Research on psychological treatments for co-occurring bipolar disorder and AOD use is minimal and has largely been limited to small studies of CBT approaches. In line with Australian and international guidance on the treatment of bipolar disorder [1024–1027], these studies have examined the use of psychotherapies as adjuncts to pharmacotherapy, not as monotherapies. The intervention that has received most investigation to date is Integrated Group Therapy (IGT), an integrated, 12- or 20-session psychosocial group treatment program that focuses on similarities between recovery and relapse processes in bipolar disorder and AOD use disorder. One pilot non-randomised trial and two small RCTs have shown more positive findings in relation to AOD use outcomes relative to group counselling control conditions, but not in relation to mood [1028–1030]. It has been suggested that the consistent superiority of IGT over group drug counselling indicates that the efficacy of drug treatment for people with co-occurring bipolar disorder is enhanced when treatment is provided in the context of mood disorder treatment, but additional strategies may be needed for mood management [871].
Preliminary studies have also been conducted on several other integrated treatments delivered as adjuncts to pharmacotherapy, but again, these have been limited to small RCTs with mixed findings. Schmitz and colleagues [1031] compared an individual integrated CBT treatment for bipolar and AOD use delivered in combination with medication monitoring to medication monitoring alone. No significant differences were found in relation to AOD use; findings in relation to mood were mixed but appeared promising. A further two intensive 6-month long programs that involved clients’ families, the Integrated Treatment Adherence Program based on ACT for adults [1032] and the Family Focused Treatment for adolescents [1033], have also undergone preliminary evaluations with promising findings in relation to symptoms of bipolar disorder, but not in relation to AOD use.
Other integrated interventions that have undergone preliminary evaluation and found to be acceptable, feasible, and potentially efficacious in reducing either AOD use and/or symptoms of bipolar disorder include HABIT, a manualised integrated group therapy that combines CBT with mindfulness-based relapse prevention [1034], and an integrated individual therapy that combines CBT and MI [1035]. Further research is needed to determine their effectiveness.