co-occurring SUDs and bipolar disorder.59 Like treatment for bipolar disorder without a co-occurring SUD, treatment for co-occurring bipolar disorder and SUDs usually involves both pharmacological and psychosocial therapies. Pharmacological therapy Many of the medications for bipolar disorder are also used to treat individuals with co-occurring bipolar disorder and SUDs, but there has been limited research on regimens that might be efficacious for both disorders simultaneously. One such study found that divalproex sodium, an anticonvulsant mood stabilizer often used to treat manic episodes, was associated with a reduction in alcohol consumption when used as a maintenance treatment with lithium.60 Quetiapine is one of the atypical antipsychotics often prescribed for bipolar disorder that has been studied for its possible efficacy for alcohol use disorder. Although some studies have found that quetiapine helped decrease alcohol consumption and craving,61,62 other studies have had negative or inconsistent results.39,63,64,65 However, a clinical synthesis66 concluded that there appears to be no evidence for avoiding the use of medication-assisted treatment medications (especially for alcohol use disorder and opioid use disorder) in the treatment of individuals with co-occurring bipolar disorder and SUDs. Psychosocial therapy Psychosocial therapy for co-occurring mental disorders and SUDs tends to involve three main treatment approaches: sequential, parallel, and integrated. With sequential treatment, providers tackle the more serious disorder first and, after that has been brought under control, then address the other disorder. In parallel treatment, the conditions are treated at the same time in different settings. Integrated treatment involves a provider or a team of providers addressing the disorders simultaneously.67 However, integrated care is not simply simultaneously delivered interventions that have been developed for each individual disorder, as if co-occurring disorders were essentially unrelated to the physiology, emotions, and overall life of individuals.39 Truly integrated treatment allows for the treatment of the whole person—including medical and medication issues, mental disorders, and SUD treatment as necessary An Introduction to Bipolar Disorder and Co-Occurring Substance Use Disorders Summer 2016, Volume 15, Issue 2 7 Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover (see the Resources section for more information). In the absence of integrated treatment, collaboration between providers becomes even more important. One type of integrated treatment uses a cognitive– behavioral relapse prevention model that also incorporates elements of individualized interpersonal therapy, the use of psychoeducational materials and group sessions, and involvement with mutualhelp groups (such as Alcoholics Anonymous and Dual Recovery Anonymous).67 Another model for integrated treatment follows basic principles that are represented by the acronym FIRESIDE (Exhibit 2).68 Proponents of a form of integrated treatment called Integrated Group Therapy (IGT) believe that clients with co-occurring bipolar disorder and SUDs should be encouraged to view co-occurrence as a single disorder—“bipolar substance abuse.” Clients are also advised that substance use will worsen their bipolar disorder and that not taking bipolar medication will increase the risk of SUD relapse.67 One study found that the likelihood of achieving at least 1 month of abstinence during treatment was almost twice as high for individuals who participated in IGT compared with individuals who participated in group drug counseling (71.0 percent and 40.0 percent, respectively), and IGT participants were almost three times as likely to remain abstinent during all 3 months of treatment when compared with individuals who participated in group drug counseling (35.5 percent and 13.3 percent, respectively).69 In addition, the IGT participants were more than twice as likely to be both abstinent and free of mood episodes during the last month of treatment when compared with individuals who participated in group drug counseling (45.2 percent and 20.0 percent, respectively). It is also important for clients and professionals to shift the focus from primarily illness and disease to wellness and recovery. An approach focusing on wellness and recovery is strengths based and includes interventions to help clients become proactive in managing their overall health and wellbeing.70 It focuses on reclaiming important aspects of life that were lost when a mental or substance use disorder began, or on discovering these aspects for the first time. The Substance Abuse and Mental Exhibit 2. The FIRESIDE Principles for an Integrated Treatment of Bipolar Disorder and Alcohol Use Disorder68 • Follow-up. The importance of aftercare strongly emphasized. • Interrelationship of diagnoses. Can’t improve in one without treating the other. • Relapse Prevention. The main addiction therapeutic intervention. • Education. Use of lectures, videos, and discussions. • Stabilization of withdrawal and mood. Pharmacotherapy used aggressively during and after the program. • Individuation of program. Flexibility of program to aid retention. • Diagnostic equivalence. Both