Between 40% and 70% of people with bipolar disorder have a history of substanceuse disorder. A current or past comorbid substance use disorder may lead toworse outcomes for bipolar disorder, including more symptoms, more suicideattempts, longer episodes, and lower quality of life. Unfortunately, fewtreatments have been studied in patients with both illnesses, and largecontrolled trials are needed. Evidence from small studies suggests that sometreatments proven for bipolar disorder (e.g., divalproex, lithium, quetiapine,lamotrigine, and psychotherapy) may decrease substance abuse or dependence. Boththe bipolar disorder and the substance use disorder should be considered whendetermining the best management strategy. Once treatment has begun, cliniciansshould ensure that medication and psychotherapy are administered appropriatelyand that treatment is modified when there is inadequate response.
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