Background. Comorbid substance use disorders (SUD) are associated with increased illness severity and functional impairment among adolescents with bipolar disorder (BD). Previous psychosocial treatment studies have excluded adolescents with both BD and SUD. Studies suggest that integrated interventions are optimal for adults with BD and SUD. Methods. We modified family-focused treatment for adolescents with BD (FFT-A) in order to explicitly target comorbid SUD (FFT-SUD). Ten adolescents with BD who had both SUD and an exacerbation of manic, depressed, or mixed symptoms within the last 3 months were enrolled. FFT-SUD was offered as an adjunct to pharmacotherapy, with a target of 21 sessions over 12 months of treatment. The FFT- SUD manual was iteratively modified to integrate a concurrent focus on SUD. Results. Six subjects completed a mid-treatment 6-month assessment (after a mean of 16 sessions was completed). Of the 10 subjects, 3 dropped out early (after ≤1 session); in the case of each of these subjects, the participating parent had active SUD. No other subjects in the study had a parent with active SUD. Preliminary findings suggested significant reductions in manic symptoms and depressive symptoms and improved global functioning in the subjects who completed 6 months of treatment. Reduction in cannabis use was modest and did not reach significance. Limitations. Limitations included a small sample, open treatment, concurrent medications, and no control group. Conclusions. These preliminary findings suggest that FFT-SUD is a feasible intervention, particularly for youth without parental SUD. FFT-SUD may be effective in treating mood symptoms, particularly depression, despite modest reductions in substance use. Integrating motivation enhancing strategies may augment the effect of this intervention on substance use. Additional strategies, such as targeting parental substance use, may prevent early attrition.(Journal of Psychiatric Practice 2014;20:237–248)
B. GOLDSTEIN: Sunnybrook Health Sciences Centre, University of Toronto, and Western Psychiatric Institute and Clinic, University of Pittsburgh; T. GOLDSTEIN, AXELSON, and BIRMAHER: Western Psychiatric Institute and Clinic, University of Pittsburgh; COLLINGER: Sunnybrook Health Sciences Centre, University of Toronto; BUKSTEIN: Department of Psychiatry and Behavioral Sciences, University of Texas-Houston; MIKLOWITZ: Semel Institute for Neuroscience and Human Behavior, UCLA.
Preliminary findings from this manuscript were presented at the 2008 NCDEU Annual Meeting, Phoenix, AZ and at the 2009 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, Honolulu, HI.
The authors thank Amy Schlonski, MSW, and Timothy Winbush, MSW, for their efforts in providing care for participants in this study and for their valuable feedback regarding the treatment manual. This study was supported by a Barbara Jonas NARSAD Young Investigator Award to Benjamin Goldstein, MD, PhD, by an NIMH grant (MH073871) to David A. Axelson, MD (PI), Benjamin I. Goldstein, MD, and Boris Birmaher, MD, and by an NIMH grant (K23MH074581) to Tina R. Goldstein, PhD.
The authors declare no conflicts of interest.
Please send correspondence to: Dr. B. Goldstein, Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, FG53, Toronto, ON M4N-3M5 Canada. Benjamin.Goldstein@sunnybrook.ca