CBT (cognitive behavioral therapy) appears to help patients in drug and alcohol abuse treatment programs with symptoms of depression, researchers from the RAND Corporation, Santa Monica, California reported in Archives of General Psychiatry today.

The authors explain that depressive symptoms are common in individuals with a history of substance abuse. However, patients with both disorders are sometimes not treated for both problems.

They wrote:

“The consequences of this unmet need are great. The interactive nature of the two disorders leads to poorer depression and substance abuse treatment outcomes compared with the outcomes when only one disorder is treated.”

Katherine E. Watkins, M.D., M.S.H.S., carried out a study in LA County, California at four Behavioral Health Service facilities. Every four months, treatment alternated in each facility between usual care for substance abuse and the same plus CBT as modeled in the Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study. This went on from August 2006 to January 2009. The intervention consisted of 16 two-hour BRIGHT sessions over an eight-week period.

To start with, 1,262 individuals were screened to take part in the study. The investigators recruited 140 patients in the intervention group and 159 in the control group. On average, participants scored in the clinically severe range on a scale of depression symptoms and nearly half (45.8%) had a past 12-month depressive disorder.

Within three months of treatment, those on the combination CBT program had mild symptoms, compared to moderate symptoms in the usual care-alone group. 55.8% of those in the combination treatment had minimal symptoms versus 33.6% in the control group.

Within six months 66.9% of those in the combination group had minimal symptoms, compared to 43.8% in the control group.

Those who were not longer residents in a treatment center after six months and had done the combination program had fewer days of problem substance abuse and fewer drinking days compared to those in the control group.

A gap in the substance abuse treatment system needs to be addressed, the researchers stressed, especially in the public sector.

The authors wrote:

“The study demonstrates that it is possible to develop the capacity of substance abuse programs to deliver evidence-based mental health care by enhancing the skills and expanding the clinical roles of substance abuse counselors,” the researchers state. This is important, they add, because “Lack of access to efficacious depression treatment for substance abusers is an important public health problem.”

Arch Gen Psych. 2011;68[6]:577-584.

Written by Christian Nordqvist