Abstract
Objectives: Research suggests that patients with co-morbid bipolar disorder (BD) and substance use disorder (SUD) have a poorer illness course and clinical outcome. The evidence is limited as SUD patients are often excluded from BD studies. In particular, evidence regarding long term outcomes from studies using psychotherapies as an adjunctive treatment is limited. We therefore examined data from two studies of Interpersonal Social Rhythm Therapy (IPSRT) for BD to determine whether lifetime or current SUD affected outcomes.Methods: Data were analyzed from two previous clinical trials of IPSRT for BD patients. Change in scores on the Social Adjustment Scale (SAS) from 0 to 78 weeks and cumulative mood scores from 0 to 78 weeks, measured using the Life Interval Follow-Up Evaluation (LIFE), were analyzed.Results: Of 122 patients (non-SUD n = 67, lifetime SUD but no current n = 43, current SUD n = 12), 79 received IPSRT and 43 received a comparison therapy—specialist supportive care—over 18 months. Lifetime SUD had a significant negative effect on change in SAS score but not LIFE score. There was no effect of current SUD on either change in score. Secondary analysis showed no correlation between symptom count and change in SAS total score or LIFE score.Conclusion: Current SUD has no impact on mood or functional outcomes, however, current SUD numbers were small, limiting conclusions. Lifetime SUD appears to be associated with impaired functional outcomes from psychotherapy. There is limited research on co-morbid BD and SUD patients undergoing psychotherapy.
Highlights
The prevalence of co-morbid Substance Use Disorder (SUD) in Bipolar Disorder (BD) has been shown to be consistently higher than in the general population
One study using the 36-Item Short Form Health Survey (SF-36) found BD patients with co-morbid SUD to have improved physical functioning when compared to co-morbid SUD in Major Depressive Disorder (MDD) and Schizophrenia, and vitality when compared to Schizophrenia
We note that the 26-week Longitudinal Interval Followup Examination (LIFE) does extend back to week zero. In this post-hoc combined analysis of 122 BD patients undergoing 18 months of psychotherapy and medication management, there was a difference in change in functioning but not in mood outcomes over 78 weeks in patients with a lifetime history of SUD compared to those without SUD
Summary
The prevalence of co-morbid Substance Use Disorder (SUD) in Bipolar Disorder (BD) has been shown to be consistently higher than in the general population. This is exacerbated by substance use, and several cross-sectional studies [7, 11,12,13] have found greater baseline impairment in occupational, relationship and cognitive function in co-morbid BD and SUD patients, both current and with a lifetime history It is well-established that co-morbid SUD leads to poorer clinical outcomes including unstable course of illness [1, 14, 15] decreased quality of life [16] and increased suicide attempts [17]. Findings indicated significantly poorer health-related quality of life, especially Social Functioning, Role-Emotional and Mental Health, compared with population norms [19]
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