{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:40:47Z","timestamp":1792111247804,"version":"4.4.0"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute on Alcohol Abuse and Alcoholism","award":["U10AA008401"],"award-info":[{"award-number":["U10AA008401"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Objective: The comorbidity of alcohol and substance use disorders among persons with bipolar disorder is elevated, as indicated by epidemiological and clinical studies. Following alcohol use, cannabis is the most frequently used and abused illicit substance among bipolar individuals, and such use may lead to comorbid cannabis use disorders (CUD). Previous research indicated that CUDs were related to a more severe course of bipolar disorder and higher rates of other comorbid alcohol and substance use disorders. Few studies, however, have conducted longitudinal research on this comorbidity. The aim of this study is to investigate the influence of CUD on the course of bipolar I and II individuals during a 5-year follow-up. Methods: The characteristics of bipolar disorder, cannabis use disorders, and other alcohol and substance use disorders, as well as comorbid mental disorders, were assessed using a standardized semi-structured interview (SSAGA) at both baseline and the 5-year follow-up. N = 180 bipolar I and II patients were subdivided into groups of with and without comorbid cannabis use disorders (CUD). Results: Of the 77 bipolar I and 103 bipolar II patients, n = 65 (36.1%) had a comorbid diagnosis of any CUD (DSM-IV cannabis abuse or dependence). Comorbid bipolar patients with CUD had higher rates of other substance use disorders and posttraumatic stress disorders, more affective symptoms, and less psychosocial functioning at baseline and at 5-year follow-up. In contrast to previously reported findings, higher rates of anxiety disorders and bipolar disorder complications (e.g., mixed episodes, rapid cycling, and manic or hypomanic episodes) were not found. The effect of CUD on other substance use disorders was confirmed using moderation analyses. Conclusions: A 5-year prospective evaluation of bipolar patients with and without CUD confirmed previous investigations, suggesting that the risk of other substance use disorders is significantly increased in comorbid individuals. CUD has a moderation effect, while no effect was found for other mental disorders. Findings from this study and previous research may be due to the examination of different phenotypes (Cannabis use vs. CUD) and sample variation (family study vs. clinical and epidemiological populations).<\/jats:p>","DOI":"10.3390\/brainsci13081130","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T01:51:47Z","timestamp":1690509107000},"page":"1130","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Prospective Comparison of Bipolar I and II Subjects with and without Comorbid Cannabis Use Disorders from the COGA Dataset"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6588-1342","authenticated-orcid":false,"given":"Ulrich W.","family":"Preuss","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, RKH Hospital Ludwigsburg, 71640 Ludwigsburg, Germany"},{"name":"Department of Psychiatry, Psychotherapy and Psychosomatics, Martin Luther-University Halle-Wittenberg, 06112 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michie N.","family":"Hesselbrock","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor M.","family":"Hesselbrock","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.jad.2006.08.018","article-title":"Validity of the assessment of bipolar spectrum disorders in the WHO CIDI 3.0","volume":"96","author":"Kessler","year":"2006","journal-title":"J. Affect. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1192\/bjp.bp.114.154286","article-title":"Gambling problems in bipolar disorder in the UK: Prevalence and distribution","volume":"207","author":"Jones","year":"2015","journal-title":"Br. J. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jad.2016.06.051","article-title":"Comorbidity of bipolar and substance use disorders in national surveys of general populations, 1990\u20132015: Systematic review and meta-analysis","volume":"206","author":"Hunt","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.jad.2016.07.011","article-title":"Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990\u20132015: Systematic review and meta-analysis","volume":"206","author":"Hunt","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_5","unstructured":"United Nations Office on Drugs Crime (2023, May 12). World Drug Report. Available online: https:\/\/www.unodc.org\/unodc\/en\/data-and-analysis\/world-drug-report-2022.html."},{"key":"ref_6","unstructured":"(2023, May 12). Delphin-Rittmon ME 2022 The National Survey on Drug Use and Health, Available online: https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/reports\/slides-2020-nsduh\/2020NSDUHNationalSlides072522.