We propose to adapt, refine, and pilot-test a motivationally based model of adherence therapy for the dual disorders of alcoholism and bipolar disorder in early recovery. This proposal pertains to the major areas of interest identified in the Program Announcement, namely the development and evaluation of specialized behavioral interventions for the engagement, retention, and adherence of comorbid patients in treatment. Comorbid alcoholism and bipolar disorder is highly prevalent. The presence of comorbidity has a significant negative impact on treatment adherence, treatment response, and course of illness with heightened risk for suicide, recurrence of bipolar illness. Despite the substantial recent increased attention to the problem of psychiatric comorbidity with alcoholism, surprisingly little research has been conducted on this complex form of comorbidity, especially in regard to effective treatment approaches. There are no existing individual psychotherapeutic interventions that are tailored to patients with alcoholism and comorbid bipolar disorder. Our proposed intervention is based on treatment models that emphasize integrating psychosocial and pharmacotherapeutic interventions in an empathic and motivationally informed paradigm. We propose the following three specific aims: 1) To develop and refine a theoretically based and procedurally specified individual adherence therapy intervention for co-occurring alcohol use and bipolar disorder in early recovery. 2) To develop standardized procedures, methods, and techniques so that treatment is delivered with a high degree of fidelity and competence. And 3) To conduct a pilot-efficacy study with randomized, parallel-group design comparing this new intervention with current regular clinical care standardized as Treatment as Usual (TAU). We propose to achieve the above aims in three stages over three years of requested support. During Stage 1 we will develop, implement, and continuously refine the treatment protocol by collaborative, expert review by applying the proposed therapy to 8 cases. During Stage 2 we will train two new therapists on 8 additional cases, and finalize the treatment manual. During Stage 3 we will pilot-test the efficacy of our protocol as compared to the Treatment as Usual (TAU) condition by conducting a randomized, parallel group pilot-efficacy study of 32 subjects (16 in each group).
