ABSTRACT
BACKGROUND: The authors' goal was to pilot test a newly developed manual-based group psychotherapy, called Integrated Group Therapy (IGT), for patients with bipolar disorder and substance dependence. METHOD: In this open trial, patients with DSM-IV bipolar disorder and substance dependence (N = 45) were recruited in sequential blocks to receive either group therapy (N = 21) or 6 monthly assessments, but no experimental treatment (N = 24). RESULTS: When compared with patients who did not receive group therapy, patients who received IGT had significantly better outcomes on the Addiction Severity Index drug composite score (p < .03), percentage of months abstinent (p < .01), and likelihood of achieving 2 (p < .002) or 3 (p < .004) consecutive abstinent months. CONCLUSION: IGT is a promising treatment for patients with bipolar disorder and substance dependence, who have traditionally had poor outcomes. It is unclear, however, how much of the improvement among the group therapy patients is attributable to the specific content of the treatment. A study comparing this treatment with another active psychotherapy treatment is warranted.
Subject(s)
Bipolar Disorder/therapy , Psychotherapy, Group/methods , Substance-Related Disorders/therapy , Adult , Age Distribution , Bipolar Disorder/diagnosis , Bipolar Disorder/epidemiology , Cohort Studies , Comorbidity , Diagnosis, Dual (Psychiatry) , Female , Follow-Up Studies , Humans , Male , Manuals as Topic , Pilot Projects , Severity of Illness Index , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Treatment OutcomeABSTRACT
BACKGROUND: This study examined patterns of medication compliance and reasons for noncompliance among patients with bipolar disorder and substance use disorder. METHOD: Forty-four patients with current bipolar disorder and substance use disorder were administered a structured interview regarding lifetime compliance with prescribed psychotropic medications. RESULTS: Patients who were prescribed both lithium and valproate were significantly (p = .03) more likely to report full compliance with valproate than with lithium. Side effects were the most common reason for lithium noncompliance, but were not cited as a reason for valproate noncompliance. Also, a common pattern of noncompliance among patients prescribed benzodiazepines, neuroleptics, and tricyclic antidepressants was the use of more medication than prescribed. CONCLUSION: Valproate may have greater acceptability than lithium among patients with bipolar disorder and substance use disorder. Clinicians should also be aware that these patients may take higher doses of medication than prescribed.
Subject(s)
Bipolar Disorder/drug therapy , Lithium/therapeutic use , Patient Compliance , Psychotropic Drugs/therapeutic use , Substance-Related Disorders/drug therapy , Valproic Acid/therapeutic use , Adult , Benzodiazepines/therapeutic use , Bipolar Disorder/epidemiology , Bipolar Disorder/psychology , Carbamazepine/therapeutic use , Comorbidity , Female , Humans , Male , Psychiatric Status Rating Scales , Retrospective Studies , Selective Serotonin Reuptake Inhibitors/therapeutic use , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychologyABSTRACT
OBJECTIVE: The purpose of this study was to assess the validity of self-reports of substance use among outpatients dually diagnosed with substance use disorder and either bipolar disorder or posttraumatic stress disorder. METHOD: Self-reports of substance use were compared with supervised urine samples collected on the same day for 55 subjects. RESULTS: Self-reports were highly valid. Only 4.7% of cases involved subjects not reporting substance use detected by urine screens. CONCLUSIONS: Self-reports of substance use may be highly valid in nonpsychotic, dually diagnosed outpatients under certain conditions, i.e., when patients are in treatment, when urine samples are collected with patients' prior knowledge, when patients are well-known to staff, and when honest self-reporting is encouraged.
