Background-Integrated group therapy, a new treatment for patients with bipolar disorder and substance use disorder, has previously been found to be efficacious in reducing substance use, but its length (20 sessions) and need for highly trained therapists may limit its adoption in substance use disorder community treatment programs. This paper compares a briefer (12-session) version of integrated group therapy, led by substance use disorder counselors without previous cognitivebehavioral training or bipolar disorder experience, to group drug counseling. Methods-Sixty-one patients with bipolar disorder and substance dependence, taking mood stabilizers, were randomized to 12 sessions of integrated group therapy (n=31) or group drug counseling (n=30).Results-Analyses of primary outcomes showed trends favoring integrated group therapy, with greater reduction in substance use during follow-up and a greater decline in risk of mood episodes during treatment. Secondary analyses favored integrated group therapy, with a significantly greater likelihood of achieving total abstinence, a significantly shorter time to the first abstinent month, and a significantly greater likelihood of achieving a "good clinical outcome" (a composite measure encompassing both substance use and mood simultaneously).Conclusions-A shortened version of integrated group therapy can be delivered successfully by substance use disorder counselors, with better overall outcomes than those achieved with group drug counseling.

Background-Bipolar and substance use disorders frequently co-occur, and both are associated with impulsivity, impaired judgment, and risk-taking.Objectives-This study aimed to: (1) describe the rates of HIV sexual and drug risk behaviors among patients with co-occurring bipolar and substance use disorders, (2) test whether acute mania, psychiatric severity, and drug severity independently predict HIV risk, and (3) examine the relationship between specific substance dependencies and sexual risk behaviors.Method-Participants (N = 101) were assessed for psychiatric diagnoses, substance abuse, and HIV risk behavior using structured clinical interviews and self-report questionnaires.Results-The majority (75%) were sexually active in the past 6 months and reported high rates of sexual risk behaviors, including unprotected intercourse (69%), multiple partners (39%), sex with prostitutes (24%, men only), and sex trading (10%). In a multivariate linear regression model, recent manic episode, lower psychiatric severity, and greater drug severity were independent predictors of total HIV risk. Cocaine dependence was associated with increased risk of sex trading.Conclusions-Results underscore the importance of HIV prevention for this population.

Reviews of the dropout literature note significant attrition from addiction treatment. However, consistent predictors have not been identified and few studies have examined factors related to retention and engagement for women in gender-specific treatment. The current study consisted of 102 women and their partners randomized to individual or couples outpatient alcoholism treatment. Women attended more treatment sessions if they were assigned to individual treatment, older, had fewer symptoms of alcohol dependence, had more satisfying marital relationships, had spouses who drank, and had matched preference for treatment condition. Women were more engaged in treatment (i.e., completed more assigned homework) if they had fewer children at home, fewer alcohol dependence symptoms, later age of onset of alcohol diagnosis, more satisfying marital relationships, and spouses who accepted or encouraged their drinking. Results highlight important associations of treatment and relationship variables with treatment retention and engagement.

Objective Bipolar disorder (BD) and substance use disorders (SUDs) frequently co-occur. However, little is known about the near-term effects of substance use on BD. Thus the present study tests whether alcohol use precipitates depression among patients with co-occurring BD and SUD. Method This study uses data collected as part of two clinical trials of a manualized group therapy for patients with co-occurring bipolar disorder and substance dependence. One hundred fifteen participants were assessed at baseline and each month through month 8. Baseline diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID), and monthly substance use and mood data were collected using the Longitudinal Interval Follow-Up Evaluation (LIFE) and the Addiction Severity Index. Generalized Estimating Equation (GEE) methodology was used to analyze these longitudinal data. Results Our primary hypotheses were supported: days of alcohol use and an increase in days of alcohol use each significantly predicted the presence of a depressive episode in the subsequent month, when controlling for current depression and current drug use. Conclusion These data suggest that alcohol use in patients with BD and substance dependence increases the risk of a depressive episode in the short term.

