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The initial onset of bipolar disorder occurs in childhood or adolescence in about 50% of patients. Early-onset forms of the disorder have a poorer prognosis than adult-onset forms and are frequently characterized by comorbid substance abuse. Clinical trials research suggests that family psychoeducational approaches are effective adjuncts to medication in stabilizing the symptoms of bipolar disorder in adults and youth, although their efficacy in patients with comorbid substance use disorders has not been systematically investigated. This article describes the family-focused treatment (FFT) of a late adolescent with bipolar disorder and polysubstance dependence. The treatment of this patient and family required adapting FFT to consider the family's structure, dysfunctional alliance patterns, and unresolved conflicts from early in the family's history. The case illustrates the importance of conducting manual-based behavioral family treatments with a psychotherapeutic attitude, including addressing unstated emotional conflicts and resistances that may impede progress.

Original publication




Journal article


J Clin Psychol

Publication Date





502 - 513


Adolescent, Antimanic Agents, Bipolar Disorder, Caregivers, Combined Modality Therapy, Communication, Diagnosis, Dual (Psychiatry), Expressed Emotion, Family Therapy, Female, Humans, Lithium Carbonate, Male, Medication Adherence, Models, Psychological, Parent-Child Relations, Problem Solving, Recurrence, Rehabilitation, Vocational, Risk Factors, Substance-Related Disorders