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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 [greater than or equal to] 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.

Objective: The feasibility of the 1999 voluntary, community-based National Alcohol Screening Day (NASD) was assessed by determining 1) the extent to which community and college sites were registered to hold screenings and the extent to which the subjects came to participate, 2) the demographic and clinical characteristics of the participants at these screening sites, and 3) the extent to which individuals who were referred for evaluation and treatment adhered to follow-up recommendations. Method: Registered community and college sites were documented. Screening forms returned by the participants were analyzed. A subgroup of randomly selected participants from community and college sites was contacted by telephone. Results: A total of 1,218 community sites and 499 college sites participated in NASD. At the 1,089 sites that reported results, 32,876 people participated, 18,043 were screened, and 5,959 were referred for treatment. Forty-three percent of those screened at these sites had a score of 8 or more on the Alcohol Use Disorders Identification Test (AUDIT), indicating harmful or hazardous drinking. Only 13% of those screened had previous alcohol treatment. In the subgroup that participated in the follow-up survey (N=704), community participants (N=337) had higher mean scores on the AUDIT than the college participants (N=337). Approximately 50% of the community participants and 20% of the college participants adhered to the recommendation to pursue follow-up. Conclusions: Voluntary, community-based screening for alcohol problems is feasible and offers education, screening, and referral for many individuals with harmful or hazardous drinking behavior.

Objective: Drug use by patients during inpatient substance abuse treatment is frequently a cause of premature hospital discharge. The authors examined the histories of patients who used drugs while in inpatient substance abuse treatment, the methods used to detect drug use, and the temporal relationship of drug use episodes. Method: The authors reviewed the charts of patients admitted consecutively to an inpatient substance abuse treatment unit between 1981 to 1988. Of 729 patients, 42 were found to have used drugs while receiving inpatient treatment. The diagnoses and clinical histories of these 42 patients were compared with those of all other patients. Methods of detection and circumstances of drug use were recorded, and drug use episodes were plotted on a time line that was examined for temporal clustering. Results: Results: Significantly more of the patients who used drugs during inpatient substance abuse treatment had primarily used heroin or methadone before treatment. Random urine screens, self-report, and staff observation together detected approximately 85% of the patients who used drugs during treatment. Episodes of drug use did cluster in time, but within clusters the hospital stays of the patients who used drugs did not necessarily overlap. Conclusions: Temporal clustering of drug use episodes may occur because drug use by one patient heralds drug availability and stimulates craving in other inpatients. Clinicians should be aware that one episode of drug use may be followed by others. Multiple detection methods, including random comprehensive urine screens, should be used to test for drug use on inpatient units.

Objective: Characteristics of the subsequent treatment received by people who screened positive for depression in the 1996 National Depression Screening Day were investigated. Method: A follow-up telephone survey was completed by 1,502 randomly selected participants from 2,800 sites. Results: Of 927 people for whom additional evaluation was recommended, 602 (64.9%) obtained evaluations and 503 (83.6%) received treatment. Of these 503,260 (51.7%) received psychotherapy and medication, 130 (25.8%) received medication only, and 93 (18.5%) received psychotherapy only. Compared with people without health or mental health insurance, individuals with health insurance (66.7% versus 57.5%) and mental health insurance (74.6% versus 55.3%) were more likely to comply with the recommendation to obtain follow-up evaluation. Conclusions: One-half of the people treated for depression received a combination of psychotherapy and medication. Lack of insurance was associated with not following the recommendation to obtain further evaluation and treatment.