Brit Haver and Ketil J. Oedegaard
University of Bergen, Bergen, Norway
Suicidal Behavior in Alcohol and Drug Abuse and Dependence. Hauppauge, New York: Nova Science Publishers, 2010, 540 pages.

Bipolar disorders (BPD) are common, with a lifelong risk of episodes of mood swings, deteriorating interepisode functioning, lower quality of life, as well as increased mortality. Comorbidity between BPD and substance use disorders (SUD) is more frequent than for any other psychiatric disorder. Substance abuse may precede, precipitate or follow the first episode of mood disorder, leading to poorer treatment compliance, an overall worse outcome, and an even higher suicide risk. We hypothesize that a common underpinning may explain the frequent association between BPD and substance abuse, namely impulsivity and irritable, hyperthymic or cyclothymic temperaments. Substance abuse causes impaired cognitive functioning in the frontal-cortical areas, including the inhibition of impulsive responses, thereby setting up a negative spiraling effect during the course of time. Abstinence may on the other hand set up neurogenesis in the damaged areas of the brain, thereby regaining executive cognitive functions necessary for compliance with treatment. We believe that a significant part of the poor prognosis related to BPD – and specifically mortality related to suicide – can be explained by undetected SUD which accompany the disorder. Early detection and prevention of SUD among bipolar patients, systematic use of recommended treatment regimes, and long-term follow-up may help these patients obtain a significantly better prognosis and quality of life. Integrated treatment of the BPD and substance abuse may prevent new mood swings, improve patient compliance and reduce suicidal acts. Specific programs for this subgroup of bipolar patients need to be implemented in general psychiatry and mood clinics.