Association Between Concurrent Depression and Anxiety and Six-Month Outcome of Addiction Treatment

Charney, Dara A.; Palacios-Boix, Jorge; Negrete, Juan Carlos; Dobkin, Patricia L.; Gill, Kathryn

doi:10.1176/appi.ps.56.8.927

Cited by 53 publications

(50 citation statements)

References 39 publications

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“…Meanwhile, patients with low psychiatric severity showed the most improvement, regardless of treatment modality, and treatment outcome for patients with moderate psychiatric severity varied according to patient-treatment characteristics. More recent studies have replicated these findings, with higher psychiatric severity associated with poorer outcome (Charney et al, 2005;Compton et al, 2003;Greenfield et al, 1998). Psychiatrically ill participants in these studies were likely to drop out of treatment earlier and relapse to substance use sooner than less psychiatrically ill participants.…”

Section: Introductionmentioning

confidence: 62%

Regardless of psychiatric severity the addition of contingency management to standard treatment improves retention and drug use outcomes

Weinstock

Alessi

Petry

2007

Drug and Alcohol Dependence

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The relationship between psychiatric severity and substance use disorders treatment outcome was assessed in 393 individuals who received either standard treatment or standard treatment plus contingency management. The sample was divided into groups of low, moderate, and high psychiatric severity based upon baseline Addiction Severity Index psychiatric composite scores. Participants in the high psychiatric severity group reported a greater prevalence of psychiatric hospitalization, psychiatric medications, and suicide attempts, as well as poorer baseline psychosocial functioning. In terms of treatment outcome, a significant interaction between psychiatric severity and treatment modality was found in relation to treatment retention. Participants in the standard treatment condition were more likely to dropout of treatment earlier as psychiatric severity increased, while retention was similar across the psychiatric severity groups in the contingency management condition. Psychiatric severity was not linked to longest duration of abstinence achieved during treatment or adherence with contingency management procedures. Overall, these findings suggest contingency management is an efficacious and appropriate intervention for substance use disordered individuals across a range of psychiatric problems.

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Section: Introductionmentioning

confidence: 62%

Regardless of psychiatric severity the addition of contingency management to standard treatment improves retention and drug use outcomes

Weinstock

Alessi

Petry

2007

Drug and Alcohol Dependence

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“…Psychiatric conditions are highly prevalent among individuals with SU problems (Alaja et al 1998;Harris and Edlund 2005;Kessler et al 1996;Mendelson et al 1986;Moos, Brennan, and Mertens 1994), and research has found that interventions directed at psychiatric problems during chemical dependency (CD) treatment lead to improved treatment outcomes (Chi, Satre, and Weisner 2006;McLellan et al 1993;Ray, Weisner, and Mertens 2005;Saxon and Calsyn 1995). Psychiatric severity is also a well-established predictor of SU outcomes, quality of life, and subsequent health status (Charney et al 2005;Friedmann et al 2003;Moos, Nichol, and Moos 2002;Ray, Weisner, and Mertens 2005;Ritsher et al 2002;Schaar and Ojehagen 2003).…”

Section: Abstract Longitudinal Substance Use Outcomes; Psychiatric Trmentioning

confidence: 99%

Nine-Year Psychiatric Trajectories and Substance Use Outcomes

Felicia

Weisner

2008

Eval Rev

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This study identifies longitudinal psychiatric trajectories of 934 adult individuals entering chemical dependency treatment in a private, managed care health plan and examines the relationship of these trajectories with substance use (SU) outcomes. The authors apply a group-based modeling approach to identify trajectory groups based on repeated measures of psychiatric severity for 9 years and identify four distinct groups. Results of multivariate logistic generalized estimating equation models find an association between psychiatric trajectories and long-term SU. Older cohorts and life course measures of marital status and employment status as individuals changed over time are related to drug and some alcohol outcomes. Keywords longitudinal substance use outcomes; psychiatric trajectories; group-based modeling; managed care; adult chemical dependency patientsCo-occurring psychiatric and substance use (SU) conditions are a major clinical and policy concern (Havassy, Alvidrez, and Owen 2004;Helzer and Pryzbeck 1988;Kessler et al. 1996;Mertens et al. 2003;Timko, Dixon, and Moos 2005). Psychiatric conditions are highly prevalent among individuals with SU problems (Alaja et al. 1998;Harris and Edlund 2005;Kessler et al. 1996;Mendelson et al. 1986;Moos, Brennan, and Mertens 1994), and research has found that interventions directed at psychiatric problems during chemical dependency (CD) treatment lead to improved treatment outcomes (Chi, Satre, and Weisner 2006;McLellan et al. 1993;Ray, Weisner, and Mertens 2005;Saxon and Calsyn 1995). Psychiatric severity is also a well-established predictor of SU outcomes, quality of life, and subsequent health status (Charney et al. 2005;Friedmann et al. 2003;Moos, Nichol, and Moos 2002;Ray, Weisner, and Mertens 2005;Ritsher et al. 2002;Schaar and Ojehagen 2003).However, research on long-term mental health (MH) outcomes and their relationship with SU outcomes is sparse. An earlier study of the current sample measuring medical service use and cost for 5 years found that psychiatric and medical severity declined steeply in the immediate postintake period but remained stable thereafter, and that psychiatric and medical severity were consistently associated with higher inpatient and emergency room (ER) use over time (Parthasarathy and Weisner 2005). Another study examining cocaine-dependent men and women 5 years following treatment discharge also found reduced levels of psychological (Grella, Joshi, and Hser 2003). A 12-year follow-up study of psychiatric symptomatology among cocaine-dependent men in a Veterans Affairs program found that the Hopkins Symptom Checklist-58 scores for depression, anxiety, obsessivecompulsiveness, and interpersonal sensitivity showed continuous improvement from baseline to 12-year follow-up for those with 5 or more years of cocaine abstinence, whereas those with fewer years of abstinence showed improvement from baseline to 1 year but no significant change from 1 year to 12 years (Herbeck et al. 2006). The findings of these studies suggest an overall...

