The optimum treatment plan suggested for an individual with a dual diagnosis of bipolar disorder and substance abuse suggests a combination of group and individual therapy paired with a medication regimen. Depressive episodes should be treated continually until they subside to lessen the possibility of relapse and the occurrence of suicidal thoughts (Cerullo & Strakowski, 2007). The individual should be closely monitored for any adverse reaction to the prescribed medication, possible abuse of that medication and/or any exaggerated mood swings (Basile & Davidson, 2011). Not all clinicians are familiar with the signs of substance dependence; they may mistakenly ascribe a patient’s withdrawal symptoms with mania or depression (Theodore, Basco, & Biggan, 2011).
Social support will be provided through self-help group attendance such as Narcotics Anonymous (NA), which is the most frequently recommended social outpatient treatment (Steinberg, Willingham, Asenjo, Wells & Alic, 2011). An integrated approach is needed due to the increasing occurrence of the dual diagnoses. Substance abuse is prevalent among those diagnosed with bipolar disorder. Among patients with bipolar type I disorder, 61% have a lifetime history of any drug or alcohol use disorder; among psychiatric illnesses, only those diagnosed with anti-social personality disorder had a higher lifetime prevalence rate of substance use disorder (Cerullo & Strakowski, 2007).
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"Treatment Plan for a Patient with Bipolar Disorder And Substance Abuse".
Pharmacological treatment would follow tried and tested medicines; Valproate remains the most tested and least contraindicated of the available medications. Medical treatment allows the patient to spend less time hospitalized, as the co-occurrence of substance abuse disorder intensifies bipolar disorder and increases length of hospitalization among bipolar patients. Cerullo and Strakowski (2007) report that responsiveness to lithium in dually diagnosed patients was a predictor of poor outcome.
- Basile, M. & Davidson, T. (2011). Bipolar disorder. In C.J. Fundakian (Ed.), Gale
encyclopedia of medicine (Vol, 1). Detroit: Gale. - Cerullo, M.A. & Strakowski, S.M. (2007). The prevalence and significance of substance
use disorders in in bipolar type I and II disorder. Substance Abuse Treatment,
Prevention and Policy, 2(29), doi: 10.1186/1747-597X-2-29. - Steinberg, B.S., Willingham, E.J., Asenjo, B., Wells, K.R. & Alic, M. (2011). In
C.J. Fundakian (Ed.), Gale encyclopedia of medicine (Vol, 1). Detroit: Gale. - Theodore, R.S., Basco, M.R. & Biggan, J.R. (2007). Diagnostic disagreements in bipolar
disorder: The role of substance abuse comorbidities. Depression, Research and
Treatment, (2012), doi: 10.1155/2012/435486.
