Clinical outcomes of an integrated treatment for depression and substance use disorders.

Abstract

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.

Integrated Cognitive Behavioral Therapy Versus Cognitive Processing Therapy for Adults With Depression, Substance Use Disorder, and Trauma

“…We also hypothesized that greater attendance during Phase 2 would be associated with better outcomes and maintenance of treatment gains over time, and thus tested attendance as a moderator. This is consistent with our findings from our prior study providing ICBT and the documented association between treatment dose and outcomes (Lydecker et al, 2010). Finally, we also examined PTSD diagnosis as a moderator in order to examine whether treatment effects and symptom trajectories differed between those with current PTSD and those exposed to trauma without current PTSD.…”

“…ICBT aims to help individuals develop cognitivebehavioral skills that are useful for managing both SUD and depression (e.g., challenging maladaptive cognitions, increasing pleasant activities, building healthier social networks). This treatment was found to be efficacious, with greater attendance associated with more improvement in depression and substance use (Lydecker et al, 2010). Although ICBT successfully reduced substance use and depression symptoms, veterans with a comorbid PTSD diagnosis had worse substance use at the one year follow-up compared to individuals without co-occurring PTSD, despite similar improvements during and immediately following treatment (Norman et al, 2010).…”

“…The ICBT group intervention (Lydecker et al, 2010) included cognitive-behavioral strategies for substance use disorder from the Cognitive-Behavioral Coping Skills Training manual (Kadden et al, 1992), as well as cognitive-behavioral strategies for depression from the Group Therapy Manual for Cognitive-Behavioral Treatment of Depression (Muñoz & Miranda, 1996). The primary focus of treatment was on teaching participants to manage negative cognitions related to depression and substance use, increase pleasurable activities to promote positive mood and reduce substance relapse risk, and build healthy social networks.…”

“…Integrated treatments have been shown to be helpful in reducing symptoms of both disorders (Kay-Lambkin, Baker, Lewin, & Carr, 2009;Lydecker et al, 2010). Studies have also shown high rates of Posttraumatic Stress Disorder (PTSD) in SUD treatment settings (37%: Bonin, Norton, Asmundson, Dicurzio, & Pidlubney, 2000;63%: Stewart, Conrod, Samoluk, Pihl, & Dongier, 2000), depression treatment settings (13%: Felker, Kirchner, Chan, & Rubenstein, 2007; 36%: Carlier, Voerman, & Gersons, 2000), and in co-occurring strongest evidence for addressing PTSD and SUD concurrently rather than in a sequential fashion, and that this approach is also favored by patients (McCauley, Killeen, Gros, Brady, & Back, 2012).…”

“…In our previous research, we developed Integrated Cognitive Behavioral Therapy (ICBT) for treating veterans with both SUD and depression (Lydecker et al, 2010). ICBT aims to help individuals develop cognitivebehavioral skills that are useful for managing both SUD and depression (e.g., challenging maladaptive cognitions, increasing pleasant activities, building healthier social networks).…”