Frequency of alcohol and drug use disorders in patients with bipolar disorder followed in a specialized mood disorders unit and investigation of their clinical characteristics

Objective: In a community based study (the Epidemiologic Catchment Area (ECA) Study), it was reported that the lifetime prevalence of alcohol use disorder (abuse or dependence) was 13.5% and drug use disorder (abuse or dependence) was 6.1%, in the USA. In bipolar patients the lifetime prevalence of alcohol use disorder was 44.7%, drug use disorder was 33.%, and any substance use disorder was 56.1%. The aim of this study was to identify the frequency of alcohol and drug use disorder (ADUD) in bipolar patients who are followed in a specialized mood disorders unit and to investigate the clinical characteristics of the sample.

Methods: Mood disorders and alcohol/drug use disorder modules of the Structured Clinical Interview for DSM-IV, Axis I Disorders (SCID-I) and Alcohol Use Disorders Identification Test (AUDIT), the Michigan Alcoholism Screening Test (MAST), Drug Use Disorders Identification Test (DUDIT) and Drug Abuse Screening Test (DAST-10) were applied to 292 bipolar patients in the euthymic state.

Results: In our sample ADUD was 6% (18/292). Among patients with ADUD, 15 of 18 were male and 3 were female. ADUD in males (12%) was higher than women (1.8%), and this difference was statistically significant (c2(1)=12.86, p<0.001). Alcohol use disorder rate was detected as 5% in general (15/292), 9% in men (12/125) and 1.7% in women (3/167), respectively. The rate of drug use disorder was found as 4% in general (12/292), 8% in men (10/125) and 1.1% in women (2/167).

Conclusions: The rate of bipolar patients with ADUD comorbidity followed up in our unit was found to be lower than those reported in the literature. In the 2012 report of Turkey Statistical Institute (TÜİK), which was published in 2012, the frequency of using alcoholic beverages in Turkey was reported to be 10.4% in general population, 17.2% in males and 3.8% in females. In the 2013 report of Turkey Review Center for Drugs and Drug Addiction (TUBIM), it was reported that in individuals between 15-64 years old, the rate of using any substance at least once in a life time (lifetime prevalence of substance use) was %2.7 in general population, %3.5 in men and %2.6 in women. Akkaya et al. reported that the rates of psychoactive substance abuse and alcohol dependence 3.2% and 4.9% respectively. In this study, the rate of psychoactive substance abuse was similar to our study. Discrepancy between the overall results of alcohol-drug use disorder in the literature and our study may ensue from well treatment compliance in our unit, inaccurate statements of patients, and low rates of alcohol-drug abuse among Turkish population compared with western society. We suggest that multi-centered studies which compare the rates of general psychiatry outpatient clinics and specialized mood disorder clinics would make an important contribution to the literature.