Adolescent Substance Abuse: Psychiatric Comorbidity and High-Risk Behaviors by Adolescent Substance Abuse; Psychiatric Comorbidity & High-Risk Behaviors (2008)

Author:Adolescent Substance Abuse; Psychiatric Comorbidity & High-Risk Behaviors (2008)
Language: eng
Format: epub
Tags: Behavioral Sciences
Publisher: Taylor and Francis
Published: 2011-06-23T04:00:00+00:00

RETROSPECTIVE FINDINGS FROM ADULTS

Several authors have examined whether specific characteristics of BP vary based on age of onset, as reported retrospectively by adults with BP. Although there are limitations to this approach, most notably the potential for recall bias, it is nonetheless a source of potentially important findings. Perlis and colleagues (2004) employed data from the first 1,000 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) to identify long-term implications of BP onset in childhood and adolescence. The prevalence of AUD was 47.3 percent among adults with BP onset prior to 13 years of age (child onset), 46.6 percent among those with BP onset between 13 and 18 years of age (adolescent onset), and 31.9 percent among those with BP onset after age 18 (adult onset). While the prevalence of AUD was not significantly different between participants with childhood- versus adolescent-onset BP, both of these groups had a significantly greater prevalence of AUD as compared to the adult-onset BP group. The findings were more striking when DUD was examined. The prevalence of DUD was 34.2 percent in the childhood-onset group, 33.4 percent in the adolescent-onset group, and 15.1 percent in the adult-onset group. Again, while the prevalence of DUD was not significantly different between participants with childhood- versus adolescent-onset BP, both of these groups had a greater prevalence of DUD as compared to the adult-onset BP group. Findings remained significant after controlling for current age and duration of illness.

These data from a clinically ascertained sample are corroborated by recent findings derived from a representative population sample. Participants from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who met criteria for BP-I (N = 1,411) were included (Goldstein & Levitt, 2006c). As with the STEP-BD study, participants were divided into three groups based on BP onset in childhood, adolescence, or adulthood (as determined by the previous age ranges). The prevalence of AUD was 59 percent in both childhood- and adolescent-onset participants, and 53 percent among adult-onset participants, which was not a statistically significant difference. In contrast, the prevalence of DUD in both the childhood-onset group (42 percent) and the adolescent-onset group (47 percent) was significantly higher than in the adult-onset group (31 percent). These findings remained significant after controlling for duration of illness (current age was not significantly different between groups, and was not included as a covariate).

The findings from these two studies contradict somewhat the findings from studies of clinically ascertained youth with BP that show a markedly greater prevalence of SUD among youth with adolescent-onset as compared to child-onset BP (Wilens et al., 1999, 2004). One possible explanation for this apparent discrepancy is that, over a lifespan, individuals with childhood-onset BP eventually “catch up” with their adolescent-onset BP counterparts with respect to SUD. As discussed previously, another possible explanation is that youth with childhood-onset BP who are enrolled in clinical studies receive high-quality psychiatric treatment that is protective against SUD onset, whereas many of the adults in the STEP-BD experienced prolonged latency of treatment

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