Development of Alcohol and Drug Use in Youth With Manic Symptoms

Sarah Mc Cue Horwitz, Amy Storfer-Isser, Andrea Young, Eric A. Youngstrom, H. Gerry Taylor, Thomas W. Frazier, L. Eugene Arnold, Mary A. Fristad, Boris Birmaher, Robert L Findling

Research output: Contribution to journalArticle


Objective This analysis examined alcohol and drug use over a 6-year follow-up of children in the Longitudinal Assessment of Manic Symptoms (LAMS) study. Method LAMS screened 6- to 12.9-year-old children visiting 9 child outpatient mental health (MH) clinics, using the Parent General Behavior Inventory 10-item mania scale. All children with scores ≥12 and a matched group with scores ≤12 were invited to enroll. Children were assessed every 6 months. Assessments included demographics, family, MH history, child diagnoses, child stress, and alcohol and drug use. Univariate, bivariate, and interval censored survival analyses were conducted. Results Of those >9 years at baseline, 34.9% used alcohol at least once, with 11.9% regular users; 30.1% used drugs at least once, with 16.2% regular users. Predictors of any alcohol use were parental marital status, older age at study entry, a primary diagnosis of disruptive behavior disorders at baseline, and number of impactful child life events. Predictors of regular alcohol use included parental marital status, age, and sustained high mania symptoms over the first 24 months of follow-up. Predictors of any drug use were single parent, parental substance use, and stressful child life events. Predictors of regular drug use were parental marital status, stressful child life events, and a baseline disruptive behavior disorder diagnosis. Baseline medications decreased the risk of regular drug use. Conclusion Longitudinal data on youth with elevated manic symptoms suggest that comorbid disruptive behavior disorder, manic symptom burden, family environment, and stress are predictors of initiation and regular use of substances.

Original languageEnglish (US)
Pages (from-to)149-156
Number of pages8
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number2
StatePublished - Feb 1 2017


  • bipolar disorders
  • manic symptoms
  • substance use

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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  • Cite this

    Horwitz, S. M. C., Storfer-Isser, A., Young, A., Youngstrom, E. A., Taylor, H. G., Frazier, T. W., Arnold, L. E., Fristad, M. A., Birmaher, B., & Findling, R. L. (2017). Development of Alcohol and Drug Use in Youth With Manic Symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 56(2), 149-156.