Difficulties in emotional regulation and substance use disorders: A controlled family study of bipolar adolescents

Timothy E. Wilens, Mary Kate Martelon, Jesse P. Anderson, Rachel Shelley-Abrahamson, Joseph Biederman

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Background: Self-regulatory mechanisms appear etiologically operant in the context of both substance use disorders (SUD) and bipolar disorder (BD), however, little is known about the role of deficits in emotional self-regulation (DESR) as it relates to SUD in context to mood dysregulation. To this end, we examined to what extent DESR was associated with SUD in a high-risk sample of adolescents with and without BD. Methods: 203 families were assessed with a structured psychiatric interview. Using the Child Behavior Checklist (CBCL), a subject was considered to have DESR when he or she had an average elevation of 1 standard deviation (SD) above the norm on 3 clinical scale T scores (attention, aggression, and anxiety/depression; scores: 60 × 3 ≥ 180). Results: Among probands and siblings with CBCL data (N= 303), subjects with DESR were more likely to have any SUD, alcohol use disorder, drug use disorder, and cigarette smoking compared to subjects with scores <180 (all p values <0.001), even when correcting for BD. We found no significant differences in the risk of any SUD and cigarette smoking between those with 1SD and 2SD above the mean (all p values >0.05). Subjects with cigarette smoking and SUD had more DESR compared to those without these disorders. Conclusions: Adolescents with DESR are more likely to smoke cigarettes and have SUD. More work is needed to explore DESR in longitudinal samples.

Original languageEnglish
Pages (from-to)114-121
Number of pages8
JournalDrug and Alcohol Dependence
Issue number1-2
StatePublished - 1 Sep 2013
Externally publishedYes


  • Adolescents
  • BD
  • Bipolar disorder
  • CBCL
  • Child Behavior Checklist
  • Cigarettes
  • DESR
  • Deficits in emotional self-regulation
  • Dysregulation
  • Juvenile bipolar disorder
  • Substance use disorders
  • Tobacco


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