Title : Substance use disorder in the context of bipolar disorder: The need for a dual-diagnosis framework
Abstract:
Bipolar disorder affects an estimated 37 million people globally, representing approximately 0.5% of the world’s population. While diagnosis rates are higher in regions such as North America, South America, and Oceania than other parts of the world, this is likely due to diagnostic, cultural, and environmental factors with the true global prevalence likely being underdiagnosed and underreported. It is estimated that bipolar disorder is initially misdiagnosed as often as 70% of the time due to the shared symptoms with other mental health conditions such as major depressive disorder, attention-deficit/hyperactivity disorder, schizophrenia, and borderline personality disorder. Complicating this further, as many as 60% or more of those diagnosed with bipolar disorder will experience a substance use disorder (SUD) at some point in their lives, with approximately 25% experiencing SUD at any given time. Concurrent SUD in these individuals can be a product of manic behavior, an attempt to self-medicate, and/or shared neurobiology between bipolar disorder and SUD, significantly increasing the risk for mortality. The notable overlap between bipolar disorder and SUD highlights the need for an integrated approach to diagnosis and treatment. Clinicians must consistently assess for bipolar disorder in individuals presenting with substance use issues—and vice versa—to ensure accurate diagnosis and effective care. A dual-diagnosis and treatment framework is essential to improve outcomes and reduce the morbidity and mortality of both conditions.
