Treatment of Co-Occurring Depression and Substance Dependence: Using Meta-Analysis to Guide Clinical Recommendations

Columbia University College of Physicians and Surgeons, and N.Y. State Psychiatric Institute, New York.
Psychiatric Annals (Impact Factor: 0.71). 12/2008; 38(11):nihpa128505. DOI: 10.3928/00485713-20081101-05
Source: PubMed
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    ABSTRACT: Objetivo. La infección por el virus de la hepatitis C (VHC) es un hecho frecuente en los pacientes con infección por el virus de la inmunodeficiencia humana (VIH), sobre todo en aquellos con historia de drogadicción parenteral. El manejo de pacientes con abuso de alcohol y coinfección por VHC y VIH es complejo aunque imprescindible para reducir la elevada morbimortalidad. Material y métodos. Se expone el caso de un paciente de 44 años, con abuso de alcohol e infección por VHC y VIH. Se describe la historia clínica desde el punto de vista del abuso de sustancias y la evolución de ambas infecciones, así como las opciones terapéuticas para el alcoholismo y la hepatitis crónica C en los pacientes con VIH/sida. Resultados. Se inicia tratamiento para el abuso de alcohol y se optimiza el del VIH/sida para mejorar la situación inmunológica y virológica; se revisa además la idoneidad del paciente para recibir tratamiento antiviral para la hepatitis crónica C con interferón y ribavirina. Conclusión. El abordaje del abuso de alcohol y otras sustancias es esencial para un control clínico de la hepatitis crónica y el VIH.
    Trastornos Adictivos 07/2009; DOI:10.1016/S1575-0973(09)72409-2
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    ABSTRACT: ISSUES AND APPROACH: The high rates of co-occurring depression and substance use, and the negative impact of this on illness course and outcomes have been well established. Despite this, few clinical trials have examined the efficacy of cognitive behaviour therapy (CBT). This paper systematically reviews these clinical trials, with an aim of providing recommendations for how future research can develop a more robust evidence base for the treatment of these common comorbidities. Leading electronic databases, including PubMed (ISI) and PsychINFO (CSA), were searched for peer-reviewed journal articles using CBT for the treatment of co-occurring depression and substance use. Of the 55 articles identified, 12 met inclusion criteria and were included in the review. KEY FINDINGS: There is only a limited evidence for the effectiveness of CBT either alone or in combination with antidepressant medication for the treatment of co-occurring depression and substance use. While there is support for the efficacy of CBT over no treatment control conditions, there is little evidence that CBT is more efficacious than other psychotherapies. There is, however, consistent evidence of improvements in both depression and substance use outcomes, regardless of the type of treatment provided and there is growing evidence that that the effects of CBT are durable and increase over time during follow up. CONCLUSIONS: Rather than declaring the 'dodo bird verdict' that CBT and all other psychotherapies are equally efficacious, it would be more beneficial to develop more potent forms of CBT by identifying variables that mediate treatment outcomes.
    Drug and Alcohol Review 09/2010; 29(5):508-17. DOI:10.1111/j.1465-3362.2010.00207.x · 1.55 Impact Factor
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    ABSTRACT: Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD) and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions. To determine the association between the 10 DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample. Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (n = 1172), cannabis use disorder (n = 454), or nicotine dependence (n = 4017) at baseline and who were reinterviewed 3 years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main Outcome Measure Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period. Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis, and nicotine use disorders (adjusted odds ratios, 2.46-3.51), as was borderline personality disorder (adjusted odds ratios, 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios, 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence. The consistent findings on the association of antisocial, borderline, and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality disorders and the role of specific components of these disorders, biological and environmental contributors to these relationships, and potential applications of these findings to treatment development.
    Archives of general psychiatry 11/2011; 68(11):1158-67. DOI:10.1001/archgenpsychiatry.2011.136 · 13.75 Impact Factor
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