Half of Adolescents With Bipolar Disorder and Cannabis Use Were Also Heavy Smokers | Research

The takeaway

Among 80 adolescents with co-occurring bipolar disorder and cannabis use disorders, 49% who had ever tried a cigarette were heavy smokers and 70% met criteria for nicotine dependence, with heavy smoking linked to more severe psychiatric profiles.

Read this if you are an adolescent or parent dealing with bipolar disorder and co-occurring substance use.

70% of adolescents with bipolar + cannabis disorders met criteria for nicotine dependence

What the researchers found

Eighty adolescents (ages 13-22) with both bipolar I disorder and cannabis abuse or dependence were assessed for tobacco use. Among those who had ever tried a cigarette, 49% were heavy smokers (10+ cigarettes/day) and 70% met lifetime criteria for nicotine dependence.

Heavy smoking was associated with a more severe clinical profile: older age, heavier marijuana use with greater compulsive craving, lifetime diagnoses of ADHD and conduct disorder, illicit drug use disorders, and poorer overall functioning. Nicotine dependence was related to White race, higher current mania severity, and poorer functioning. Cannabis and tobacco use appeared deeply entangled in this population.

Why it matters

Adolescents with bipolar disorder and cannabis problems face a triple burden when tobacco is added. The finding that heavy smoking marks a more severe psychiatric profile suggests tobacco may be both a consequence of and contributor to psychiatric severity in this population.

The numbers in context

80 adolescents with bipolar I + cannabis disorder. 49% were heavy smokers (10+/day). 70% met lifetime nicotine dependence criteria. Heavy smoking associated with: heavier marijuana use, ADHD, conduct disorder, other drug disorders, poorer functioning.

How the study worked

Cross-sectional analysis of baseline data from a clinical trial involving 80 adolescents aged 13-22 with co-occurring bipolar I disorder and cannabis abuse or dependence. Diagnostic and symptom severity measures assessed. Heavy smoking defined as 10+ cigarettes/day.

What this study cannot tell us

Cross-sectional design cannot establish causal relationships. The sample was drawn from a clinical trial, representing treatment-seeking individuals who may be more severe than the general bipolar population. The 13-22 age range spans adolescence and early adulthood, which may differ clinically.

How to read the evidence

Well-characterized clinical sample with appropriate assessments; moderate evidence for co-occurrence patterns.

When this study was published

Published in 2013. The intersection of adolescent bipolar disorder and substance use continues to be studied.

The bigger picture

This study highlights the clustering of nicotine, cannabis, and psychiatric disorders in adolescents. Treatment programs for adolescent bipolar disorder need to address all three substance categories simultaneously, as each compounds the others.

Questions still open

Would treating tobacco dependence improve bipolar and cannabis outcomes? Does the cannabis-tobacco combination accelerate bipolar disorder severity? Are integrated treatment programs for all three conditions available and effective?

Common questions

Why do bipolar adolescents use so many substances?

This study found that 70% of adolescents with bipolar disorder and cannabis problems also had nicotine dependence. The combination likely reflects shared vulnerability factors (impulsivity, sensation seeking), self-medication of mood symptoms, and the tendency for substance use to cluster. Each substance may address different aspects of bipolar symptoms.

Does heavy smoking mean worse bipolar disorder?

In this study, heavy smoking was associated with more severe psychiatric profiles: more ADHD, more conduct disorder, heavier marijuana use, and poorer overall functioning. This does not necessarily mean smoking worsens bipolar disorder directly, but heavy smoking appears to be a marker that identifies adolescents with more complex and severe conditions.

Read the original research

Prevalence and correlates of heavy smoking and nicotine dependence in adolescents with bipolar and cannabis use disorders.

Psychiatry research, 210(3), 857-62

View on PubMed ↗Publisher’s paper ↗

Citation

Heffner, Jaimee L; Anthenelli, Robert M; Adler, Caleb M; Strakowski, Stephen M; Beavers, Jennifer; DelBello, Melissa P. (2013). Prevalence and correlates of heavy smoking and nicotine dependence in adolescents with bipolar and cannabis use disorders.. Psychiatry research, 210(3), 857-62. https://doi.org/10.1016/j.psychres.2013.04.010