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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 this comorbidity.

Box 15 illustrates the continuation of case study C, following Layla after the identification of her bipolar disorder.

Box 15: Case study C: Treating comorbid bipolar and AOD use: Layla’s story continued

Layla completed her assessment with the AOD worker, commenting that it was one of the only times she had really felt listened to without being judged. The AOD worker emphasised that should Layla wish to work on her AOD use, they would work together with her psychiatrist and any other service that may be of assistance, to help her manage her bipolar disorder. Although sceptical, Layla accepted this offer and began embarking on a plan that involved a concurrent approach to her mental health and AOD use, with very active communication between her health providers. This communication was facilitated by regular meetings involving Layla and the professionals involved in both her mental health care and AOD treatment. In addition, Layla’s medications were comprehensively reviewed, and, rather than a process of ‘tweaking’ and modifying medications, a conference was convened to consider the best medication approach. This conference was attended by Layla, who was for the first time able to freely express her reservations about some of the medications that she was taking; in particular, how a particular mood stabilising drug made her feel overwhelmingly flat.

In addition to the use of psychotherapy and medication, the team identified the need to deal more generally with Layla’s lifestyle, and with initial encouragement and support she was able to begin to attend regular training sessions at the gym and, thus, begin the process of losing some of the weight she had gained over the years. She was also able to contact some of her friends she used to swim with, and, with the encouragement of her care coordinator, resumed her interest in music.

Key points

  • In cases of bipolar disorder comorbid with AOD use, treatments need to be coordinated and carefully integrated.
  • Although there are many effective medications to address disturbances in mood, as with all medications, mood stabilisers can have significant side effects. In particular, mood stabilisers have the potential to make a client feel flat.
  • Strategies to address medication compliance, 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.