Mental Health Care Aids Substance Abuse Treatment

Mental Health Care Aids Substance Abuse Tx
Family Practice News

Volume 40, Issue 20, Pages 60-61 (December 2010)



Major Finding: BDI-II scores decreased by an additional 6.3 points after 3 months and 4.6 points after 6 months in the intervention group, compared with usual care.

Data Source: A quasi-experimental study with 299 participants.

Disclosures: Dr. Watkins reported having no financial conflicts of interest regarding this study.

BOSTON — Integrating cognitive behavioral therapy for depression with residential substance abuse treatment leads to improvements in mood and substance use outcomes in clients with persistent depressive symptoms, a study has shown.

The findings support the delivery of evidence-based mental health care within substance abuse treatment programs, Dr. Katherine Watkins said at the meeting.

Depression often goes hand in hand with substance abuse, yet few individuals in public-sector substance abuse treatment facilities have access to effective depression treatment, according to Dr. Watkins, senior natural scientist at RAND in Santa Monica, Calif.

To determine whether integrating cognitive behavioral therapy (CBT) for depression into the usual-care cognitive model for substance use would improve outcomes in residential substance abuse treatment, she and her colleagues conducted a quasi-experimental study to compare the efficacy of a 16-session, evidence-based CBT intervention plus usual care to that of usual care alone in 299 clients (age range, 18-63 years) with depression being treated in a single public-sector residential alcohol or other drug (AOD) treatment center.

The primary and secondary outcome measures were, respectively, depressive symptoms as measured by the Beck Depression Inventory II (BDI-II) and improved functioning measured by the Short Form 12 (SF-12) health survey at 3 and 6 months after intervention relative to baseline. All patients had baseline BDI-II scores greater than 17 (mean total was 33.5, indicating scores in the clinically severe range), she said.

Of the 299 study participants, 140 received usual care and the group CBT intervention – Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) – delivered by a trained substance abuse treatment counselor; and 159 received usual care.

The CBT program included discussions of the connection between mood and substance use and provided strategies for identifying and modifying harmful thoughts, activities, and interactions with people related to both mood and substance use.

To be consistent with CBT, each session had a prescribed agenda of announcements, practice (homework) review, new topics, key messages, assignment of new practice, client feedback, and a description of the next session. New topics were reinforced by embedding interactive activities, such as writing down harmful thoughts the last time they wanted to drink, into each session.

At 3- and 6-month follow-ups, the BDI-II scores decreased by an additional 6.3 and 4.6 points in the BRIGHT group compared with usual care, and the SF-12 scores increased by 6.3 and 4.6 points, respectively, Dr. Watkins reported. “BRIGHT clients reported fewer drinking days and fewer days of problem substance use at 6 months,” she noted.

Group CBT for depression appears to be effective for persistent depression in individuals undergoing treatment for substance use disorders. “The results provide support for a new model of integrated care, in which access to effective depression treatment is increased and outcomes improved by developing the capacity of substance abuse treatment programs to deliver evidence-based mental health care,” she said.