Also consistent with Hypothesis 2, psychiatric morbidity was positively associated with the likelihood of self-help program participation. Specifically, ASPD and bipolar disorder, although unrelated to cocaine dependence treatment utilization, were positively related to self-help participation. The relationship of both bipolar disorder and ASPD with one index of cocaine dependence severity—the extent of use in the period of heaviest cocaine use—suggests that heavy cocaine use may be a link between these disorders and self-help participation. However, individuals with comorbid cocaine dependence and ASPD or bipolar disorder may not be identified (or self-identify) as being in need of cocaine dependence treatment. Thus, self-help may be a means to obtain support for sobriety in relation to cocaine use that may be more acceptable, or more often recommended or required, for cocaine dependent individuals who also have ASPD or bipolar disorder. Given the initial evidence of efficacy of psychological treatments for comorbid cocaine dependence and bipolar disorder or ASPD, it may be important to encourage cocaine dependence self-help programs to provide educational information or materials about evidence-based treatment options for comorbid cocaine dependence and
