Outcomes of an integrated cognitive behaviour therapy (CBT) treatment program for co-occurring depression and substance misuse in young people

doi:10.1016/j.jad.2009.06.002

Journal of Affective Disorders

Volume 121, Issues 1–2, February 2010, Pages 169-174

https://doi.org/10.1016/j.jad.2009.06.002 Get rights and content

Abstract

Background

There are high rates of co-occurring depression among young people with substance use disorders. While there is preliminary evidence for the effectiveness of integrated cognitive behaviour therapy (CBT) in combination with antidepressants among alcohol and substance dependent adolescents and adults with co-existing depression, no studies have examined the effectiveness of integrated CBT interventions in the absence of pharmacotherapy. The aim of the current study was to determine the outcomes of an integrated CBT intervention for co-occurring depression and substance misuse in young people presenting to a mental health setting.

Methods

Sixty young people (aged 15 to 25), with a DSM-IV diagnosis of Major Depressive Disorder and concurrent substance misuse (at least weekly use in the past month) or disorder were recruited from a public youth mental health service in Melbourne, Australia. Participants received 10 sessions of individual integrated CBT treatment delivered with case management over a 20-week period.

Results

The intervention was associated with significant improvements in depression, anxiety, substance use, coping skills, depressive and substance use cognitions and functioning at mid- (10 weeks) and post- (20 weeks) treatment. These changes were maintained at 6 months follow-up (44 weeks).

Conclusions

These results provide preliminary evidence for the effectiveness of the integrated CBT intervention in young people with co-occurring depression and substance misuse. Further studies using randomised controlled designs are required to determine its efficacy.

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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Brief reportOutcomes of an integrated cognitive behaviour therapy (CBT) treatment program for co-occurring depression and substance misuse in young people

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Participants

Participation and attrition

Symptom and substance use outcomes

Role of funding source

Conflict of interest

Acknowledgements

Journal of the American Academy of Child and Adolescent Psychiatry

Journal of Affective Disorders

Impact of co-occurring substance use on 6 month outcomes for young people seeking mental health treatment

Australian & New Zealand Journal of Psychiatry

Cognitive-behavioural treatment for depression in alcoholism

Journal of Consulting & Clinical Psychology

Integrated cognitive behaviour therapy (CBT) for co-occurring substance use and major depression: lessons from a youth mental health service

Australasian Psychiatry

The psychometric characteristics of the Hamilton Depression Inventory

Journal of Personality Assessment

Assessment of multidimensional coping: task, emotion, and avoidance strategies

Psychological Assessment

The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users

Addiction

Move over ANOVA. Progress in analyzing repeated-measures data and its reflection

Archives of General Psychiatry

Brief report
Outcomes of an integrated cognitive behaviour therapy (CBT) treatment program for co-occurring depression and substance misuse in young people