Pilot study of interpersonal psychotherapy versus supportive psychotherapy for dysthymic patients with secondary alcohol abuse or dependence.
ABSTRACT Interpersonal psychotherapy (IPT) has demonstrated efficacy for depression but yielded negative results for substance disorders. Alcohol abuse frequently complicates mood disorders. This pilot study compared IPT with brief supportive psychotherapy (BSP) for dysthymic disorder and alcohol abuse. We hypothesized that effect sizes would suggest greater IPT efficacy for both diagnoses, despite limited statistical power. Subjects with primary DSM-IV dysthymic disorder and secondary alcohol abuse/dependence were randomly assigned 16 weeks of IPT (N = 14) or BSP (N = 12). Patients in both treatments reported improved depressive symptoms and alcohol abstinence. IPT had a large and BSP a moderate effect size in depression, whereas BSP had a moderate and IPT a small effect size in percentage of days abstinent. This pilot study offers initial data on IPT and BSP for comorbid chronic depression and alcohol abuse/dependence. Results suggest IPT may have specific antidepressant benefits for dysthymic alcoholic patients but not in treating alcoholism.
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ABSTRACT: To review published studies on the effectiveness of combining cognitive-behavioural therapy (CBT) and motivational interviewing (MI) to treat comorbid clinical and subclinical alcohol use disorder (AUD) and major depression (MDD) and estimate the effect of this compared with usual care. We conducted systematic literature searches in PubMed, PsycINFO and Embase up to June 2013 and identified additional studies through cross-references in included studies and systematic reviews. Twelve studies comprising 1721 patients met our inclusion criteria. The studies had sufficient statistical power to detect small effect sizes. CBT/MI proved effective for treating subclinical and clinical AUD and MDD as compared with controls, with small overall effect sizes at post-treatment (g = 0.17, CI: 0.07-0.28, p <.001 for decrease of alcohol consumption and g = 0.27, CI: 0.13-0.41, p <.001 for decrease of symptoms of depression respectively). Subgroup analyses revealed no significant differences for both AUD and MDD. However, digital interventions showed a higher effect size for depression than face to face interventions (g = 0.73 and g= 0.23 respectively p = .030). Combined cognitive-behavioural therapy and motivational interviewing for clinical or subclinical depressive and alcohol use disorders has a small but clinically significant effect in improving outcomes compared with treatment as usual.Addiction 12/2013; 109(3). DOI:10.1111/add.12441 · 4.60 Impact Factor
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ABSTRACT: We conducted a pilot randomized trial of telephone-delivered acceptance and commitment therapy (ACT) versus cognitive behavioral therapy (CBT) for smoking cessation. Participants were 121 uninsured South Carolina State Quitline callers who were adult smokers (at least 10 cigarettes/day) and who wanted to quit within the next 30 days. Participants were randomized to 5 sessions of either ACT or CBT telephone counseling and were offered 2 weeks of nicotine replacement therapy (NRT). ACT participants completed more calls than CBT participants (M = 3.25 in ACT vs. 2.23 in CBT; p = .001). Regarding satisfaction, 100% of ACT participants reported their treatment was useful for quitting smoking (vs. 87% for CBT; p = .03), and 97% of ACT participants would recommend their treatment to a friend (vs. 83% for CBT; p = .06). On the primary outcome of intent-to-treat 30-day point prevalence abstinence at 6 months postrandomization, the quit rates were 31% in ACT versus 22% in CBT (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.7-3.4). Among participants depressed at baseline (n = 47), the quit rates were 33% in ACT versus 13% in CBT (OR = 1.2, 95% CI = 1.0-1.6). Consistent with ACT's theory, among participants scoring low on acceptance of cravings at baseline (n = 57), the quit rates were 37% in ACT versus 10% in CBT (OR = 5.3, 95% CI = 1.3-22.0). ACT is feasible to deliver by phone, is highly acceptable to quitline callers, and shows highly promising quit rates compared with standard CBT quitline counseling. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed.Nicotine & Tobacco Research 06/2014; 16(11). DOI:10.1093/ntr/ntu102 · 2.81 Impact Factor
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ABSTRACT: Integrated psychological treatment addressing co-existing alcohol misuse and depression has not been compared with single-focused treatment. This trial evaluates changes over 36months following randomization of 284 outpatients to one of four motivational interviewing and cognitive-behavior therapy (MICBT) based interventions: (1) brief integrated intervention (BI); or BI plus 9 further sessions with (2) an integrated-, (3) alcohol-, or (4) depression-focus. Outcome measures included changes in alcohol consumption, depression (BDI-II: Beck Depression Inventory) and functioning (GAF: Global Assessment of Functioning), with average improvements from baseline of 21.8 drinks per week, 12.6 BDI-II units and 8.2 GAF units. Longer interventions tended to be more effective in reducing depression and improving functioning in the long-term, and in improving alcohol consumption in the short-term. Integrated treatment was at least as good as single-focused MICBT. Alcohol-focused treatment was as effective as depression-focused treatment at reducing depression and more effective in reducing alcohol misuse. The best approach seems to be an initial focus on both conditions followed by additional integrated- or alcohol-focused sessions.Journal of substance abuse treatment 10/2013; DOI:10.1016/j.jsat.2013.10.001 · 2.90 Impact Factor