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


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.
    Full-text · Article · May 2014 · Journal of Gambling Behavior
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    • "Regarding alcohol dependence and comorbid depression, there have been only two psychosocial intervention trials. Brown et al. [9] observed in 35 inpatients that adding CBT for depression versus relaxation training to standard partial hospital alcohol treatment was more effective in reducing depressive symptoms and some drinking outcomes than treatment for the alcohol problem only. They also observed that decreases in somatic depressive symptoms mediated the relationship between treatment condition and drinking outcomes. "
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    ABSTRACT: A major barrier to successful treatment in alcohol dependence is psychiatric comorbidity. During treatment, the time to relapse is shorter, the drop-out rate is increased, and long-term alcohol consumption is greater for those with comorbid major depression or anxiety disorder than those with an alcohol use disorder with no comorbid mental disorder. The treatment of alcohol dependence and psychological disorders is often the responsibility of different services, and this can hinder the treatment process. Accordingly, there is a need for an effective integrated treatment for alcohol dependence and comorbid anxiety and/or depression. We aim to assess the effectiveness of a specialized, integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting. Following a three-week stabilization period (abstinence or significantly reduced consumption), participants will undergo complete formal assessment for anxiety and depression. Those patients with a diagnosis of an anxiety and/or depressive disorder will be randomized to either 1) integrated intervention (cognitive behavioral therapy) for alcohol, anxiety, and/or depression; or 2) usual counseling care for alcohol problems. Patients will then be followed up at weeks 12, 16, and 24. The primary outcome measure is alcohol consumption (total abstinence, time to lapse, and time to relapse). Secondary outcome measures include changes in alcohol dependence severity, depression, or anxiety symptoms and changes in clinician-rated severity of anxiety and depression. The study findings will have potential implications for clinical practice by evaluating the implementation of specialized integrated treatment for comorbid anxiety and/or depression in an alcohol outpatient service.Trial registration: Identifier: NCT01941693.
    Full-text · Article · Nov 2013 · Addiction science & clinical practice
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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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