Working with Substance Use in Bipolar Disorder

Bipolar disorder is linked to high levels of comorbid substance use. Substance use is a risk factor for bipolar disorder, as well as being a potential trigger for relapse, and increases during acute mood episodes. This chapter overviews considerations and adaptations to using psychological therapy for those with comorbid substance use problems, focusing on an integrative approach tackling both problems at the same time. Diagnostic considerations are discussed along with assessment recommendations including the use of standardized measures. Formulating within the Integrative Cognitive Model and focusing on substance-specific conditions is overviewed. Considerations for therapy including service delivery considerations and involving family members in care are discussed, and an overview of the evidence base is presented. Specific techniques including Acceptance and Commitment Therapy, Dialectical Behavior Therapy, Cognitive Behavioral Therapy, and Motivational Interviewing are then discussed with a case study to illustrate these approaches.