Mechanisms of Action in Integrated Cognitive-Behavioral Treatment Versus Twelve-Step Facilitation for Substance-Dependent Adults With Comorbid Major Depression

Veterans Affairs San Diego Healthcare System and University of California, San Diego, 3350 La Jolla Village Drive, San Diego, California 92161-2002,USA.
Journal of studies on alcohol and drugs (Impact Factor: 2.76). 10/2007; 68(5):663-72. DOI: 10.15288/jsad.2007.68.663
Source: PubMed


In a population of veterans with co-occurring substance use disorders and concomitant major depressive disorder, the current study compared mechanisms of change and therapeutic effects relevant to both disorders between integrated, dual disorder-specific cognitive behavioral therapy (ICBT) and twelve-step facilitation (TSF).
Veterans (N = 148) were given standard pharmacotherapy for depression and were randomly assigned to receive 24 weeks of either TSF or ICBT. Process measures were selected to quantify (1) changes in self-efficacy in ICBT, (2) changes in ability to terminate negative affect in ICBT, (3) twelve-step affiliation (TSA) in TSF, and (4) changes in social support in both conditions. Measures of depression and substance use were administered to all participants before treatment, during treatment, and at the end of treatment.
Self-efficacy increased among both TSF and ICBT participants during treatment, whereas self-reported ability to regulate negative affect did not change. Consistent with predictions, TSF participants increased community TSA during treatment, whereas those receiving ICBT reduced TSA. Changes in self-efficacy and TSA were associated with improvement in substance use outcomes at the end of treatment. Hypothesized changes in social support were not supported.
Both ICBT and TSF produce improvements in self-efficacy, and these changes are related to substance use outcomes for depressed substance abusers. In TSF, intervention-specific changes in TSA occur during the course of treatment and are related to substance use outcomes.

8 Reads
  • Source
    • "Previous studies revealed similar decreases in substance use frequency during treatment for TSF and ICBT, but comparatively less increase in substance use during follow-up for the ICBT group (Lydecker et al., 2010; Worley et al., 2012). During treatment, selfefficacy increased similarly for both groups and was significantly associated with substance use (Glasner-Edwards et al., 2007). This study examined the effects of self-efficacy and social networks on alcohol/drug use during the year of posttreatment follow-up, hypothesizing that greater abstinence selfefficacy and lower network substance use would predict lower future alcohol/drug use. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Proximal personal and environmental factors typically predict outcomes of treatment for alcohol or drug dependence (AODD), but longitudinal treatment studies have rarely examined these factors in adults with co-occurring psychiatric disorders. In adults with AODD and major depression, the aims of this study were to: (a) disaggregate person-and time-level components of network substance use and self-efficacy, (b) examine their prospective effects on posttreatment alcohol/drug use, and (c) examine whether residential environment moderated relations between these proximal factors and substance use outcomes. Veterans (N = 201) enrolled in a trial of group psychotherapy for AODD and independent MDD completed assessments every 3 months during 1 year of posttreatment follow-up. Outcome variables were percent days drinking (PDD) and using drugs (PDDRG). Proximal variables included abstinence self-efficacy and social network drinking and drug use. Self-efficacy and network substance use at the person-level prospectively predicted PDD (ps < .05) and PDDRG (ps < .05). Within-person, time-level effects of social networks predicted future PDD (ps < .05) but not PDDRG. Controlled environments moderated person-level social network effects (ps < .05), such that greater time in controlled settings attenuated the association between a heavier drinking/using network and posttreatment drinking and drug use. Both individual differences and time-specific fluctuations in proximal targets of psychosocial interventions are related to posttreatment substance use in adults with co-occurring AODD and MDD. More structured environmental settings appear to alleviate risk associated with social network substance use, and may be especially advised for those who have greater difficulty altering social networks during outpatient treatment. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychology of Addictive Behaviors 10/2014; 28(4). DOI:10.1037/a0037901 · 2.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Self-efficacy is a robust predictor of short- and long-term remission after treatment. This study examined the predictors of self-efficacy in the year after treatment and 15 years later. A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years. Predictors of self-efficacy at 1 year included improvement from baseline to 1 year in heavy drinking, alcohol-related problems, depression, impulsivity, avoidance coping, social support from friends, and longer duration of participation in Alcoholics Anonymous (AA). Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years. Clinicians should focus on keeping patients engaged in AA, addressing depressive symptoms, improving patient's coping, and enhancing social support during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.
    Journal of substance abuse treatment 12/2007; 35(2):148-55. DOI:10.1016/j.jsat.2007.09.003 · 2.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study is a report of a systematic review to assess current evidence for the efficacy of psychosocial interventions for reducing substance use, as well as improving mental state and encouraging treatment retention, among people with dual diagnosis. Substance misuse by people with a severe mental illness is common and of concern because of its many adverse consequences and lack of evidence for effective psychosocial interventions. Several electronic databases were searched to identify studies published between January 1990 and February 2008. Additional searches were conducted by means of reference lists and contact with authors. Results from studies using meta-analysis, randomized and non-randomized trials assessing any psychosocial intervention for people with a severe mental illness and substance misuse were included. Fifty-four studies were included: one systematic review with meta-analysis, 30 randomized controlled trials and 23 non-experimental studies. Although some inconsistencies were apparent, results showed that motivational interviewing had the most quality evidence for reducing substance use over the short term and, when combined with cognitive behavioural therapy, improvements in mental state were also apparent. Cognitive behavioural therapy alone showed little consistent support. Support was found for long-term integrated residential programmes; however, the evidence is of lesser quality. Contingency management shows promise, but there were few studies assessing this intervention. These results indicate the importance of motivational interviewing in psychiatric settings for the reduction of substance use, at least in the short term. Further quality research should target particular diagnoses and substance use, as some interventions may work better for some subgroups.
    Journal of Advanced Nursing 11/2008; 65(2):238-58. DOI:10.1111/j.1365-2648.2008.04879.x · 1.74 Impact Factor
Show more