Case Series: Simultaneous Use of Long-Acting Injectable Antipsychotics and Vivitrol or Long-Acting Buprenorphine in Dual Diagnosis Patients with Bipolar Disorder and Substance Use Disorders

Background: Co-occurring substance use disorders and bipolar disorder present treatment challenges including poor medication adherence, increased relapse rates, and complex symptom interactions. This case series evaluates the feasibility and outcomes of concurrent long-acting injectable (LAI) antipsychotics with LAI naltrexone (Vivitrol) or buprenorphine (Sublocade). Methods: Retrospective chart review of patients receiving dual LAI therapy at an addiction psychiatry clinic from January 2016 through December 2020. Inclusion criteria: adults ⩾ 18 years receiving concurrent LAI antipsychotic plus LAI addiction medication for ⩾ 3 months. All data were de-identified in accordance with HIPAA Safe Harbor standards and confirmed by Department. Patient consent was obtained. Per Northwell Health Institutional Review Board policy, approval for case series with fewer than 4 patients was not required. Results: Three patients with bipolar I disorder and polysubstance use disorders (opioids, cocaine, benzodiazepines) were identified. Medication combinations included paliperidone palmitate with Sublocade (n = 2) and aripiprazole lauroxil with Sublocade (n = 1). All three patients demonstrated clinical improvement: one achieved excellent response with sustained remission of both psychiatric and substance use symptoms; two showed partial response with reduced opioid use (though cocaine use remained problematic in one patient). No severe adverse effects occurred. All patients received adjunctive acceptance and commitment therapy. Conclusions: Simultaneous use of LAI antipsychotics with Vivitrol or Sublocade demonstrated feasibility and utility, with all patients showing benefit. This combination approach may be particularly valuable for patients with poor medication adherence. Preliminary findings support the need for controlled research to establish optimal patient selection criteria, medication combinations, and predictors of treatment response.