There is a substantial co-occurrence between substance use disorders and bipolar disorder. Bipolar disorder is five to eight times more likely to occur in patients with substance use disorders than in the general population. Conversely, rates of substance use disorders in bipolar samples have been reported to be as high as 60% or more. This comorbidity is associated with an earlier age of illness onset, increased symptom severity, greater tendency for violence, higher rates of psychiatric hospitalization, slower time to remission of acute mood episodes, poorer response to lithium treatment, and increased suicidality and mortality rates. Although treatment nonadherence is a significant problem in both substance use and bipolar disorders independently, the co-occurrence of these conditions is related to even poorer compliance rates. Further, research indicates that bipolar substance abusers have a worse course of illness compared to noncomorbid patients, and nonadherence is the most consistent predictor of these poor outcomes. To date, there is very little research on behavioral interventions specifically designed to improve treatment adherence in this high-risk, comorbid population. The present proposal is designed to meet the objectives of Stage I of the NIDA Behavioral and Integrative Therapies Development Program (PA-07-111). Stage I is the initial stage of treatment development research: to formulate new behavioral therapies;to operationally define therapy manuals and procedures;and to pilot test and refine new therapies. The overall aim of this study is to develop the Integrated Treatment Adherence Program (ITAP), which is designed as an adjunctive intervention for improving treatment adherence (broadly defined) in bipolar substance abusers, and to collect preliminary data on the feasibility, acceptability, and initial efficacy of the program. More specifically, we propose the following major aims: 1. To develop a comprehensive treatment manual for ITAP - an innovative, multi-modal intervention that combines motivational, family, and telephone-based strategies - by conducting a small open trial (n = 15) with patients with drug dependence and bipolar disorder. 2. To conduct a randomized controlled pilot study in a sample (n = 60) of patients initially hospitalized with comorbid substance dependence and bipolar disorder by comparing ITAP to treatment as usual to estimate relevant treatment parameters (e.g., acceptability, preliminary efficacy), including HIV risk behaviors. This pilot study will lay the groundwork for a larger clinical trial (Stage II) evaluating the efficacy of this new treatment for improving adherence in bipolar substance abusers.
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