Cognitive-behavioral treatment for depression in alcoholism

Butler Hospital-Brown University School of Medicine, Providence, Rhode Island 02906, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 10/1997; 65(5):715-26. DOI: 10.1037/0022-006X.65.5.715
Source: PubMed

ABSTRACT Alcoholics with depressive symptoms score > or = 10 on the Beck Depression Inventory (A.T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) received 8 individual sessions of cognitive-behavioral treatment for depression (CBT-D, n = 19) or a relaxation training control (RTC; n = 16) plus standard alcohol treatment. CBT-D patients had greater reductions in somatic depressive symptoms and depressed and anxious mood than RTC patients during treatment. Patients receiving CBT-D had a greater percentage of days abstinent but not greater overall abstinence or fewer drinks per day during the first 3-month follow-up. However, between the 3- and 6-month follow-ups, CBT-D patients had significantly better alcohol use outcomes on total abstinence (47% vs. 13%), percent days abstinent (90.5% vs. 68.3%), and drinks per day (0.46 vs. 5.71). Theoretical and clinical implications of using CBT-D in alcohol treatment are discussed.

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Available from: Richard A Brown, Dec 19, 2014
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    • "Traditional CBT approaches have also been successful in treating co-occurring depression and substance use disorders (Hides et al. 2010). Furthermore, CBT treatment for depression alone in alcoholics has produced better reductions in somatic depressive symptoms and depressed and anxious mood than standard alcohol treatment and also better alcohol related outcomes between 3 and 6 months follow-up (Brown et al. 1997). There are only a few reported studies concerning the effects of co-varying problem gambling and other psychopathology on CBT outcomes. "
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    ABSTRACT: This study evaluated the influence of 12-month affective and anxiety disorders on treatment outcomes for adult problem gamblers in routine cognitive-behavioural therapy. A cohort study at a state-wide gambling therapy service in South Australia. Primary outcome measure was rated by participants using victorian gambling screen (VGS) 'harm to self' sub-scale with validated cut score 21+ (score range 0-60) indicative of problem gambling behaviour. Secondary outcome measure was Work and Social Adjustment Scale (WSAS). Independent variable was severity of affective and anxiety disorders based on Kessler 10 scale. We used propensity score adjusted random-effects models to estimate treatment outcomes for sub-populations of individuals from baseline to 12 month follow-up. Between July, 2010 and December, 2012, 380 participants were eligible for inclusion in the final analysis. Mean age was 44.1 (SD = 13.6) years and 211 (56 %) were males. At baseline, 353 (92.9 %) were diagnosed with a gambling disorder using VGS. For exposure, 175 (46 %) had a very high probability of a 12-month affective or anxiety disorder, 103 (27 %) in the high range and 102 (27 %) in the low to moderate range. For the main analysis, individuals experienced similar clinically significant reductions (improvement) in gambling related outcomes across time (p < 0.001). Individuals with co-varying patterns of problem gambling and 12 month affective and anxiety disorders who present to a gambling help service for treatment in metropolitan South Australia gain similar significant reductions in gambling behaviours from routine cognitive-behavioural therapy in the mid-term.
    Journal of Gambling Behavior 05/2014; DOI:10.1007/s10899-014-9465-2 · 1.28 Impact Factor
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    • "Depression in community populations is associated with premature drop-out from addiction treatment (Brown, 1997). With few exceptions (Carroll et al., 1995; Gerra et al., 2006), depression is also associated with poorer prognosis in community addiction treatment (Bottlender and Soyka, 2005; Brown et al., 1997, 1998; Kosten et al., 1986; McKay et al., 2002; O'Sullivan et al., 1988; Richardson et al., 2008; Rounsaville et al., 1987, 1986a, 1986b; Thase et al., 2001), despite higher treatment motivation (Joe et al., 1995; McKay et al., 2002; see also Rounsaville, 2004). In correctional populations, MDD and depressive symptoms strongly predict dropout from correctional substance use programs (Brady et al., 2004; Gray and Saum, 2005; Hickert et al., 2009; Hiller et al., 1999) and poorer addiction treatment outcomes (Johnson et al., 2011b). "
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    ABSTRACT: This study, the largest randomized controlled trial of treatment for major depressive disorder (MDD) in an incarcerated population to date, wave-randomized 38 incarcerated women (6 waves) with MDD who were attending prison substance use treatment to adjunctive group interpersonal psychotherapy (IPT) for MDD or to an attention-matched control condition. Intent-to-treat analyses found that IPT participants had significantly lower depressive symptoms at the end of 8 weeks of in-prison treatment than did control participants. Control participants improved later, after prison release. IPT's rapid effect on MDD within prison may reduce serious in-prison consequences of MDD.
    Journal of Psychiatric Research 06/2012; 46(9):1174-83. DOI:10.1016/j.jpsychires.2012.05.007 · 4.09 Impact Factor
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    • "It therefore remains unclear whether pharmacological or other treatments targeted to co-occurring MDD impact SUD outcomes. However, adolescents whose depression remitted did have a significant reduction in drug use compared with those whose depression did not remit, regardless of whether taking fluoxetine or placebo (Riggs et al., 2007), which is consistent with findings in adults (Brown et al., 1997). A recent RCT of psychostimulant medication (osmotic release methylphenidate, OROS-MPH) was conducted in adolescents (n = 303) with ADHD concurrently receiving CBT for co-occurring SUD. "
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    ABSTRACT: Major depressive disorder (MDD) frequently co-occurs in adolescents with substance use disorders (SUDs) and attention deficit hyperactivity disorder (ADHD), but the impact of MDD on substance treatment and ADHD outcomes and implications for clinical practice are unclear. Adolescents (n=303; ages 13-18) meeting DSM-IV criteria for ADHD and SUD were randomized to osmotic release methylphenidate (OROS-MPH) or placebo and 16 weeks of cognitive behavioral therapy (CBT). Adolescents with (n=38) and without (n=265) MDD were compared on baseline demographic and clinical characteristics as well as non-nicotine substance use and ADHD treatment outcomes. Adolescents with MDD reported more non-nicotine substance use days at baseline and continued using more throughout treatment compared to those without MDD (p<0.0001 based on timeline followback; p<0.001 based on urine drug screens). There was no difference between adolescents with and without MDD in retention or CBT sessions attended. ADHD symptom severity (based on DSM-IV ADHD rating scale) followed a slightly different course of improvement although with no difference between groups in baseline or 16-week symptom severity or 16-week symptom reduction. There was no difference in days of substance use or ADHD symptom outcomes over time in adolescents with MDD or those without MDD treated with OROS-MPH or placebo. Depressed adolescents were more often female, older, and not court ordered. These preliminary findings suggest that compared to non-depressed adolescents with ADHD and SUD, those with co-occurring MDD have more severe substance use at baseline and throughout treatment. Such youth may require interventions targeting depression.
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