Half of Adolescents With Bipolar Disorder and Cannabis Use Were Also Heavy Smokers
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- 70% of adolescents with bipolar + cannabis disorders met criteria for nicotine dependence
- Evidence Grade:
- Well-characterized clinical sample with appropriate assessments; moderate evidence for co-occurrence patterns.
- Study Age:
- Published in 2013. The intersection of adolescent bipolar disorder and substance use continues to be studied.
- Original Title:
- Prevalence and correlates of heavy smoking and nicotine dependence in adolescents with bipolar and cannabis use disorders.
- Published In:
- Psychiatry research, 210(3), 857-62 (2013)
- Authors:
- Heffner, Jaimee L(2), Anthenelli, Robert M(2), Adler, Caleb M(2), Strakowski, Stephen M, Beavers, Jennifer, DelBello, Melissa P
- Database ID:
- RTHC-00686
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked 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 More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-00686APA
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
MLA
Heffner, Jaimee L, et al. "Prevalence and correlates of heavy smoking and nicotine dependence in adolescents with bipolar and cannabis use disorders.." Psychiatry research, 2013. https://doi.org/10.1016/j.psychres.2013.04.010
RethinkTHC
RethinkTHC Research Database. "Prevalence and correlates of heavy smoking and nicotine depe..." RTHC-00686. Retrieved from https://rethinkthc.com/research/heffner-2013-prevalence-and-correlates-of
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.