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Cocaine Abuse in 448 Alcoholics: Evidence for a Bipolar Connection

Pacini, Matteo MD*,†; Maremmani, Icro MD*,‡; Vitali, Mario MD; Romeo, Marina MD; Santini, Patrizia MD; Vermeil, Valeria MD; Ceccanti, Mauro MD

Addictive Disorders & Their Treatment: December 2010 - Volume 9 - Issue 4 - p 164–171
doi: 10.1097/ADT.0b013e3181f954f2
Original Articles

Background Several studies indicate a specific relationship between bipolar disorder and stimulant use and abuse. It has generally been assumed that cocaine use represents self-enhancement or attempts to optimize one's level of hypomania, cyclothymia, or hyperthymia. This topic required further examination among alcoholics because cocaine abuse is commonly comorbid with alcoholism.

Methods Cocaine abuse by bipolar participants was investigated in a group of 448 consecutive treatment-seeking alcoholics. We collected data with (1) the Drug Addiction History Rating Scale; and (2) the semistructured interview for depression that inquires systematically among others, about hypomania, cyclothymia, hyperthymia, and depressive temperament. Participants were aged 44±9 years, and were predominantly male (75.4%).

Results Univariate and multivariate analyses provided correlations in favor of a link between current cocaine abuse and bipolar spectrum (P<0.01).

Limitation The modality of access to cocaine in different communities and the difficulty to distinguish cocaine use from abuse and dependence may have limited the interpretation of results. Blindness to the chronologic sequence of alcohol and cocaine use is also a major limitation.

Conclusions It can be hypothesized that cocaine use is an attempt to maintain a baseline level of mood elation similar to a hyperthymic temperament or hypomanic state. Alcohol use, especially in youngsters, may be an instrument to cope with chronic dysphoria corresponding to an affective temperament. The attempt to induce and maintain hypomania by cocaine use would lead to full-blown bipolar disorders. In this context, alcohol use may favor the engagement into cocaine use by cyclothymics owing to its sedating effect, but would eventually become a further prodysphoric factor.

*Institute of Behavioural Sciences “G. De Lisio”

Vincent P. Dole Dual Diagnosis Group, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa, Pisa

Center for the Assessment and Treatment of Alcohol-Related Pathology, “Umberto I” University Hospital, “La Sapienza” University, Rome, Italy

Reprints: Icro Maremmani, MD, Vincent P. Dole, Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, University of Pisa, Via Roma, 67 56100 Pisa, Italy, EU (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.