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100227","DOI":"10.1016\/j.lanepe.2021.100227","article-title":"Public health monitoring of cannabis use in Europe: Prevalence of use, cannabis potency, and treatment rates","volume":"10","author":"Manthey","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1177\/07067437221099769","article-title":"Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: A Systematic Review and Recommendations of Cannabis use in Bipolar Disorder and Major Depressive Disorder","volume":"68","author":"Tourjman","year":"2022","journal-title":"Can. J. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1001\/archpsyc.64.1.57","article-title":"Effects of co-occurring cannabis use disorders on the course of bipolar disorder after a first hospitalization for mania","volume":"64","author":"Strakowski","year":"2007","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.psychres.2012.12.014","article-title":"Bipolar disorder and co-occurring cannabis use disorders: Characteristics, co-morbidities and clinical correlates","volume":"209","author":"McKenzie","year":"2013","journal-title":"Psychiatry Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.comppsych.2017.09.004","article-title":"Patterns of cannabis use and clinical correlates among individuals with Major Depressive Disorder and Bipolar Disorder","volume":"80","author":"Taub","year":"2018","journal-title":"Compr. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"247","DOI":"10.4088\/JCP.v67n0211","article-title":"Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: Results from the national epidemiologic survey on alcohol and related conditions","volume":"67","author":"Conway","year":"2006","journal-title":"J. Clin. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.addbeh.2017.07.012","article-title":"DSM-5 cannabis use disorder in the National Epidemiologic Survey on Alcohol and Related Conditions-III: Gender-specific profiles","volume":"76","author":"Kerridge","year":"2018","journal-title":"Addict. Behav."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1177\/0004867412460591","article-title":"Prevalence, correlates and comorbidity of DSM-IV cannabis use and cannabis use disorders in Australia","volume":"46","author":"Teesson","year":"2012","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.drugalcdep.2013.10.003","article-title":"Psychiatric, psychosocial, and physical health correlates of co-occurring cannabis use disorders and nicotine dependence","volume":"134","author":"Peters","year":"2014","journal-title":"Drug Alcohol Depend."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"522228","DOI":"10.3389\/fpsyt.2020.522228","article-title":"A Prospective Comparison of Bipolar I and II Subjects With and Without Comorbid Alcohol Dependence From the COGA Dataset","volume":"11","author":"Preuss","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1080\/00952990.2017.1292279","article-title":"Management of comorbid bipolar disorder and substance use disorders","volume":"43","author":"Salloum","year":"2017","journal-title":"Am. J. Drug Alcohol Abus."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1111\/j.1399-5618.2007.00575.x","article-title":"Sequencing of substance use and affective morbidity in 166 first-episode bipolar I disorder patients","volume":"10","author":"Baethge","year":"2008","journal-title":"Bipolar Disord."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Patel, R.S., Manikkara, G., and Chopra, A. (2019). Bipolar Disorder and Comorbid Borderline Personality Disorder: Patient Characteristics and Outcomes in US Hospitals. Medicina, 55.","DOI":"10.3390\/medicina55010013"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1080\/10826084.2021.2012690","article-title":"Cannabis Use is an Independent Risk Factor for Manic Episode: A Report from 380,265 Bipolar Inpatients","volume":"57","author":"Patel","year":"2022","journal-title":"Subst. Use Misuse"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/NMD.0b013e31819292a6","article-title":"Does cannabis use affect treatment outcome in bipolar disorder? A longitudinal analysis","volume":"197","author":"Boomsma","year":"2009","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.psychres.2010.07.007","article-title":"Cannabis involvement in individuals with bipolar disorder","volume":"185","author":"Agrawal","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.comppsych.2015.10.003","article-title":"Demographic and clinical characteristics associated with comorbid cannabis use disorders (CUDs) in hospitalized patients with bipolar I disorder","volume":"65","author":"Weinstock","year":"2016","journal-title":"Compr. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/S0006-3223(00)00900-8","article-title":"The impact of substance abuse on the course of bipolar disorder","volume":"48","author":"Strakowski","year":"2000","journal-title":"Biol. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1080\/10550490500528423","article-title":"Validity of the distinction between primary and secondary substance use disorder in patients with bipolar disorder: Data from the first 1000 STEP-BD participants","volume":"15","author":"Fossey","year":"2006","journal-title":"Am. J. Addict."