I Maremmani et al, (2011). Are “social drugs” (tobacco, coffee and chocolate) related to the bipolar spectrum? Journal of Affective Disorders, published online ahead of print.

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Background: Across all ages and cultures, mankind has always used substances in order to
induce pleasurable sensations or desirable psychophysical states. These substances, notably
caffeine, tobacco, alcohol and chocolate, can be labeled ‘social drugs’.
Methods: We analyzed the social drug habits of 562 patients suffering from mood disorders,
according toDSM-IV-R criteria (major depressive episode, recurrent depression, bipolar type I and
II disorders and depression not otherwise specified). The samplewas also divided into bipolar and
non-bipolar according toHypomania Check-list 32 (HCL-32),which proposes a broader concept of
hypomania and soft bipolarity, comprising the spectrum of bipolar disorders proper, along with
other, “softer” expressions of bipolarity intermediate between bipolar disorder and normality.
Results: Using HCL-32 criteria, but DSM-IV-R criteria, a link was confirmed between bipolar
spectrum and substance use including social drugs such as tobacco and coffee.
Limitation: Observational correlational study.
Conclusion: This study is in support of earlier theoretical formulations within the framework of
the Pisa-San Diego collaboration.
© 2011 Elsevier B.V. All rights reserved.

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