No abstract

ClinicalTrials.gov identifier: NCT01693874.

The authors examined life stress and self-efficacy as predictors of time to relapse for 113 adults with comorbid major depressive disorder and alcohol and/or substance dependence in a randomized clinical trial comparing 2 psychotherapy interventions (integrated cognitive- behavioral therapy and 12-step facilitation therapy). Life stress, self-efficacy, and substance use were assessed at treatment entry, 12 weeks (mid-treatment), and 24 weeks (end of treatment). Time to relapse was defined as the number of days from treatment initiation until first alcohol and/or drug use. Half of the sample relapsed within the study period of 24 weeks. There was no significant difference between treatment groups. Individuals experiencing life stressors were more likely to relapse early than those not experiencing life stressors. Lower self-efficacy also predicted earlier relapse. Chronic stress levels and self-efficacy were stable across time for most individuals. In contrast, acute stress events occurred at differing times, and survival analyses provided evidence of heightened relapse risk in the month following acute stressors. The interaction of self-efficacy and life stress was not significant. The results highlight the significance of life stress and self-efficacy as predictors of early relapse.

The present study compared longitudinal treatment outcomes for depressed substance-dependent veterans (N=206) assigned to Integrated Cognitive Behavioral Therapy plus standard pharmacotherapy (ICBT+P) or Twelve Step Facilitation Therapy plus standard pharmacotherapy (TSF+P). Drug and alcohol involvement and depressive symptomology were measured at intake and at three-month intervals during treatment and up to one year post-treatment. Participants in both treatment conditions showed decreased depression and substance use from intake. ICBT+P participants maintained improvements in substance involvement over time whereas TSF+P participants had more rapid increases in use in the months following treatment. Decreases in depressive symptoms were more pronounced for TSF+P than ICBT+P in the six months post-treatment. Within both treatment groups, higher attendance was associated with improved substance use and depression outcomes over time. Initial levels of depressive symptomology had a complex predictive relationship with long-term depression outcomes. Early treatment response predicted long-term substance use outcomes for a portion of the sample. Although both treatments were associated with improvements in substance use and depression, ICBT+P may lead to more stable substance use reductions compared to TSF+P.