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/BF00789056","article-title":"An economic evaluation of manic-depressive illness\u20141991","volume":"30","author":"Wyatt","year":"1995","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"483","DOI":"10.2165\/00019053-200119050-00004","article-title":"The lifetime cost of bipolar disorder in the US: An. estimate for new cases in 1998","volume":"19","author":"Begley","year":"2001","journal-title":"Pharmacoeconomics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1002\/da.22248","article-title":"Co-occurrence of anxiety and bipolar disorders: Clinical and therapeutic overview","volume":"31","author":"Baldessarini","year":"2014","journal-title":"Depress. Anxiety"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Patel, R.S., Virani, S., Saeed, H., Nimmagadda, S., Talukdar, J., and Youssef, N.A. (2018). Gender Differences and Comorbidities in U.S. Adults with Bipolar Disorder. Brain Sci., 8.","DOI":"10.3390\/brainsci8090168"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.jad.2014.10.006","article-title":"The association between cannabis use and mood disorders: A longitudinal study","volume":"172","author":"Feingold","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/add.12153","article-title":"Characterizing the longitudinal patterns of substance use among individuals diagnosed with serious mental illness after psychiatric hospitalization","volume":"108","author":"Bahorik","year":"2013","journal-title":"Addiction"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1001\/jamapsychiatry.2015.3229","article-title":"Cannabis use and risk of psychiatric disorders: Prospective evidence from an US national longitudinal study","volume":"73","author":"Blanco","year":"2016","journal-title":"JAMA Psychiatry"},{"key":"ref_33","unstructured":"APA American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [4th ed.]."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1046\/j.1360-0443.1999.94913618.x","article-title":"A validity study of the SSAGA\u2014A comparison with the SCAN","volume":"94","author":"Hesselbrock","year":"1994","journal-title":"Addiction"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1001\/archpsyc.62.7.753","article-title":"Long-term stability of alcohol and other substance dependence diagnoses and habitual smoking: An evaluation after 5 years","volume":"62","author":"Culverhouse","year":"2005","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.psyneuen.2014.11.002","article-title":"The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study","volume":"51","author":"Jetly","year":"2015","journal-title":"Psychoneuroendocrinology"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hasbi, A., Madras, B.K., and George, S.R. (2023). Endocannabinoid System and Exogenous Cannabinoids in Depression and Anxiety: A Review. Brain Sci., 13.","DOI":"10.3390\/brainsci13020325"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s00406-018-0970-7","article-title":"Cannabis and mental illness: A review","volume":"269","author":"Lowe","year":"2019","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1001\/jama.2009.369","article-title":"Impairments in endocannabinoid signaling and depressive illness","volume":"301","author":"Hill","year":"2009","journal-title":"JAMA"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/S2215-0366(23)00143-8","article-title":"The relationship between cannabis use, schizophrenia, and bipolar disorder: A genetically informed study","volume":"10","author":"Cheng","year":"2023","journal-title":"Lancet Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1038\/s41386-021-01209-w","article-title":"The addiction risk factor: A unitary genetic vulnerability characterizes substance use disorders and their associations with common correlates","volume":"47","author":"Hatoum","year":"2022","journal-title":"Neuropsychopharmacology"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Preuss, U.W., and Moggi, F. (2023). Affektive St\u00f6rungen und Sucht, Kohlhammer.","DOI":"10.17433\/978-3-17-040685-8"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"465","DOI":"10.4088\/JCP.v59n0905","article-title":"Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization","volume":"59","author":"Strakowski","year":"1998","journal-title":"J. Clin. Psychiatry"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1046\/j.1360-0443.2000.9545537.x","article-title":"A latent class analysis of antisocial personality disorder symptom data from a multi-centre family study of alcoholism","volume":"95","author":"Bucholz","year":"2000","journal-title":"Addiction"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/8\/1130\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:20:57Z","timestamp":1760127657000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/8\/1130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,27]]},"references-count":44,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["brainsci13081130"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13081130","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,27]]}}}