1. Poor Bipolar Outcome The Effect of Substance Abuse On Bipolar Disorder Phillip Long M.D.

2. What Are The Most Common Disabilities? In developed countries, the ten leading causes of lost years of healthy life at ages 15-44 are: 1. Major Depressive Disorder 2. Alcohol Use 3. Road Traffic Accidents 4. Schizophrenia 5. Self-Inflicted Injuries 6. Bipolar Disorder 7. Drug Use 8. Obsessive-Compulsive Disorder 9. Osteoarthritis 10. Violence "The Global Burden Of Disease" by C.J.L. Murray and A.D. Lopez, World Health Organization, 1996, Table 5.4 page 270

3. The Most Common Disabilities Are Mental Disorders Notice that 8 of these 10 leading causes of disability are mental disorders: 1. Major Depressive Disorder 2. Alcohol Use 3. Road Traffic Accidents 4. Schizophrenia 5. Self-Inflicted Injuries 6. Bipolar Disorder 7. Drug Use 8. Obsessive-Compulsive Disorder 9. Osteoarthritis 10. Violence "The Global Burden Of Disease" by C.J.L. Murray and A.D. Lopez, World Health Organization, 1996, Table 5.4 page 270

4. Bipolar Disorder The 6th leading cause of disability (ages 15-44) is Bipolar Disorder, which presents with symptoms identical to cocaine intoxication: Inflated self-esteem or grandiosity Decreased need for sleep Being more talkative than usual Flight of ideas or racing thoughts Distractibility Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences

5. Drug Addiction The 7th leading cause of disability (ages 15-44) is Drug Addiction. Alcohol or drug problems and noncompliance with medication were the most important factors related to frequency of hospitalization. Am J Psychiatry. 1995 Jun;152(6):856-61. Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Haywood TW et al Fifty percent of schizophrenic patients and 25% of bipolar patients abused one or more drugs. Am J Drug Alcohol Abuse. 1989;15(3):291-5. Drug abuse in schizophrenia and bipolar disorder. Miller FT et al

6. Poor Bipolar Outcome With Substance Abuse I compared the outcome of all of the Bipolar I Disorder outpatients I treated from October 2004 to the present. Two patients with dementia were excluded. 47 patients were studied; 12 had substance abuse and 35 didn’t. 94.3% of non-substance abusers had a good outcome (asymptomatic, back to work, adequate social life). 8.3% of substance abusers had a good outcome.

7. “Clean + Dry” Bipolar Sibling

8. Substance Abusing Bipolar Sibling

9. Does Cannabis Trigger Schizophrenia? Swedish research found that cannabis users were 6.7 times more likely to be hospitalized for Schizophrenia than non-users. This study started with a 1969-70 survey of Swedish conscripts (>97% of the country's male population aged 18- 20). There was a 15 year follow-up study of the conscripts medical records. Cannabis use is associated with an increased risk of developing schizophrenia, consistent with a causal relation. This association is not explained by use of other psychoactive drugs or personality traits relating to social integration. BMJ. 2002 Nov 23;325(7374):1199. Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. Zammit S et al

10. Schizophrenia And Work Disability For patients with schizophrenia in Oslo, Norway: 94% were unemployed 47% were socially isolated Psychiatr Serv. 2000 Feb;51(2):223-8. Social functioning of patients with schizophrenia in high- income welfare societies. Melle I et al Current medical treatment for schizophrenia is literally life-saving and usually prevents psychiatric rehospitalization and the return of psychosis. Unfortunately, neurological impairments in concentration, memory, problem-solving, and motivation prevent the vast majority of individuals with schizophrenia from returning to the workforce.

11. Substance Abuse Worsens Prognosis It is essential that we appreciate how destructive substance abuse is in worsening Bipolar Disorder and Schizophrenia. My research showed that non- substance abusing Bipolar I Disorder patients can expect an excellent response to their medications. However, substance abusing Bipolar I Disorder patients can expect almost no benefit from their medications.