Brief reportOutcomes of an integrated cognitive behaviour therapy (CBT) treatment program for co-occurring depression and substance misuse in young people
Introduction
While co-occurring substance use disorders (SUDs) among young people with depression are associated with poorer treatment course and outcomes (Baker et al., 2007, Lubman et al., 2007), studies of cognitive behaviour therapy (CBT) for adolescent depression typically exclude individuals with drug and alcohol problems, despite growing evidence for their efficacy in the treatment of SUDs (Waldron and Kaminer, 2004). The use of integrated CBT for co-occurring disorders has recently been proposed, with preliminary evidence for its effectiveness in alcohol and substance dependent adolescents and adults with co-occurring depression in combination with antidepressant treatment (Brown et al., 1997, Moak et al., 2003, Riggs et al., 2007). However, no studies have examined the effectiveness of integrated CBT interventions without adjunctive pharmacotherapy. The aim of the current study was to determine the effectiveness of integrated CBT for co-occurring depression and substance misuse in young people presenting to a youth mental health service. It was hypothesised that the integrated intervention would be associated with improvements in substance use, mood and functional outcomes.
Section snippets
Participants
Sixty young people (aged 15–25), with a DSM-IV diagnosis of Major Depressive Disorder (MDD) and concurrent SUD or risky alcohol/drug use (defined as weekly illicit drug use in the month prior to referral, or alcohol consumption exceeding the Australian National Health and Medical Research Council guidelines (males, > 5 standard drinks (STD) per day and/or > 7 STD on any day; females, > 3 STD per day and/or > 5 STD on any day) were recruited from Orygen Youth Health (OYH), Melbourne, Australia (see
Participation and attrition
Eight young people refused to participate in the study. The mean number of weeks that young people attended treatment was 11.6 (SD = 6.8, min = 1, max = 28). Almost 70% (n = 41) attended CBT treatment for 10 weeks or completed the content of 10 sessions of CBT treatment. Attrition was related to a failure to engage in treatment (n = 11), clinical improvement (n = 2), development of psychotic symptoms (n = 2) or inability to contact the young person (n = 4). There were no significant differences between
Symptom and substance use outcomes
CBT was associated with significant improvements in young people's depression, anxiety and social and occupational functioning, consistent with previous research in populations with co-occurring depression and alcohol misuse (Brown et al., 1997, Moak et al., 2003). Integrated CBT resulted in significant reductions in the presence and number of SUDs, substance use (particularly cannabis and other drug use), the severity of dependence on substances as well as increased days of abstinence at week
Role of funding source
Leanne Hides and Dan Lubman are supported by the Colonial Foundation. This study was completed with the assistance of funding from Pfizer Australia and the Australian Government Department of Health and Ageing, National Illicit Drugs Strategy (NIDS). These funding bodies had no involvement in the design or conduct of the study, or in the collection, analysis or interpretation of data or preparation of the manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
The authors would like to acknowledge the assistance of Steve Mathias, Nick Allen, Patricia DiParsia, Cathy Greenwood-Smith and Kristen Tulloch for their assistance with the conduct of the study.
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