A Randomized Controlled Trial of Cognitive-Behavioral Treatment for Depression Versus Relaxation Training for Alcohol-Dependent Individuals With Elevated Depressive Symptoms

Abstract

ABSTRACT. Objective: A previous pilot study found positive outcomes among alcohol-dependent individuals with elevated depressive symptoms who received cognitive-behavioral treatment for depression (CBT-D; n = 19) compared with a relaxation training control (RTC; n = 16). The current study represents a replication of this pilot study using a larger sample size and a longer follow-up assessment period. Method: Patients entering a partial hospital drug and alcohol treatment program who met criteria for alcohol dependence and elevated depressive symptoms (Beck Depression Inventory score ≥ 15) were recruited and randomly assigned to receive eight individual sessions of CBT-D (n = 81) or RTC (n = 84). Results: There were signifi cant improvements in depressive and alcohol use outcomes over time for all participants.Compared with RTC, the CBT-D condition had signifi cantly lower levels of depressive symptoms, as measured by the Beck Depression Inventory, at the 6-week follow-up. However, this effect was inconsistent because there were no differences in the Modifi ed Hamilton Rating Scale for Depression between conditions at that time point and there were no signifi cant differences at any other follow-up. No signifi cant between-group differences on alcohol use outcomes were found. Conclusions: The current fi ndings did not replicate the positive outcomes observed in the CBT-D condition in our previous pilot study. Possible explanations for why these fi ndings were not replicated are discussed, as are theoretical and clinical implications of using CBT-D in alcohol treatment. (J. Stud. Alcohol Drugs, 72, 286-296, 2011)

Depression in patients with alcohol use disorders: Systematic review and meta-analysis of outcomes for independent and substance-induced disorders

“…There was also evidence that SID is not a stable diagnosis, with about one quarter of patients initially labelled with SID meeting criteria for ID within the next 12 months (R. A. Brown, et al, 2011). No studies demonstrated that patients with SID show more improvement in depression than those with ID if they reduce drinking.…”

“…Brown, et al, 2011) directly compared depression outcomes between ID and SID subjects. Brown et al (2011) reported ID was associated with significantly poorer depression outcomes than SID for both treatment arms. However the study also demonstrated that about one in four subjects initially diagnosed with SID had ongoing major depression during a 4-week abstinence during follow-up, thereby meeting criteria for ID.…”

“…High heterogeneity (Q=14.05, df=2, p<.001, I 2 =86%) persisted in the low baseline depression severity studies (n=3). Nine studies reported depression scores at multiple follow-up timepoints (Altintoprak, et al, 2008;R. A.…”

“…Brown, et al, 2011). In this trial, depression was categorised as independent or substance-induced at baseline.…”

Brief web-based intervention for college students with comorbid risky alcohol use and depressed mood: Does it work and for whom?

“…Geisner et al, 2006) as well as combined treatment (Baker et al, 2014; Riper et al, 2014). However additional alcohol studies utilizing a similar type of intervention approach had less than optimal or mixed findings (Brown et al, 2011; Lysaught et al, 2003; Merrill, 2014). Specifically, some studies observed significant reductions in drinking but not negative consequences (e.g., Larimer et al, 2007; Walters et al, 2007), and others found no significant differences on any alcohol outcomes (e.g., Neal & Carey, 2004).…”