Substance use and perceived symptom improvement among patients with bipolar disorder and substance dependence

UMMS Affiliation

Department of Psychiatry

Publication Date


Document Type



Adult; Bipolar Disorder; Combined Modality Therapy; Diagnosis, Dual (Psychiatry); Female; Humans; Male; *Perception; Psychotherapy, Group; *Self Medication; *Substance-Related Disorders; Treatment Outcome


Mental and Social Health | Mental Disorders | Psychiatry | Psychiatry and Psychology | Substance Abuse and Addiction


BACKGROUND: Bipolar disorder (BPD) is the Axis I disorder with the highest risk for coexisting substance use disorder. One explanation for this phenomenon is the 'self-medication hypothesis', which states that some patients experience improvement in psychiatric symptoms as a result of substance use. We thus investigated reasons for substance use and perceived substance-induced improvement in BPD symptoms among patients with current BPD and substance dependence.

METHODS: A total of 45 patients received six monthly assessments; 21 also received integrated group therapy (IGT), focusing simultaneously on BPD and substance dependence, while 24 did not receive IGT. Patients reported at intake their current reasons for initiating substance use (including BPD symptoms) and the effects of substance use on those symptoms.

RESULTS: Nearly all patients initiated substance use because of at least one BPD symptom, especially depression (77.8%) and racing thoughts (57.8%); most (66.7%) reported improvement in at least one BPD symptom as a result of substance use. Among patients reporting substance-induced improvement in BPD symptoms, those receiving IGT reported fewer days of drug use over the 6-month study period than those not receiving IGT; this difference was not significant among patients without substance-induced improvement in BPD symptoms.

LIMITATIONS: The study is limited by its small sample size and by the potential inaccuracy of self-reports regarding the effects of substance use on mood.

CONCLUSIONS: Substance dependent patients who report that substance use improves their BPD symptoms may benefit from treatment that focuses simultaneously on both disorders.

DOI of Published Version



J Affect Disord. 2004 Apr;79(1-3):279-83. Link to article on publisher's site

Journal/Book/Conference Title

Journal of affective disorders


At the time of publication, Monika Kolodziej was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID