Thursday, June 14, 2012

Bipolar Smokers: Implication of Nicotine Additiction and Other Substance Use Disorders

Bipolar Disorder and Addiction
Last month (5/2012) a scientific article appeared in the Psychiatric Annals titled "Implications and Strategies for Clinical Management of Co-occurring Substance Use in Bipolar Disorder." It is not actually a new study, but a new article that examines what is currently known on the topic by looking at data from numerous studies. My last post, "Dual Diagnosis of Bipolar & Substance Use Disorder: Summary of New Scientific Article" summarized the general findings of this study.

Bipolar Disorder and Substance Use Disorders
Bipolar patients have an unusually high incidence of Substance Use Disorders (SUD), including nicotine addiction. When bipolar disorder and an SUD occur together, it is considered a dual-diagnosis condition, and described as co-morbidity. Previous studies have shown that 50-60% of bipolar patients will develop at least one SUD in their lifetime. 

Bipolar Disorder, SUDs & Cigarette Smoking 
Cigarette smoking (nicotine addiction) is also considered a Substance Use Disorder. The medical co-morbidities commonly associated with smoking, such as cardiovascular disease and metabolic syndrome (pre-diabetes), occur at higher rates in patients with bipolar disorder and, as would be expected, at even higher rates in bipolar patients with SUDs, particularly nicotine dependence. Smokers with bipolar disorder also have particularly low quit rates.

In addition to the overall impact that smoking has on health, cigarette smoking can reduce plasma levels of many medications used to manage bipolar disorder, making the disorder even more difficult for smokers to control.

The article also noted that even though smoking cessation could dramatically improve patients physical and mental health, few psychiatrists discuss this topic with their bipolar patients, and when the topic of nicotine addition is broached, smoking cessation medications are rarely prescribed. But I do wonder how many patients don't tell their doctor that they smoke.

My History of Smoking
I have smoked cigarettes, on and off, since adolescence. I have a lot of addiction vices, including alcohol as well.  Lately I have spent more days smoke-free than I have in the past, and currently I am not smoking, but am chewing nicotine gum to curb my cravings. The gum works very well to manage my nicotine addiction.

I am not sure, from this study, if nicotine alone lowers plasma levels of bipolar medications, or if smoking (and the additional chemicals it introduces) is the culprit. I will try to get hold of studies that specifically deal with cigarette smoking and bipolar disorder and see if there is data on this.

If you are a bipolar smoker, don't quit quitting. Discuss smoking with your psychiatrist, and see if he/she will recommend some smoking cessation tactics. If your therapist isn't helpful, consider trying nicotine gum, patches or look into the following free programs:


Bipolar Stats:

  • Level of Mania (on scale of 1 - 10, with 1=none, 10=practically levitating): 0
  • Level of Depression (on a scale of 1 - 10, with 1=none, 10=can't get out of bed): 3
  • Medication Compliance (0 = not taking, 5=taking some, 10=taking all): 5 (was not compliant with Wellbutrin yesterday)
I am recording my mania and depression bipolar data separately because I often have mixed episodes where manic and depressive symptoms occur at the same time.

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional, not a computer. 


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