Cognitive–Behavioral Treatment of Bipolar Disorder and Substance Abuse: A Preliminary Randomized Study

Abstract

Objective This article describes a two-group outcome study designed to evaluate the feasibility and potential efficacy of cognitive–behavioral therapy (CBT) in conjunction with pharmacotherapy for dually diagnosed patients (bipolar disorder and substance use disorder). Methods Forty-six randomly assigned outpatients received up to 12 weeks of medication monitoring (MM) plus individual CBT (MM + CBT) or MM only. Results Sixty percent of subjects in the MM + CBT group completed treatment compared with 33% of subjects in the MM group (P < 0.08), with session attendance significantly higher in the MM + CBT group (P < 0.01). The two groups did not differ in substance use outcomes during treatment, but there was some indication of greater improvement in the MM + CBT group with regard to outcomes related to medication compliance and mood symptoms. Conclusions This article documents a preliminary attempt to develop and evaluate a new, integrated treatment approach for patients with bipolar disorder who have coexisting substance abuse, and to address effectively those aspects of bipolar disorder that are not impacted by medication alone.