title: Substance use and perceived symptom improvement among patients with bipolar disorder and substance dependence.
abstract: BACKGROUND
  Bipolar disorder (BPD) is the Axis I disorder with the highest risk for coexisting substance use disorder. One explanation for this phenomenon is the 'self-medication hypothesis', which states that some patients experience improvement in psychiatric symptoms as a result of substance use. We thus investigated reasons for substance use and perceived substance-induced improvement in BPD symptoms among patients with current BPD and substance dependence.
  
  
  METHODS
  A total of 45 patients received six monthly assessments; 21 also received integrated group therapy (IGT), focusing simultaneously on BPD and substance dependence, while 24 did not receive IGT. Patients reported at intake their current reasons for initiating substance use (including BPD symptoms) and the effects of substance use on those symptoms.
  
  
  RESULTS
  Nearly all patients initiated substance use because of at least one BPD symptom, especially depression (77.8%) and racing thoughts (57.8%); most (66.7%) reported improvement in at least one BPD symptom as a result of substance use. Among patients reporting substance-induced improvement in BPD symptoms, those receiving IGT reported fewer days of drug use over the 6-month study period than those not receiving IGT; this difference was not significant among patients without substance-induced improvement in BPD symptoms.
  
  
  CONCLUSIONS
  The study is limited by its small sample size and by the potential inaccuracy of self-reports regarding the effects of substance use on mood.
  
  
  CONCLUSIONS
  Substance dependent patients who report that substance use improves their BPD symptoms may benefit from treatment that focuses simultaneously on both disorders.
authors.affiliation: Alcohol and Drug Abuse Program, McLean Hospital, Belmont, MA, USA. weissr@mcleanpo.mclean.org
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
authors.forename: Monika
authors.initials: M
authors.lastname: Kolodziej
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Griffin
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Najavits
authors.forename: Lara M
authors.initials: LM
authors.lastname: Jacobson
authors.forename: Shelly F
authors.initials: SF
authors.lastname: Greenfield
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003131:Combined Modality Therapy; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D010465:Perception; D011615:Psychotherapy, Group; D012651:Self Medication; D019966:Substance-Related Disorders / Q000628:therapy; D016896:Treatment Outcome