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Comorbid SUDs can worsen the clinical presentation of BD, contributing to more severe mood episodes, rapid cycling, and poorer recovery outcomes. However, the unique impacts of different SUDs on the BD clinical profile are less studied, potentially obscuring substance\u2010specific effects on the course of illness and prognosis in BD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic review of the literature (PubMed, PsycINFO) and identified\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200948 clinical studies exploring the clinical effects of specific SUDs on BD symptomatology, course of illness, and treatment outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our findings revealed that cannabis use disorder (CUD) and alcohol use disorder (AUD) are the most studied SUDs in BD. Concurrent CUD is frequently associated with increased manic episodes, rapid cycling, psychosis, and earlier BD onset, with mixed findings for depressive episodes, suicidality, and treatment outcomes. AUD is frequently linked with worse depression outcomes and increased suicidality, with mixed findings for manic symptoms, rapid cycling, age of onset, psychosis, and treatment outcomes. Other SUDs, including cocaine, tobacco, opioids, and methamphetamine, were underexplored but were linked to increased suicidality, hospitalizations, and medication nonadherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Specific clinical profiles were associated with different SUDs, which underscores the need for more research to improve our understanding and treatment of comorbid BD\u2010SUDs. Further research exploring non\u2010alcohol and non\u2010cannabis SUDs and utilizing more rigorous methodological designs is needed to clearly elucidate these associations and advance substance\u2010specific interventions in BD patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bdi.70132","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T06:10:25Z","timestamp":1781331025000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Phenomenology of Bipolar Disorder With Substance Use Disorders: A Systematic Review"],"prefix":"10.1111","volume":"28","author":[{"given":"Shivahn","family":"Garvie","sequence":"first","affiliation":[{"name":"Addictions Division Centre for Addiction and Mental Health (CAMH)  Toronto Ontario Canada"},{"name":"Institute of Medical Sciences, Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Department of Psychiatry, Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4695-9586","authenticated-orcid":false,"given":"Maryam","family":"Sorkhou","sequence":"additional","affiliation":[{"name":"Addictions Division Centre for Addiction and Mental Health (CAMH)  Toronto Ontario Canada"},{"name":"Institute of Medical Sciences, Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Department of Psychiatry, Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1645-9767","authenticated-orcid":false,"given":"Tony P.","family":"George","sequence":"additional","affiliation":[{"name":"Addictions Division Centre for Addiction and Mental Health (CAMH)  Toronto Ontario Canada"},{"name":"Institute of Medical Sciences, Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Department of Psychiatry, Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)00241\u2010X"},{"key":"e_1_2_6_3_1","volume-title":"StatPearls","author":"Jain A.","year":"2024"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2010.101"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12794"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1990.03450190043026"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2017.1292279"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.07.011"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20105618.2004.00110.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.09.062"},{"issue":"11","key":"e_1_2_6_11_1","first-page":"8","article-title":"Illness Course, Comorbidity, Gender, and Suicidality in Patients With Bipolar Disorder","volume":"67","author":"Baldassano C. 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