The effectiveness of integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression - a group randomized trial

Abstract

BackgroundIntegrated Treatment (IT) has proved effective in treating patients with Substance Use Disorders (SUD) co-occurring with severe Mental Disorders (MD), less is known about the effectiveness of IT for patients with SUD co-occurring with less severe MD.The aim of this study was to investigate the effectiveness of IT for patients with SUD co-occurring with anxiety and/or depression on the following parameters:1. The use of substances, as measured by the Alcohol Use Identification Test (AUDIT), the Drug Use Identification Test (DUDIT), and the Addiction Severity Index (EuropASI).2. The severity of psychiatric symptoms, as measured by the Symptom Check List 90 r (SCL 90R).3. The client’s motivation for changing his/her substance use behaviour, as measured by the Substance Abuse Treatment Scale (SATSr).MethodsThis is a group randomized clinical trial comparing the effectiveness of IT to treatment as usual in Community Mental Health Centres (CMHCs). Five CMHCs were drawn to the Intervention Group (IG) and four CMHCs to the Control Group (CG). The allocation to treatment conditions was not blinded. New referrals were screened with the AUDIT and the DUDIT. Those who scored above the cut-off level of these instruments were assessed with the Structured Clinical Interview for DSM-IV 1 and 2. We included patients with anxiety and/or depression together with one or more SUDs.ResultsWe included 55 patients in the IG and 21 in the CG. A linear multilevel model was used. Both groups reduced their alcohol and substance use during the trial, while there was no change in psychiatric symptoms in either group. However, the IG had a greater increase in motivation for substance use treatment after 12 months than had the CG with an estimate of 1.76, p = 0.043, CI95% (0.08; 3.44) (adjusted analyses). There were no adverse events.ConclusionsIntegrated treatment is effective in increasing the motivation for treatment amongst patients with anxiety and/or depression together with SUD in outpatient clinics.Trial registrationClinicalTrials.gov: NCT00447733.

Motivation for treatment in patients with substance use disorder: personal volunteering versus legal/familial enforcement

“…Numerous studies have indicated a high degree of comorbidity between major depression and substance use disorders. This comorbidity is associated with a poorer effect of treatment, resulting in poorer psychosocial functioning, a higher number of days in treatment, higher attrition rates, more admissions, and a higher burden of disease arising from both major depression and substance use disorder 26. This study found a relationship between depression and problem recognition, and this finding is in accordance with a previous report 27.…”

Interrelationship of Opioid Dependence, Impaired Impulse Control, and Depressive Symptoms: An Open-Label Cross-Sectional Study of Patients in Maintenance Therapy

“…As this presents a common and often underestimated comorbidity [63, 64], future studies should assess and control for depression when comparing patients with OD and healthy controls. Especially in severe substance use disorders, other psychopathological impairments are also common and barely improve during maintenance therapy [65-68]. However, in our regression model, the score of the SCL-90R was no longer significant after controlling for other confounders.…”

Comorbidity of Anxiety Disorders and Substance Use

“…A smaller (N ¼ 55) but randomized Norwegian study recently showed that integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression compared to treatment as usual increased motivation for substance use treatment after 12 months significantly in the intervention group, while substance use was decreased in both groups (Wüsthoff et al 2014). In the intervention group, therapists were trained in motivational interviewing and CBT.…”