Smoking cigarettes predicted new cannabis and alcohol disorders in teens with bipolar disorder
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- Quitting smoking did not worsen bipolar symptoms
- Evidence Grade:
- Prospective observational study with up to 8 years of follow-up. Good temporal data but observational design limits causal conclusions.
- Study Age:
- Published in 2012. The safety of smoking cessation in bipolar disorder has been further supported by subsequent studies.
- Original Title:
- Cigarette smoking and its relationship to mood disorder symptoms and co-occurring alcohol and cannabis use disorders following first hospitalization for bipolar disorder.
- Published In:
- Bipolar disorders, 14(1), 99-108 (2012)
- Authors:
- Heffner, Jaimee L(2), DelBello, Melissa P(2), Anthenelli, Robert M(2), Fleck, David E, Adler, Caleb M, Strakowski, Stephen M
- Database ID:
- RTHC-00570
Evidence Hierarchy
Enrolls participants and follows them forward in time.
What do these levels mean? →Frequently Asked Questions
Will quitting smoking make my bipolar disorder worse?
This study found no evidence that quitting smoking worsened depressive or manic symptoms. Participants who were smoke-free for at least 2 months showed stable mood. The fear that smoking cessation triggers mood episodes was not supported.
Why does smoking predict cannabis and alcohol problems in teens with bipolar?
The study could not prove causation, but the association was significant. Possible explanations include shared genetic vulnerability to addiction, nicotine priming of reward circuits, or smoking serving as a behavioral gateway to other substance use.
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Cite This Study
https://rethinkthc.com/research/RTHC-00570APA
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
MLA
Heffner, Jaimee L, et al. "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, 2012. https://doi.org/10.1111/j.1399-5618.2012.00985.x
RethinkTHC
RethinkTHC Research Database. "Cigarette smoking and its relationship to mood disorder symp..." RTHC-00570. Retrieved from https://rethinkthc.com/research/heffner-2012-cigarette-smoking-and-its
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.