Table 1.

Summary of the detrimental impact of comorbid drug abuse on BD.

diagnostic problems	worse compliance/adherence
earlier onset of illness	worse response/outcome
no treatment or treatment delay	more frequent relapses with manic and depressive episodes
increased psychosocial problems (job, debts...)	accelerated progression of BD
poorer social support	more negative and cognitive symptoms
increased severity of disease	increased risk for suicide attempts or suicide
somatic comorbidities (Hepatitis C, other liver diseases, Acquired Immune Deficiency Syndrome (AIDS), …)	increased risk of switching into manic, hypomanic, or mixed phases after depression
more rapid cycling	reduced response to lithium and other pharmacological treatments