Integrated Cognitive Behavioral Therapy Versus Twelve-Step Facilitation Therapy for Substance-Dependent Adults with Depressive Disorders

Abstract

In a randomized trial, this study compared the longitudinal outcome patterns of veterans (N = 66) with substance use disorders and major depressive disorder receiving standard pharmacotherapy and either 12-Step Facilitation Therapy (TSF) or disorder-specific Integrated Cognitive Behavioral Treatment (ICBT). Depression and substance use were assessed at intake, during and after treatment using the Hamilton Depression Rating Scale and the Time Line Follow Back. Reductions in depression during treatment were comparable between the two treatment groups; however, their posttreatment patterns were distinct. While ICBT participants evidenced a steady linear decline in depression through six months posttreatment, a quadratic trend characterized TSF participants, for whom depression declined during treatment, but increased throughout posttreatment follow-up. During treatment, TSF participants used substances less frequently relative to those in ICBT; however, reductions in substance use were more stable through six months posttreatment among those in ICBT relative toTSF. While both interventions produced improvement in depression and substance use during treatment, ICBT may yield more stable clinical outcomes once treatment ceases.

Does initial treatment focus influence outcomes for depressed substance abusers?

“…Participants entered treatment at the beginning of any of the three modules. Our preliminary findings document similar reductions for both the ICBT and TSF interventions in substance use and depression symptoms during the 24-week active treatment phase (Brown et al, 2006). However, although these adjustments permitted group delivery of our interventions with acceptable waiting periods, they raised the question of whether treatment response might differ based on which module was received first.…”

“…The need for interventions specifically tailored to these comorbid disorders has been advocated, but few clinical trials have been conducted. We developed two psychotherapy interventions for individuals with comorbid SUDs and depression (Brown et al, 2006). The addiction portions of our interventions were based on the treatments utilized in the Project Matching Alcoholism Treatment to Client Heterogeneity (MATCH) study (Project MATCH Research Group, 1998) study: the Twelve-Step Facilitation (TSF; Nowinksi, Baker, & Carroll, 1994) and the CognitiveBehavioral Coping Skills (Kadden et al, 1994) interventions.…”

“…The addiction portions of our interventions were based on the treatments utilized in the Project Matching Alcoholism Treatment to Client Heterogeneity (MATCH) study (Project MATCH Research Group, 1998) study: the Twelve-Step Facilitation (TSF; Nowinksi, Baker, & Carroll, 1994) and the CognitiveBehavioral Coping Skills (Kadden et al, 1994) interventions. Along with the addiction-focused Project MATCH cognitive-behavioral coping-skills, we incorporated depression treatment from the Munoz and Miranda (1996) manual into our new integrated cognitive-behavioral therapy (ICBT; Brown et al, 2006). An issue that has been raised in efficacy studies concerns the delivery method of the treatments: Most research interventions are provided in an individual format, which maximizes the internal validity but limits the generalizability to standard treatment delivery scenarios (Persons & Siberschatz, 1999).…”

Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

“…Published trials of psychological treatments for depression and anxiety in substance users suggest that cognitive behavioral therapy (CBT) may be an effective treatment (Baillie & Sannibale, 2007;Baker et al, 2010;Brown et al, 2006;Brown, Evans, Miller, Burgess & Mueller, 1997;Hides, Samet, & Lubman, 2010;Hunter et al, 2012;Kay-Lambkin, Baker, Lewin, & Carr, 2009;Kay-Lambkin, Baker, Kelly, & Lewin, 2011;Watkins, Paddock, Zhang, & Wells, 2006;Watkins et al, 2011). There is, however, scarce research on the application of contemporary behavioral activation (BA) models of treatment in clinical populations of substance users.…”

Empowering people with concurrent disorder in a clinical context: a structural perpective

“…CBT for people with CD involves identifying maladaptive cognitions; generating alternative, realistic, positive thoughts; and practicing techniques for challenging thoughts in situations that have a propensity to exacerbate mental health symptoms and/or precipitate substance use (Brown et al , 2006). Part of the CBT process for people with CD is to help them understand the interaction between their mental health disorder and substance use (Chan-Osilla et al , 2009).…”