Community-Friendly Version of Integrated Group Therapy Shows Promise

Although their research demonstrated that integrated group therapy (IGT) can foster recovery in abusers with bipolar disorder, a group of Massachusetts scientists recognized barriers that might prevent community programs from adopting the treatment. Now, they report that during a 12-week study, patients who received a modified IGT therapy, designed especially for delivery in community addiction treatment programs, were nearly twice as likely as those in standard drug counseling to attain 1 month of abstinence from illicit drugs and alcohol and nearly three times as likely to abstain for the entire period.

Dr. Roger D. Weiss, professor of psychiatry at Harvard Medical School and chief of the Division of Alcohol and Drug Abuse at McLean Hospital in Belmont, Massachusetts, and colleagues made three major changes in their IGT treatment:

• To increase the likelihood of insurance reimbursement, they decreased therapy from 20 to 12 group sessions.
• Rather than using counselors with experience in both substance abuse and psychiatric disorder treatment, the modified IGT program was delivered by addiction counselors who had received general information on bipolar disorder and the cognitive-behavioral therapeutic approach but who had little experience in these areas.
• Rather than participating as a single group for a predefined 12-week period, patients could join ongoing group therapy at any time, which is the usual practice in most community treatment programs.

All of the new study's 61 participants were taking mood-stabilizing medications. They were randomly assigned to one of two treatment groups and further divided into groups of six to eight members led by clinicians who provided either the modified IGT or standard, manual-based substance abuse counseling.

Both treatments helped patients reduce their days of substance use. Comparing results from the month before treatment began to the last month of treatment, drug use dropped from 18.6 days to 4.4 days in the modified IGT group and from 17.9 days to 6.5 days in the group receiving standard drug counseling. Of the patients who received modified IGT, 71 percent attained at least 1 month of abstinence from both drugs and alcohol during treatment, compared with 40 percent of those in standard group drug counseling. Modified-IGT patients also achieved their first month of abstinence sooner than those in group drug counseling. Moreover, 36 percent of the men and women who participated in modified IGT were abstinent throughout all 3 months of treatment, compared with only 13 percent of the patients in standard counseling.

About 70 percent of patients reported depression, mania, or a mixture of the two during treatment. Patients receiving modified IGT, however, were more than twice as likely as those in group drug counseling to be abstinent and to report no mood disorder episode during the final month of treatment.

"If the findings are borne out in future studies with larger numbers of patients, community addiction treatment programs could benefit from adding modified IGT to mood-stabilizing pharmacotherapies for people with co-occurring substance abuse and bipolar disorders," says Dr. Lisa Onken, chief of NIDA's Behaviorial and Integrated Treatment Branch. "This approach might not only improve outcomes in this difficult-to-treat group but also do so in a community-friendly way," she adds.

SOURCE

Weiss, R.D., et al. A "community-friendly" version of integrated group therapy for patients with bipolar disorder and substance dependence: A randomized controlled trial. Drug and Alcohol Dependence 104(3):212-219, 2009.

From the National Institute on Drug Abuse