Depressed mood often co-exists with frequent drug and alcohol use. This trial examined the feasibility of screening, recruitment, randomization and engagement of drug and alcohol users in psychological interventions for depression symptoms. A total of 50 patients involved in community drugs and alcohol treatment (CDAT) were randomly allocated to behavioral activation delivered by psychological therapists (n = 23) or to cognitive behavioral therapy based self-help introduced by CDAT workers (n = 27). We examined recruitment and engagement rates, as well as changes in depression (PHQ-9) symptoms and changes in percent days abstinent (PDA within last month) at 24 weeks follow-up. The ratio of screened to recruited participants was 4 to 1, and the randomization schedule successfully generated 2 groups with comparable characteristics. Follow-up was possible with 78% of participants post-treatment. Overall engagement in psychological interventions was low; only 42% of randomized participants attended at least 1 therapy session. Patients offered therapy appointments co-located in CDAT clinics were more likely to engage with treatment (odds ratio = 7.14, p = .04) compared to those offered appointments in community psychological care clinics. Intention-to-treat analyses indicated no significant between-group differences at follow-up in mean PHQ-9 change scores (p = .59) or in PDA (p = .08). Overall, it was feasible to conduct a pragmatic trial within busy CDAT services, maximizing external validity of study results. Moderate and comparable improvements in depression symptoms over time were observed for participants in both treatment groups.

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Purpose – The purpose of this paper is to explore addiction service users’ experiences of psychological interventions for depression symptoms, with an emphasis on understanding obstacles to engage with treatment. Design/methodology/approach – This was a thematic analysis of semi-structured interviews with ten people who took part in a randomised controlled trial of cognitive and behavioural interventions; four of whom never engaged with treatment. Findings – Five prominent obstacles to access therapy were: memory deficits, becoming overwhelmed by multiple demands and appointments, being housebound due to fluctuations in mental health problems, tendency to avoid the unfamiliar, and contextual life problems related to deprivation and social conflict. Research limitations/implications – The authors note some possible limitations related to overreliance on telephone interviews and interviewers’ field notes. The authors discuss the findings in light of epidemiological research, cognitive, behavioural and motivational enhancement theories. Practical implications – The authors propose it is important to recognise and address multiple obstacles to therapy. Offering therapy appointments that are co-located within addiction services and time-contingent to other social/medical interventions may help to address some of these obstacles. Originality/value – The present qualitative results complement the prior experimental research and enrich the understanding of how to maximise engagement with psychological interventions.