Objective: Although bipolar disorder and substance use disorder frequently co-occur, there is little information on the effectiveness of behavioral treatment for this population. Integrated group therapy, which addresses the two disorders simultaneously, was compared with group drug counseling, which focuses on substance use. The authors hypothesized that patients receiving integrated group therapy would have fewer days of substance use and fewer weeks ill with bipolar disorder. Method: A randomized controlled trial compared 20 weeks of integrated group therapy or group drug counseling with 3 months of posttreatment follow-up. Sixty-two patients with bipolar disorder and current substance dependence, treated with mood stabilizers for ≥2 weeks, were randomly assigned to integrated group therapy (N=31) or group drug counseling (N=31). The primary outcome measure was the number of days of substance use. The primary mood outcome was the number of weeks ill with a mood episode. Results: Intention-to-treat analysis revealed significantly fewer days of substance use for integrated group therapy patients during treatment and follow-up. Groups were similar in the number of weeks ill with bipolar disorder during treatment and follow-up, although integrated group therapy patients had more depressive and manic symptoms. Conclusions: Integrated group therapy, a new treatment developed specifically for patients with bipolar disorder and substance dependence, appears to be a promising approach to reduce substance use in this population.
The authors studied a group of 149 hospitalized cocaine abusers as a follow-up to previous research performed in 1980-82, which had revealed a high prevalence of affective disorder in cocaine abusers. The authors hypothesized that the changing epidemiology of cocaine abuse since that time may have been accompanied by changes in the characteristics of patients seeking treatment for dependence on the drug. The cocaine abusers were compared with 293 other drug abusers to see whether clinical changes over time were specific to individuals abusing cocaine. The authors found slightly more affective disorder in the cocaine abusers when compared with the other patients (26.8% vs. 20.1%), with a significantly higher rate of cyclothymic disorder (11.4% vs. 2.7%, p<.001). Affective illness was significantly more prevalent in the first-degree relatives of the cocaine abusers when compared with the sex-matched relatives of the other patients (p<.05). Diagnostic trends changed a great deal, however, between the original 1980-82 study sample and the follow-up 1982- 86 sample. The rate of affective disorder decreased over time from 50.0% to 21.0% (p<.01), and the rate of affective illness in the families also declined, from 31.0% to 11.5% in females (p<.001) and from 14.3% to 2.2% in males (p<.001). No such change occurred in the comparison group of opioid and central nervous system depressant abusers. The authors conclude that although a substantial number of cocaine abusers suffer from concurrent affective disorder, this form of premorbid psychopathology has become a less important risk factor for the development of chronic cocaine abuse as cocaine use has become more widespread.
The most effective use of electronic medical records (EMRs) will result from wide-scale adoption and appropriate use of the technology—two factors that rely heavily on a system’s usability. We conducted a qualitative and quantitative usability assessment of an EMR developed specifically for treating the HIV/AIDS patient population. The purpose of this study was to inform developers on how to prioritize resources for their impending software rebuild initiative and to evaluate a dual methodology consisting of both quantitative and qualitative components. The results indicated that the methodology was valid, although there were some variations recommended for future usability assessments of EMRs. The study also underscored the need to assess usability based on user feedback and to employ multiple methods to elicit information; this research revealed many insights into the software that contradicted initial assumptions and also found that asking questions in multiple ways yielded more complete feedback.
The authors administered a five‐item craving questionnaire daily to 86 outpatients to determine whether initial craving scores predicted the likelihood of initiation of abstinence within a 30‐day period. Patients with higher mean craving scores during the first 3 days of the study were less likely to initiate abstinence. However the relationship between craving and abstinence initiation was not linear. Rather, patients in the top quartile of craving scores were significantly less likely to abstain than were patients in the lower three quartiles. The findings suggest that this rapid, easily administered craving questionnaire may have short‐term predictive validity.
This study investigated the value of collateral informant reports of substance use for patients with current bipolar disorder and substance dependence. We collected collateral informant reports on 132 occasions for 32 patients and found a high level of agreement between collateral reports and self-report/urine screen data (75.0%). In only 3 instances did collateral informants report substance use for patients who denied use and had negative urine screens. Frequency of contact between informants and patients was associated significantly with the level of agreement. These findings suggest that obtaining collateral informant data when studying this population may be of limited value.
Abstract Background and Objectives Early recovery from substance use disorder (SUD) is often characterized by hopelessness and despair about the future. Optimism, or the expectation that good things will happen, may provide a buffer against despair, and motivate adaptive goal engagement and coping. Study objectives were to (1) compare levels of optimism among individuals in substance use disorder inpatient treatment to other populations and (2) examine correlates of optimism. Methods This exploratory study utilized a cross‐sectional survey design. Participants ( n = 355) completed self‐report measures assessing sociodemographic and clinical characteristics. The main variable of interest, optimism, was assessed by Life Orientation Test‐Revised scores. Multivariate regression was used to examine the association among sociodemographic and clinical variables and optimism. Results Our sample ( n = 342) scored lower on optimism (mean = 11.7) than general population and SUD patients reported in the literature (range = 13.0–18.5). Optimism was higher for SUD inpatients who were college‐educated and those with higher scores on the recovery protection factor, while greater anxiety severity was associated with lower optimism scores. Conclusions and Scientific Significance This study contributes to emerging research on the association between optimism and SUDs. Optimism has not been previously studied among patients in acute, short‐term inpatient SUD treatment and doing so may be clinically useful in addressing low optimism as an obstacle to motivation for treatment. Bolstering optimism may be a promising target for intervention and future research.
