Integrated Group Therapy for Bipolar Disorder and Substance Abuse is essentially a treatment manual. It describes a programme for the treatment of co‐morbid bipolar and substance use disorders in which both disorders are treated simultaneously. The central theme of the book, that of treating bipolar and substance misuse disorder as a single entity (“bipolar substance misuse”), is particularly pertinent at the moment, given the increasing range of providers within the UK treatment system: many drug and alcohol treatment services are provided within the non‐statutory sector, while adult mental health services generally remain with the National Health Service. While there are a number of books relating to the treatment of dual diagnosis from a theoretical basis, there are far fewer practical, “how‐to” guides focusing on psychotherapeutic treatment in any modality for those with dual disorders.
The book is in two parts. The first, an “Overview of integrated group therapy” covers general principles of working with those with bipolar and substance use disorders. For those who have worked in the substance misuse field for some years, the overview of bipolar disorder is particularly helpful in refreshing core knowledge. Equally useful is the clear linkage between the mental states in bipolar disorder that may challenge recovery in substance misuse disorders and the “focus on commonalities” in the two disorders during recovery and relapse: this, I would imagine, is intrinsically appealing to service users wishing to access a holistic approach to their treatment.
The focus on the commonalities is maintained throughout the second part of the book which is dedicated to 12 integrated group therapy sessions. The “central recovery rule” (“no matter what, don't drink, don't take drugs and take your medication as prescribed – no matter what”) is revisited at every session. The sessions provide structured, comprehensive coverage of a large number of issues which are common to both bipolar and substance use disorders, explained in a thought‐provoking manner. For example, in the session on “Dealing with depression without abusing substances”, negative cognitions are linked with an increased risk of substance use via clear, everyday scenarios in a way that is likely to resonate with the service user.
In terms of therapeutic practicalities, the sessions are designed as “stand‐alone” and can thus be delivered as either an open or closed programme. The authors specifically state that integrated group therapy in this context is designed to be used in conjunction with medication rather than instead of medication, which will undoubtedly improve the feasibility of adopting such a treatment programme with this complex service user group.
Integrated Group Therapy for Bipolar Disorder and Substance Abuse is written within the context of the US treatment system which differs markedly from that in the UK. This highlights one of the limitations of applying this treatment modality and hence of the book. In the UK, funding streams for substance misuse and mental health services, along with an increasing plurality of providers, has tended to divide the services and there can be considerable challenges in working with both. Additionally, there are demographic differences: the number of bipolar service users within the semi‐urban/rural substance misuse services where I work may be too few to regularly run such a programme. Community mental health services are much more likely to have sufficient numbers of bipolar substance misusers to make this treatment modality viable. If resource and commissioning challenges can be overcome, this model of treatment may provide an opportunity for both services to work holistically with this service user group.
Aside from the challenges provided by service provision, the book contains a number of interesting tools and a style of working that certainly challenges traditional models of group therapy, where the process of therapy is viewed through either the lens of mental illness or of substance misuse. Many of the handouts/models proposed can be utilised to the more common cohort seen in UK drug services – those with substance misuse disorders, emotionally unstable/impulsive personality traits and intermittent depressive symptomatology – and the content of the sessions can be adapted/incorporated into more standard substance misuse group programmes.
From a personal perspective, this book has encouraged me to think more flexibly in terms of exploring the potential for integrated group therapy in the inpatient and community services, as well as service development with other partnership agencies. It has also broadened the range of therapeutic interpretations, ideas and tools I can offer as part of each individual clinical encounter I have. Both of these outcomes are highly desirable in improving overall service user care.
