Effective Treatment for Co-Occurring Alcohol use Disorder and Persistent Depression: A Case Report

Abstract

Abbreviations: CBASP, cognitive behavioral analysis system of psychotherapy; HAM-D, hamilton rating scale for depression; CIWA, clinical institute withdrawal assessment for alcohol; SA, situational analysis; SDU, standard drinking units; CBT, cognitive behavioral therapy; MI, motivational interviewing; CSQ, coping survey questionnaire; IMI-C, impact message inventory circumplex IntroductionAlcohol use disorder is frequently comorbid with other psychiatric disorders such as major depression, and professionals working with these patients are facing a unique challenge. 1 The estimated cost of excessive drinking in 2010 was $249.0 billion, which equates to $2.05 per drink or $807 per person. 2 The prevalence rate for major depression rose from 13.8 million to 15.4 million adults between 2005 and 2010, and this increased the cost by 21.5 % from $173.2 billion to $210.5 billion in 2010. 3 As a result of the deleterious psychological impact on the individual and the economic burden on society, there is a growing need to develop and evaluate effective treatments for these significant and prevalent disorders.There are currently multiple empirically supported behavioral treatments for depression and alcoholism as individual disorders. However, there have been few well-specified, empirically supported behavioral therapies with an integrated approach to treating symptoms of both disorders. [4][5][6] The most commonly evaluated types of behavioral therapies for co-occurring disorders include motivational interviewing (MI), cognitive behavioral therapy (CBT) and contingency management (CM); 4 research supports that an integrated therapy possessing components of MI, CBT, and CM would be most ideal to target co occurring depression and alcoholism. [4][5][6] The lack of successful treatment options for chronically depressed alcohol dependent individuals may be due in part to the complex characteristics these individuals possess that make their treatment more challenging. [7][8][9][10] Comorbid depression is associated with poorer prognosis during and after alcoholism treatment and depressed mood may be an important trigger of alcoholic relapse. 7,11 Interpersonal avoidance behaviors are salient variables in individuals diagnosed with both alcoholism and depression. These patients typically report a high rate of adverse early home environments, a lifelong history of intrapersonal and interpersonal failure, an earlier onset of depression and alcohol use disorders, more comorbidity, a more severe course of illness, and they demonstrate interpersonal avoidance and detachment. 8,12,13 Early abuse/trauma history impairs development of adequate interpersonal coping skills, resulting in depression, social isolation, or withdrawal. 14 In addition, real-world and prolonged environmental stressors usually accompany these individuals' presenting complaints. They are often skeptical or ambivalent about change, and the processes of change are often slow, irregular, and inconsistent. In fact, a pattern of success followed by a setback is commo...