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Management of Comorbid Bipolar Disorder and Substance Abuse

E. Sherwood Brown, M.D., Ph.D.

Rates of alcohol and other substance abuse or dependence disorders are substantially higher in persons with bipolar disorders than in the general population, reaching approximately 61% in patients with bipolar I disorder. As a result, clinicians must be prepared to treat substance  use disorders and bipolar disorder simultaneously. This presentation reviews data from the 4 published randomized, controlled trials of pharmacotherapy (lithium, carbamazepine, valproate, and quetiapine) in this population. Also reviewed are data from promising open-label, uncontrolled trials. While the results of published research have been generally positive and support the efficacy and tolerability of several agents from different classes in patients with a dual diagnosis of bipolar disorder and substance abuse or dependence, more randomized, controlled research is needed.

(J Clin Psychiatry 2006;67[8]:e05)

From the Psychoneuroendocrine Research Program and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas.