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Exploring experiences of substance use in bipolar disorder: A Q methodological design

Black, Nancy

[Thesis]. Manchester, UK: The University of Manchester; 2011.

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Abstract

Background: There is a high level of substance use disorder (SUD) in individuals with bipolar disorder (BD). Substance use may have profound effects on the course and outcome of BD however to date the reason for this common co-occurrence is unclear. Aims: To examine the substance use experiences of individuals with BD with particular emphasis on the self reported reasons for, and after-effects of use.Method: Q methodology was employed to explore substance use experiences. A pool of substance use experiences was derived from three sources: a literature search of self reported reasons for use studies; a set of semi-structured interviews carried out for a qualitative study exploring reasons for substance use in BD (Healy, Peters, Kinderman, McCracken & Morriss, 2009), and therapy tapes from a pilot study of integrated psychological treatment for substance use in BD (Jones et al, in press). This pool was divided into two sets of experiences: reasons for, and after-effects of substance use. Individuals with BD (n = 50) and current alcohol and/or cannabis use were asked to complete the two Q sorts. Participants were recruited from mental health services and support groups in the North West of England.Results: Analysis of reasons for use revealed two distinct groups of substance users: those who used substances predominantly in relation to mood regulation and those who used substances socially. Analysis of the after-effects sort revealed three distinct groups of experiences: those who reported mainly positive after-effects of substance use, those who reported mainly negative after-effects of substance use and those who endorsed after-effects in relation with feeling high or intoxicated.Conclusions: Individuals with BD report idiosyncratic experiences of substance use; a subgroup of individuals appear to report use in direct relation to symptoms of BD. The establishment of subgroups of individuals reporting differences in reasons for and after-effects of substance use may be relevant in designing therapeutic interventions to support the reduction of substance use in this clinical group.