Substance use diagnoses among patients who present to federally run mental health facilities with co-morbid ADHD and bipolar disorder between 2013-2023: a national analysis using random forest methods.

Abstract

Background/objectives: Although substance use disorder is common in patients with attention deficit hyperactivity disorder or bipolar disorder, limited recent data exist for those with these co-occurring conditions. Our study analyzes recent trends and predictors of these diagnoses.

Methods: We conducted a secondary analysis of 2013-2023 Mental Health Client-Level Data, identifying patients with co-morbid ADHD and bipolar disorder and their SUD prevalence. Joinpoint regression was used to analyze trends, and random forest models identified the most important predictors.

Results: Between 2013 and 2023, 5,691 patients (0.008%) had comorbid ADHD and bipolar disorder, with rates increasing by 0.01% per year starting in 2016 (p < 0.0001). All patients had a documented SUD. Most patients were White (75.7%) and unemployed (1,284; 22.6%). The most common SUD diagnoses were 1) other unspecified substance dependence (665, 11.7%), 2) alcohol dependence (474, 8.3%), and 3) cannabis dependence (450, 7.9%). Key predictors included age, education, employment, and marital status.

Conclusions: Our study identified the most common types of SUDs among those with co-morbid ADHD and bipolar disorder and associated risk factors. This will guide prevention and early intervention to reduce adverse outcomes.