Integrated Group Therapy for Bipolar Disorder and Substance Abuse

Roger D. Weiss, MD, is Professor of Psychiatry at Harvard Medical School and Chief of the Division of Alcohol and Drug Abuse at McLean Hospital in Belmont, Massachusetts. Through his research, international teaching, clinical work, and writings, Dr. Weiss has made significant contributions to the field of substance use disorders, with a particular focus on those individuals with co-occurring psychiatric illness. He has been Principal Investigator on numerous National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism grants, and he recently led a multisite national study of the treatment of prescription opioid dependence as part of the National Institute on Drug Abuse Clinical Trials Network. He has authored over 300 articles and book chapters and has participated in a number of prominent national committees, including serving as vice chair of the American Psychiatric Association Task Force on Practice Guidelines for Patients with Substance Use Disorders. Dr. Weiss is a recipient of the H. David Archibald Award for Outstanding Research and/or Practice in the Addictions from the Centre for Addiction and Mental Health in Toronto. Hilary Smith Connery, MD, PhD, is Clinical Director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital in Belmont, Massachusetts, and Instructor in Psychiatry at Harvard Medical School. Dr. Connery is a clinical researcher who studies innovative behavioral treatments for patients with co-occurring substance use disorders and mental illness. She has special interest in the treatment of patients with opioid dependence and mental illness and has been a recipient of the Eleanor and Miles Shore/Harvard Medical Scholars Fellowship to study this population. She participated as site Principal Investigator on two national studies of buprenorphine treatment of opioid dependence through the National Institute on Drug Abuse Clinical Trials Network, and she is co-investigator on other federally funded clinical research studies addressing substance use treatment in women and medically ill individuals. Dr. Connery also has community psychiatry experience running assertive community treatment teams and studying barriers to recovery among homeless persons. She is currently listed in Best Doctors in America, is a consultant to the Massachusetts Board of Registration in Medicine and the National Football League, and is Area 1 Director for the American Academy of Addiction Psychiatry.

• I. Overview of Integrated Group Therapy 1. An Introduction to Integrated Group Therapy 2. General Principles of Integrated Group Therapy for Co-Occurring Bipolar Disorder and Substance Abuse 3. Therapist Guide for the Integrated Group Therapy Pregroup Interview 4. Conducting an Integrated Group Therapy Session II. Integrated Group Therapy Sessions Session 1. It’s Two against One, but You Can Win! Session 2. Identifying and Fighting Triggers Session 3. Dealing with Depression without Abusing Substances Session 4. Dealing with Family Members and Friends Session 5. Denial, Ambivalence, and Acceptance Session 6. Reading Your Signals: Recognizing Early Warning Signs of Trouble Session 7. Refusing Alcohol and Drugs: Thinking It Through and Knowing What to Say Session 8. Using Self-Help Groups Session 9. Taking Medication Session 10. Recovery versus Relapse Thinking: It Matters What You Do Session 11. Taking Care of Yourself Session 12. Taking the Group with You Appendix A. Rating Adherence and Fidelity: Ensuring That Integrated Group Therapy Is Done Properly Appendix B. Bulletin Board Material Appendix C. Frequently Asked Questions about Integrated Group Therapy

"A valuable clinical resource. Weiss and Connery provide an excellent guide to the nature of bipolar disorder and substance abuse, their interactions, and the role of group therapy in fostering recovery. The practicalities of implementing the approach are succinctly described, including the logistics of setting up and running group sessions. The heart of the book lies in its clear, step-by-step explication of each session. This book is destined to become a classic in the treatment of dual disorders. It deserves to be on the shelf of any clinician working with this challenging population."--Kim T. Mueser, PhD, Department of Occupational Therapy, Department of Psychological and Brain Sciences, and Center for Psychiatric Rehabilitation, Boston University"Bipolar disorder complicated by substance abuse is an enormous clinical challenge. This book presents timely and clinically relevant information that will be of extraordinary value to any clinician interested in learning about and treating individuals who have both disorders. This is a readily understandable, well-organized, and practical 'how-to' guide to one of the most efficacious treatments available for individuals with co-occurring substance abuse and psychiatric disorders."--Kathleen T. Brady, MD, PhD, Distinguished University Professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina"This is a much-needed and all-too-rare contribution--a practical, compelling, and clinically focused description of a true evidence-based approach. Weiss and Connery offer extensive clinical wisdom and practical advice for addressing an enormously challenging and underserved group of patients. Moreover, their brief group approach is highly flexible and can be used in a range of clinical settings. It will set the standard for integrated treatment of substance use and psychiatric disorders."--Kathleen M. Carroll, PhD, Department of Psychiatry, Yale University School of Medicine "Combining craft and science, the approach in this book will help you and your students deliver effective treatment to an often-neglected, deeply troubled population. The book is clearly written and evidence based. It includes essential tools for motivating your patients and helping them adhere to their abstinence and treatment adherence goals, 'no matter what.'"--Richard J. Frances, MD, Department of Psychiatry, New York University School of Medicine- The introductory chapters are a kind of primer. The practitioner is given an overview of addictions and bipolar disorder, as well as CBT. This includes a crisp review of symptoms for each disorder, their attendant behaviors, approximate ages of onset, steps to recovery, and signs of relapse. For less experienced clinicians, or for those in need of some review, these chapters are particularly helpful and beautifully rewritten....The workbook is extremely thorough in that it provides the worker with alternative ways to present the information and process the handouts. In so doing, group workers will have a variety of ways to reach group members with differing learning styles. The lesson, the group process, the handouts, and homework assignments enable group members to apply the content they have just learned to situations they are likely to encounter in their lives outside of the group....In addition to the handouts that are included for group members' use, there are additional worksheets provided and a collection of 'bulletin boards' for the worker's use. These can be posted as a vehicle for discussions....One of the most interesting resources that the workbook provides is a template for program evaluation....An exceptional resource for practitioners and clients alike. Workers who are not trained specifically as cognitive-behavioral therapists or addictions specialists, and novice group workers will find the curriculum very accessible, as the authors have given them every tool they might need. I recommend this workbook for use in partial hospital programs, and outpatient mental health and substance abuse recovery and relapse prevention groups. I also recommend it for use in graduate-level training programs in courses that teach Assessment and Diagnosis, Cognitive Behavioral Therapy, Advanced Group Work, and as an adjunct to Mindfulness Based Stress Reduction, which can be part of an exceedingly effective relapse prevention plan. --Social Work with Groups, 3/13/2011ƒƒ The book is designed for mental health and drug and alcohol counsellors or clinicians. It does not require prior group therapy facilitation experience as it gives step-by-step advice and guidance for implementation....It is particularly heartening to see the inclusive approach: participants may join the open group format in various stages of preparedness or motivation for change....I plan to use the IGT manual for treatment groups as well as for teaching trainee facilitators....A welcome addition to a limited number of practical, integrated treatment manuals for therapy for people with co-occurring mental illness and substance abuse disorders. --Drug and Alcohol Review, 3/13/2011