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“…The lifetime prevalence rates of major depression in the general population are notable, with rates ranging from 13-16% (Kessler et al 2003;Hasin et al 2005), while the rates of major depression in treatment-seeking cocaine abusers are higher, with rates ranging from 15-30% (Rounsaville and Carroll 1991;Kilbey, Breslau and Andreski 1992;Charney et al 2005;McLean et al 1999). Similarly, Kessler et al (2006) found that the rate of adult ADHD in the U.S. population is 4.4%, whereas recent prevalence studies in substance dependent samples seeking treatment have obtained rates ranging from 15-24% (Levin, Evans and Kleber 1998;King et al 1999;Schubiner et al 2000), suggesting that these disorders merit clinical attention in substance abuse treatment settings.…”

Section: Introductionmentioning

confidence: 99%

“…A number of studies show major depression, or psychiatric severity in general, to be associated with poorer substance use outcome or treatment retention (Rounsaville et al 1986;Kosten, Rounsaville and Kleber 1987;Rounsaville et al 1987;Carroll et al 1993;Hasin et al 2002;Greenfield et al 1998;Charney et al 2005;Dodge, Sindelar and Sinha 2005), whereas other studies suggest that there is no negative impact on treatment retention or perhaps even a positive impact of depression on retention in treatment Agosti, Stewart and Quitkin 1991;McKay et al 2002;Siqueland et al 2002;Brown et al 1998). In one review of this literature, Hasin and colleagues (2004) conclude that major depression tends to confer a poor prognosis, while the impact of depressive symptoms, measured with cross-sectional scales, is less clear.…”

Section: Introductionmentioning

confidence: 99%

Effects of major depressive disorder and attention-deficit/hyperactivity disorder on the outcome of treatment for cocaine dependence

Levin¹,

Bisaga²,

Raby³

et al. 2008

Journal of Substance Abuse Treatment

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Co-occurring psychiatric disorders have been associated with poor prognosis among substance dependent patients, but few studies have examined this association among patients with cocaine dependence (CD). Baseline characteristics and treatment outcome were compared between cocainedependent patients with major depression (MDD) (N = 66), attention-deficit/hyperactivity disorder (ADHD) (N = 53), or cocaine dependence without comorbid disorders (CD alone) (N = 48), who had been randomized to the placebo arms of clinical trials of venlafaxine, methylphenidate, and gabapentin, respectively. The three groups differed significantly in racial makeup, with more Caucasians and Hispanics among patients with MDD or ADHD, and more African Americans among those with CD alone. The groups did not differ significantly in treatment retention, with retention rates ranging from 42-47%, or in the rates of achieving 2 consecutive weeks of urine-confirmed abstinence, with rates ranging from 40-50%. Using logistic regression for repeated measures with general estimating equations, modeling the likelihood of a cocaine positive week over time in treatment, diagnostic group was found to interact with the baseline level of cocaine use and time. Among cocaine dependent patients who achieved abstinence at baseline, the groups with MDD or ADHD had better outcome over time than those with CD alone. However, among patients with cocaine positive urines at baseline, MDD or ADHD were associated with poor outcome compared to patients with CD alone. The findings suggest that diagnosis and treatment of co-occurring disorders such as depression and ADHD may be an important component of treatment planning for cocaine dependence, and that baseline level of cocaine use should be included as a covariate in studies evaluating the impact of such treatment.

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Association Between Concurrent Depression and Anxiety and Six-Month Outcome of Addiction Treatment

Abstract: Concurrent depression or anxiety symptoms at intake had a small but significant predictive effect on addiction treatment outcome over and above factors that are clearly known to influence outcome (length of stay in treatment and initial addiction severity).

Cited by 53 publications

References 39 publications

Regardless of psychiatric severity the addition of contingency management to standard treatment improves retention and drug use outcomes

Regardless of psychiatric severity the addition of contingency management to standard treatment improves retention and drug use outcomes

Nine-Year Psychiatric Trajectories and Substance Use Outcomes

Effects of major depressive disorder and attention-deficit/hyperactivity disorder on the outcome of treatment for cocaine dependence

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