Bipolar disorder and substance abuse: Overcome the challenges of ‘dual diagnosis’ patients

Long recognized to be more prevalent in forensic populations, bipolar disorder (BD) is especially overrepresented among those with repeat arrests and incarcerations. In a recent study of >79,000 inmates incarcerated in Texas in 2006 and 2007, those with BD were 3.3 times more likely to have had ≥4 previous incarcerations.^k

Comorbid substance use disorder (SUD) is a significant risk factor for criminal arrest. For example, in a Los Angeles County (CA) sample of inmates with BD, 75.8% had co-occurring SUDs, compared with 18.5% in a comparison group of hospitalized BD patients.^l The association of SUDs with arrest is especially high in females with BD. In the Los Angeles sample mentioned above, incarcerated bipolar women were >38 times more likely to have a SUD than a comparison group of female patients treated in the community.^m

References

k. Baillargeon J, Binswanger IA, Penn JV, et al. Psychiatric disorders and repeat incarcerations: the revolving prison door. Am J Psychiatry. 2009;166:103-109.
l. Quanbeck CD, Stone DC, Scott CL, et al. Clinical and legal correlates of inmates with bipolar disorder at time of criminal arrest. J Clin Psychiatry. 2004;65:198-203.
m. McDermott BE, Quanbeck CD, Frye MA. Comorbid substance use disorder in women with bipolar disorder is associated with criminal arrest. Bipolar Disord. 2007;9(5):536-540.