McLean Study Finds Integrated Group Therapy Better than Standard Group Therapy for People with both Bipolar Disorder and Substance Abuse

January 03, 2007

Public Affairs
Cindy Lepore

Belmont, MA - Individuals with both bipolar disorder and substance abuse reduced their substance use more during integrated group therapy designed to address both issues than did those in groups addressing only substance abuse, report researchers at Harvard-affiliated McLean Hospital. The findings could lead to a significant improvement in treating these co-occurring conditions.

"Many people with these disorders have traditionally not done well in groups in which the focus is solely on their substance abuse,'' said Roger Weiss, MD, clinical director of McLean Hospital's Alcohol and Drug Abuse Treatment Program and author of an article (PubMed) appearing in the January 2007 issue of the American Journal of Psychiatry. "Our findings show that integrated group therapy, because it addresses both issues, may be more clinically effective."

The study is thought to be the first-ever controlled evaluation of a group-based psychosocial treatment for this population group.

Individuals with both bipolar disorder and substance abuse are typically treated with medication and, in many cases, individual therapy. To address their substance abuse, they are often referred to substance abuse group programs dealing exclusively with drug and alcohol issues.

Weiss and his team enrolled 62 individuals-half in an integrated therapy group and half in traditional substance abuse groups. The groups ran for 20 weeks and patients were followed for an additional three months. All were taking medication for their bipolar disorder at the time of enrollment.

Those receiving the integrated group therapy had half as many days of substance use during both treatment and follow-up as did those in the drug and alcohol counseling group. They averaged 5.3 days per month of substance use, compared to 10 days per month on average for those in the drug counseling group, during treatment. Reduced alcohol use accounted for most of the differences in substance use between the groups. Subjects in the integrated group also had a shorter time from the start of treatment to their first month of total abstinence.

"That makes a big difference in this population,'' Weiss said. "Achieving good outcomes is very difficult for this group.''

At the same time, no differences were found between the groups in terms of episodes of bipolar disorder, although those in the integrated therapy group reported more depressive and manic symptoms. Weiss said the increased number of such symptoms in the integrated therapy group might have been because those in this group were specifically asked to monitor symptoms of depression or it could have occurred because they were using drugs or alcohol less often than those in the other group.

The model for the integrated group therapy, devised by Weiss, focuses on similarities between recovery and relapse processes in bipolar disorder and substance use disorder.

"One of the fundamental ideas behind this treatment is that the same kinds of thoughts and behaviors that will help in one of the disorders will also help in the other,'' he said. "Similarly, the same kinds of thoughts and behaviors that will get a person into trouble with one will get the person into trouble with the other. The treatment focuses on the parallels between the two disorders.''

McLean Hospital is the largest psychiatric clinical care, research and training facility of Harvard Medical School, an affiliate of Massachusetts General Hospital and a member of Partners HealthCare.

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