Correlates of alcohol use and alcohol use disorder among youth with bipolar disorder

BACKGROUND: Despite increased prevalence of alcohol use and alcohol use disorder (AUD) in youth with bipolar disorder (BD), little is known about the clinical correlates of this comorbidity. METHODS: Participants included 250 youth aged 13-20 years with BD (n = 135 with no alcohol use; n = 76 with alcohol use; and n = 39 with lifetime AUD). Multinomial logistic regression examined associations between demographic and clinical characteristics and alcohol use group (reference: no alcohol use), adjusting for age and sex. Binary logistic regression compared the alcohol use and AUD groups. RESULTS: Relative to youth with no alcohol use, those with alcohol use or AUD had higher rates of drug use disorder, smoking and impulsivity; these were also higher in youth with AUD versus alcohol use. Compared to no alcohol use, youth with alcohol use had higher current mania, whereas youth with AUD were older and had higher rates of oppositional defiant disorder (ODD), conduct disorder (CD), eating disorder, current and lifetime depression, emotional dysregulation and interpersonal problems. Compared to alcohol use, youth with AUD had higher rates of ODD and CD. CONCLUSION: In addition to the expected association of alcohol use and AUD with use of other substances, youth with BD and alcohol use or AUD had greater impulsivity. Furthermore, AUD was associated with increased rates of multiple internalizing and externalizing comorbidities. Adverse clinical correlates were significantly more common among youth with AUD vs. alcohol use. Pending findings from longitudinal research, these correlates provide potential prevention and treatment targets to mitigate adverse effects of alcohol.