Summary

Several psychological and pharmacological approaches for the treatment of co-occurring bipolar disorder and AOD use appear promising, however, further research is required to establish which therapeutic approaches are particularly effective for these co-occurring disorders.

Box 16 illustrates the continuation of case study C, following Scott after his initial visit with the AOD worker.

Box 16: Case study C: Treating co-occurring bipolar disorder and AOD use: Scott’s story continued

Case study C: Scott’s story continued

During the comprehensive assessment with the AOD worker, Scott described other periods where he had felt elated. His girlfriend said that he would sometimes come home after two weeks at work and start a new project in a ‘frenzy’, often staying up all night or only coming to bed at 2 or 3am, but rarely finished any of them before moving on to something new. During these periods, Scott’s girlfriend said he was like a different person - he was full of energy, talked non-stop, would do all the housework and didn’t seem to need much sleep. Scott excitedly told the AOD worker that he just started rebuilding a motorbike in his garage. Scott’s girlfriend expressed her frustration that their house was full of half-completed projects, with ‘stuff everywhere’.

Recognising a probable bipolar disorder, the AOD worker organised for Scott to see a psychiatrist, who confirmed this diagnosis. Scott’s AOD worker told him that if he wanted to work on his AOD use, they would work together with his psychiatrist to manage both conditions together. Scott agreed this was a good idea and was prescribed a mood stabiliser by his psychiatrist. A concurrent approach to Scott’s mental health and AOD use began, which involved regular meetings with Scott and the professionals involved in his mental health care and AOD treatment.

In addition to psychotherapy and medication, the team helped Scott with financial management and provided him with some strategies to help with his spending. They also discussed Scott’s lifestyle and in particular, the nature of his fly-in-fly-out employment. The first time this was raised, Scott became extremely angry. Refusing to believe there was any problem or connection between the long shift work, numerous consecutive working days, his AOD use and mental health symptoms, he told the treatment team to ‘butt out’ and stormed out of the meeting. Very late that evening, Scott’s girlfriend was contacted by a friend who had found Scott passed out in a local park – he was naked and his feet were bare and bloodied. It appeared that he had consumed a large quantity of alcohol and had been wandering around. His girlfriend picked Scott up and she and the friend took him to emergency, where he was admitted overnight.

Over the next few days, Scott’s mood had settled, and he started to think more about his life and work, and the things that were important to him. In the next treatment team meeting, he listened to the concerns raised, and said he loved his job but could see why the type of work he had been doing may be contributing to making things worse and would think about it some more. He was grateful that his team was being patient with him, listening to him think things through without judging him. Scott started going to the gym again and joined the local soccer team.

Key Points

In cases of bipolar disorder co-occurring with AOD use, treatments need to be coordinated and carefully integrated. Strategies to address medication adherence, particularly over the long-term, are a pertinent aspect of treatment.
Without addressing the familial and social consequences of longstanding bipolar disorder, the client’s quality of life will remain much diminished. As such, integrating the rehabilitative aspects of treatment may have long-term benefits.
Physical activity and exercise have physical and psychological benefits and may also help address some of the side effects of medications used to treat bipolar disorder.