Bipolar disorder (BPD) and substance use disorder (SUD) frequently coexist, with poor prognostic implications. However, little research has focused on this population. """"""""Integrated Group Therapy"""""""" (IGT) focuses on similarities in the process of recovery from BPD and SUD. In an initial open study, IGT patients had significantly fewer days of drug use than did patients who did not receive IGT. An ongoing Stage IB randomized controlled trial in 60 patients is comparing IGT vs. Group Drug Counseling (GDC), which focuses primarily on substance use. Preliminary results in the first 36 patients have favored IGT, with a significantly higher rate of attendance at group sessions, and significantly better substance use, alcohol, overall abstinence, and mood outcomes. The initial aim of the proposed study is to make IGT more easily adopted by community treatment settings by a) reducing IGT from 20 to 12 sessions and b) modifying IGT so that it can be conducted by drug counselors rather than exclusively by mental health professionals trained in psychopathology and cognitive-behavioral therapy. Patient and counselor satisfaction ratings and outside review of the revised manual will be obtained. The manual will be revised in an ongoing way, while conducting the modified treatment twice in the feasibility (i.e., pre-pilot) phase of the study. Once the manual has been finally revised, a Stage IB randomized controlled pilot study will be conducted with 60 subjects, comparing 12 sessions of revised lGT vs. GDC. Between-group treatment outcomes will be compared at 3 months (i.e., the end of treatment), 6 months, and 9 months. It is hypothesized that revised IGT will have better outcomes GDC, as measured by the primary outcomes, a) days of substance use, and b) number of weeks ill with BPD. Secondary outcomes will also be compared, including treatment retention, patient satisfaction, medication compliance, overall functioning, and engagement in HIV risk behaviors. If warranted by the results, effect sizes from the proposed study will be used to help in the preparation of a larger-scale subsequent Stage II study.
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