Among 80 adolescents hospitalized for first-episode bipolar disorder, cigarette smoking was associated with developing new-onset cannabis and alcohol use disorders in the following year.
Read this if you have bipolar disorder and smoke cigarettes and are worried about quitting.
Quitting smoking did not worsen bipolar symptoms
What the researchers found
Researchers followed 161 adolescents and adults with bipolar I disorder after their first hospitalization for a manic or mixed episode, for up to 8 years. In the first 12 months, bipolar symptom course did not differ by smoking status in either age group.
However, among adolescents, cigarette smoking was significantly associated with developing new-onset cannabis or alcohol use disorders in the year following hospitalization. These were almost entirely new disorders, not preexisting conditions.
Importantly, neither adolescents nor adults who were abstinent from smoking for at least two months experienced significant increases in depressive or manic symptoms. This countered the concern that quitting smoking would worsen bipolar disorder.
Why it matters
Clinicians often hesitate to address smoking in bipolar patients due to fear of mood worsening. This study showed smoking cessation did not worsen bipolar symptoms, while continuing to smoke predicted new substance use disorders in vulnerable teens.
The numbers in context
80 adolescents, 81 adults. Median follow-up: 122 weeks. Smoking predicted new-onset cannabis and alcohol disorders in adolescents. 2+ months of smoking abstinence did not increase depressive or manic symptoms.
How the study worked
Naturalistic, observational prospective study. 161 participants (80 adolescents, 81 adults) with bipolar I disorder followed after first hospitalization. Median follow-up: 122 weeks. Smoking status, substance use disorders, and mood symptoms assessed over time.
What this study cannot tell us
Observational study cannot prove smoking caused the new substance disorders. Confounding factors (impulsivity, sensation-seeking) may explain both smoking and substance use development. Relatively small sample sizes for subgroup analyses.
How to read the evidence
Prospective observational study with up to 8 years of follow-up. Good temporal data but observational design limits causal conclusions.
When this study was published
Published in 2012. The safety of smoking cessation in bipolar disorder has been further supported by subsequent studies.
The bigger picture
This study supported the emerging view that smoking cessation should be addressed in bipolar disorder, not avoided. The finding that smoking predicted new substance use disorders in teens suggested cigarettes may serve as a gateway in this high-risk population.
Questions still open
- Would smoking cessation intervention in bipolar teens reduce the risk of developing other substance disorders? Is nicotine itself driving the association, or is smoking a marker for broader risk-taking? Should smoking cessation be integrated into first-episode bipolar treatment?
Common questions
Will quitting smoking make my bipolar disorder worse?
Why does smoking predict cannabis and alcohol problems in teens with bipolar?
Read the original research
Cigarette smoking and its relationship to mood disorder symptoms and co-occurring alcohol and cannabis use disorders following first hospitalization for bipolar disorder.
Bipolar disorders, 14(1), 99-108
Citation
Heffner, Jaimee L; DelBello, Melissa P; Anthenelli, Robert M; Fleck, David E; Adler, Caleb M; Strakowski, Stephen M. (2012). Cigarette smoking and its relationship to mood disorder symptoms and co-occurring alcohol and cannabis use disorders following first hospitalization for bipolar disorder.. Bipolar disorders, 14(1), 99-108. https://doi.org/10.1111/j.1399-5618.2012.00985.x
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