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Heroin Addiction and Related Clinical Problems: 2016, 18, N4 (pages: 23 - 32)

Possible Trajectories of Addictions: The Role of Bipolar Spectrum

Maremmani A.G.I., Pacini M., Pani P.P., Ceccanti M., Bacciardi S., Akiskal H.S., and Maremmani I.

Summary: Background: Real-world practice forces us to deal with polydrug use disorders and addiction trajectories that show considerable heterogeneity. Several studies indicate a specific relationship between bipolar disorder and cocaine use disorder (CUD), whether in heroin use disorder (HUD) or in alcohol use disorder patients (AUD). Aims: This topic required further investigation among former heroin, now alcohol use disorder (FHUD-AUD) patients. Methods: The selection of 60 FHUD-AUD out of 448 consecutive AUD patients, made it possible to design a comparative cohort study to differentiate prevalence, and clinical characteristics (diagnosis, addiction and treatment history), between FHUD-AUD patients with and without CUD. Results: The prevalence of FHUD-AUD-CUD in sample over the study period of 3 years was 45/60 (75%). FHUD-AUD patients with CUD were more frequently diagnosed as bipolar spectrum patients and showed higher concomitant use of benzodiazepines and cannabis than peers. These cases were more frequent and they reached a higher maximum level of alcohol consumption than FHUD-AUD patients without CUD. The most important predictors of concomitant cocaine use disorder were the presence of comorbid cannabinoid use disorder and of bipolar spectrum. No differences were found in severity of heroin addiction history or treatment history when comprising the kind of Agonist Opioid Treatment (AOT). Conclusions: FHUD-AUD patients showing comorbid cannabinoid use disorder and presence of bipolar spectrum are those who have the highest risk of developing comorbid CUD too. Using previous inadequate AOT as a possible discriminating factor fails to differentiate between FHUD-AUD patients with and without CUD, so emphasizing the crucial role of a proper diagnosis of mood disorder (especially if belonging to the bipolar spectrum).