This study examined types of internal and external motivation for seeking treatment and the predictive utility of different types of motivation among 180 women with an alcohol use disorder (AUD) participating in a two-armed trial testing different individual and couple therapies for AUDs. Reasons for seeking treatment were coded for type of internal or external motivation. Most women (97%) cited internal reasons for seeking help, including: concern about progression of AUD (61.1%), health (43.3%), mental health (38.9%), and family (38.3%). Occupational concerns, an internal motivator cited by 6% of women, were associated with better drinking outcomes; interpersonal-family concerns were associated with poorer outcomes. Some motivators for seeking treatment may not be related to sustained changes in drinking, suggesting that understanding motivators for treatment may be inadequate to maintain change. Reasons for help-seeking may need to be addressed in treatment to produce long-lasting change.

ABSTRACT. Objective: The present study examined the latent continuum of alcohol-related negative consequences among fi rst-year college women using methods from item response theory and classical test theory. Method: Participants (N = 315) were college women in their freshman year who reported consuming any alcohol in the past 90 days and who completed assessments of alcohol consumption and alcoholrelated negative consequences using the Rutgers Alcohol Problem Index. Results: Item response theory analyses showed poor model fi t for fi ve items identifi ed in the Rutgers Alcohol Problem Index. Two-parameter item response theory logistic models were applied to the remaining 18 items to examine estimates of item diffi culty (i.e., severity) and discrimination parameters. The item diffi culty parameters ranged from 0.591 to 2.031, and the discrimination parameters ranged from 0.321 to 2.371. Classical test theory analyses indicated that the omission of the fi ve misfi t items did not signifi cantly alter the psychometric properties of the construct. Conclusions: Findings suggest that those consequences that had greater severity and discrimination parameters may be used as screening items to identify female problem drinkers at risk for an alcohol use disorder. (J. Stud. Alcohol Drugs, 72,

Objective-Bipolar and substance use disorders frequently co-occur. Integrated treatment for these disorders has been shown to be effective at reducing substance use, but no study has examined attrition from dual diagnosis group therapy. The current study identified baseline demographic and clinical characteristics that predict treatment dropout among patients with co-occurring bipolar and substance use disorders.Method-Using binary and multivariate analyses, baseline data were analyzed as part of a randomized controlled trial of integrated group therapy for bipolar and substance use disorders.Results-Cigarette smoking, recent mood episode, and lack of a college education were strong predictors of dropout after controlling for demographic and substance use variables.Conclusions-Given the strength of smoking as a predictor of dropout as well as the high rate of smoking among this population, a greater focus on the relationship between smoking and bipolar disorder is warranted.

Objective. Impaired cognition is a hallmark of schizophrenia and spectrum disorders such as schizotypal personality disorder, and is the best predictor of functional outcome. Cognitive remediation therapy has demonstrated efficacy for improving cognition and augmenting other rehabilitation efforts in schizophrenia, with gains in real-world functioning. Pharmacological augmentation of cognitive remediation has been attempted but the effects of augmentation on combined therapies such as cognitive remediation and social skills training has not been studied. Method. Twenty-eight participants with schizotypal personality disorder enrolled in an 8-week, randomized, double-blind, placebo-controlled trial of guanfacine plus cognitive remediation + social skills training (15 guanfacine, 13 placebo). Cognition was assessed with the MATRICS Clinical Consensus Battery (MCCB), social cognition with the Movie for the Assessment of Social Cognition (MASC), and functional capacity with the UCSD Performance Based Skills Assessment (UPSA). Results. There was a statistically significant time (pre- versus post-treatment) effect for MCCB speed of processing, verbal learning, and visual learning, and UPSA total score. There was a significant time x medication condition (guanfacine, placebo) interaction for MCCB reasoning and problem solving, and UPSA total score; the time x treatment condition interaction approached significance for MASC hypomentalizing errors. Conclusions. In this trial, both the agent guanfacine and our psychosocial intervention of cognitive remediation plus social skills training were well-tolerated, with no side effects or drop-outs. Participants treated with cognitive remediation plus social skills training plus guanfacine demonstrated statistically significant improvements in reasoning and problem solving, as well as in functional capacity and possibly social cognition, compared to those treated with cognitive remediation plus social skills training plus placebo. Cognitive remediation plus social skills training may be an appropriate intervention for individuals with schizotypal personality disorder and guanfacine appears to be a promising agent to augment cognitive remediation plus social skills training in this population.