Qiuzuo Guo’s research while affiliated with University of California, Irvine and other places

Background: Integrated digital interventions for the treatment of comorbid depression and substance use disorder have been developed, and evidence of their effectiveness is mixed. Objective: This study aimed to explore potential reasons for mixed findings in the literature on integrated digital treatments. We described the methodologies and core characteristics of these interventions, identified the presence of evidence-based treatment strategies, examined patterns across digital modalities, and highlighted areas of overlap as well as critical gaps in the existing evidence base. Methods: In June 2024, a literature search was conducted in Google Scholar to identify digital integrated interventions for comorbid major depressive disorder and substance use disorder. Articles were included if they described interventions targeting both conditions simultaneously; were grounded in cognitive behavioral therapy, motivational interviewing, or motivational enhancement therapy; and were delivered at least in part via digital modalities. In total, 14 studies meeting these criteria were coded using an open-coding approach to identify intervention characteristics and treatment strategies (n=25). Statistical analyses summarized descriptive statistics to capture the frequency and overlap of these strategies. Results: Studies included a range of digital modalities: internet (n=6, 43%), computer (n=3, 21%), smartphone (n=2, 14%), and supportive text messaging interventions (n=3, 21%). Half (n=7, 50%) of the studies included participants with mild to moderate depression symptom severity and hazardous substance use. Only 36% (n=5) of the studies required participants to meet full diagnostic criteria for major depressive disorder for inclusion and 21% (n=3) required a substance use disorder diagnosis. Most interventions targeted adults (n=11, 79%), with few targeting young or emerging adults (n=4, 29%), and only 36% (n=5) reported detailed demographic data. Treatment duration averaged 10.3 (SD 6.8) weeks. Internet-based interventions offered the widest range of treatment strategies (mean 11.7), while supportive text messaging used the fewest (mean 4.6). Common treatment strategies included self-monitoring (n=11, 79%), psychoeducation (n=10, 71%), and coping skills (n=9, 64%). Interventions often combined therapeutic strategies, with psychoeducation frequently paired with self-monitoring (n=9, 64%), assessment (n=7, 50%), coping skills (n=7, 50%), decisional balance (n=7, 50%), feedback (n=7, 50%), and goal setting (n=7, 50%). Conclusions: Among integrated digital interventions for comorbid depression and substance use, there was noteworthy variability in methodology, inclusion criteria, digital modalities, and embedded treatment strategies. Without standardized methods, comparison of the clinical outcomes across studies is challenging. These results emphasize the critical need for future research to adopt standardized approaches to facilitate more accurate comparisons and a clearer understanding of intervention efficacy.

BACKGROUND Integrated digital interventions for the treatment of comorbid depression and substance use disorder have been developed, and evidence of their effectiveness is mixed. OBJECTIVE To better understand the potential underlying causes of these mixed findings, we described intervention characteristics, examined evidence-based treatment strategies within integrated digital treatments, reported the frequency of specific evidence-based strategies across different treatment modalities, and identified overlap between various treatment strategies and critical gaps in existing literature. METHODS In June 2024, a literature search was conducted in Google Scholar to identify digital integrated interventions for comorbid MDD and SUD. Articles were included if they described interventions targeting both conditions simultaneously, were grounded in CBT, MI, or MET, and were delivered at least in part via digital modalities. Fourteen studies meeting these criteria were coded using an open coding approach to identify treatment strategies. Statistical analyses summarized the number, frequency, and overlap of these strategies. RESULTS Half of studies (50.0%, n=7) included participants with mild to moderate depression symptom severity and hazardous substance use. Only 35.7% (n=5) of the studies required that participants meet the full diagnostic criteria for MDD, as assessed by the SCID or MINI, for inclusion and 21.4% (n=3) required a SUD diagnosis. Web-based (35.3%, n=6), computer-based (21.4%, n=3) and supportive text messaging interventions (21.4%, n=3) were included. Treatment duration averaged 10.3 weeks (SD=6.8). Common treatment strategies included self-monitoring (78.6%, n=11), psychoeducation (71.4%, n=10), and coping skills (64.3%, n=9). Interventions often combined therapeutic strategies, with psychoeducation frequently paired with self-monitoring (64.3%, n=9) and coping skills (50%, n=7). CONCLUSIONS Among integrated digital interventions for comorbid depression and substance use, there was significant variability in inclusion criteria, digital modalities, methodology, and treatment strategies, significant methodological challenges, and underrepresentation of evidence-based practices. Without standardized methodologies comparison of the clinical outcomes across studies is challenging. These results emphasize the critical need for future research to adopt standardized approaches, thereby facilitating more accurate comparisons and a deeper understanding of intervention efficacy.