CQAIMH - center for quality assessment and improvement in mental health



Bipolar Disorder or Depression: Assessment for substance use


This measure assesses the percentage of patients with bipolar disorder, or unipolar depression, who receive an initial assessment that considers alcohol and chemical substance use.

Clinical Rationale:

Bipolar Disorder, Major Depression & Substance Use

  • Between 40-70% of people with bipolar disorder have a history of substance use disorder (1,2)
  • A current or past comorbid substance use disorder may lead to worse outcomes for bipolar disorders, including more symptoms, more suicide attempts, longer episodes and lower quality of life (1)
  • Substance abuse may obscure or exacerbate mood swings that have no other apparent external cause (3)
  • Substance abuse may also precipitate mood episodes or be used by patients to self-treat in an attempt to improve the symptoms of episodes (3)
  • Alcohol or chemical substance abuse or dependence is a frequent comorbidity of major depressive disorder and a detailed history of the patient’s substance use should be obtained (4)
  • Patients suffering from major depressive disorder with comorbid addiction are more likely to require hospitalization, more likely to attempt suicide and less likely to comply with treatment than are patients with these disorders of similar severity not complicate by these factors (4)

Denominator Population:

Patients diagnosed with bipolar disorder
Patients diagnosed with unipolar depression

Data Sources:

  • Administrative data
  • Medical Record

Numerator Population:

Patients who receive an initial assessment for bipolar disorder (or unipolar depression) that includes consideration of alcohol/chemical substance use

Data Source:

  • Medical Record

Initial Case-finding Guidance:

Patients with a diagnosis involving bipolar disorder 
ICD9CM or DSM IV TR: 296.0x; 296.1x; 296.4x; 296.5x; 296.6x; 296.7; 296.80-82; 296.89; or 301.13
Patients with a diagnosis involving unipolar depression
ICD9CM or DSM IV TR:  296.2x; 296.3x; 300.4 or 311

STABLE Resource Toolkit:

The following instruments are recommended by the STABLE National Coordinating Council for use in assessing substance use.  The tools are available in the corresponding section of the STABLE Resource Toolkit.

  • AUDIT-C:  Brief self-report tool for alcohol use
  • CAGE-AID: Brief self-report tool; adaptation of CAGE that also includes drug use


  1. Ostacher, MJ; Sachs, GS, Update on Bipolar Disorder and Substance Abuse: Recent Findings and Treatment Strategies, J Clin Psychiatry 2006; 67[9]:e10
  2. Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study, JAMA 1990; 264:2511-1518
  3. American Psychiatric Association, Practice Guideline for the Treatment of Patients with Bipolar Disorder, Am J Psychiatry 159: 4, April 2002 Supplement
  4. American Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depressive Disorder (2000)

Copyright 2007 by the Center for Quality Assessment and Improvement in Mental Health