violence of attempt. This challenges the common assumption that impulsivity directly drives suicidal behavior in bipolar disorder and suggests other factors are more important for suicide risk.

Read the original research

Clinical features associated with trait-impulsiveness in euthymic bipolar disorder patients.

Journal of affective disorders, 144(3), 240-7

View on PubMed ↗Publisher’s paper ↗

Citation

Etain, B; Mathieu, F; Liquet, S; Raust, A; Cochet, B; Richard, J R; Gard, S; Zanouy, L; Kahn, J P; Cohen, R F; Bougerol, T; Henry, C; Leboyer, M; Bellivier, F. (2013). Clinical features associated with trait-impulsiveness in euthymic bipolar disorder patients.. Journal of affective disorders, 144(3), 240-7. https://doi.org/10.1016/j.jad.2012.07.005