Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

Abstract

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.

Initiation and retention in couples outpatient treatment for parents with drug and alcohol use disorders.

“…In contrast, Delgadillo et al (2015) found only 42% of participants who met criteria for substance abuse and potentially met criteria for depression and consented to take part in an intervention study, actually attended at least one treatment session. After combining rates across eight studies, Kelly et al (2004) argued that for every 100 callers attending the first treatment session, between 26 and 46 will actually attend their first treatment session.…”

Suicide among people treated for drug use disorders: a Danish national record-linkage study

“…There is growing evidence that patients with DUD who experience mental health problems may be helped by interventions that are integrated with substance abuse treatment. At least one meta-analysis [45], as well as more recent clinical trials [46][47][48], indicate that both mental health problems and substance use disorders are receptive to psychotherapy as a mode of treatment. Evidence from large-scale trials indicate that integrated services for people with co-morbid substance use disorders and mental health problems can be implemented in routine clinical settings [49].…”

Why run the risk? Motivation for offences by patients with substance use and antisocial personality disorders which they rated as most risky to their own well‐being

“…Study participants were selected from 175 patients who participated in a pragmatic randomised trial (Watkins et al, ; Delgadillo et al, ) to test the efficacy of a brief psychoeducational intervention for ASPD – the Impulsive Lifestyle Counselling program as a supplement to standard substance abuse treatment in an outpatient context (see also Thylstrup et al, , ; Thylstrup & Hesse, ). The trial took place between January 2012 and June 2014 at 13 public outpatient substance abuse treatment services in Denmark.…”