Cocaine use disorder prevalence in bipolar disorder is 10.94 percent with worse clinical outcomes

INTRODUCTION: Substance Use Disorders (SUD) are among the most common comorbidities in individuals with Bipolar Disorder (BD). However, the prevalence of cocaine use disorder (CUD) and its impact on the clinical course of BD have not been extensively explored and synthesized to date. OBJECTIVE: To estimate the prevalence of CUD among individuals with BD and describe its associated clinical correlates. METHODS: We conducted a systematic review with meta-analysis and meta-regression following PRISMA guidelines. Six databases were searched through December 2024. We included observational studies reporting CUD prevalence or clinical comparisons between BD individuals with and without CUD. Risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects model was used for meta-analyses. RESULTS: Twenty-seven studies comprising 6150,881 individuals with BD were included in the meta-analysis. The pooled overall prevalence of CUD in BD was 10.94% (95% CI: 6.15-18.73), rising to 46.25% (95% CI: 34.77-58.15) in studies including primary SUD samples; heterogeneity across studies was high. Seven studies were included in the qualitative synthesis of clinical correlates. BD+CUD individuals showed worse affective symptoms, higher rates of psychiatric comorbidities (e.g., post-traumatic stress disorder, attention-deficit/hyperactivity disorder), polysubstance use, and lower medication adherence compared to BD individuals without comorbid CUD. Sociodemographic vulnerability and increased risk behaviors were also more frequent. Although cognitive performance was broadly similar, BD+CUD patients performed slightly better than BD+AUD in delayed recall, possibly reflecting substance-specific effects. CONCLUSION: CUD is common among individuals with BD and is associated with more severe clinical profiles. Findings highlight the need for integrated treatment strategies and greater clinical attention to this comorbidity.