An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment

Abstract

Context: Although depression frequently co-occurs with substance abuse, few individuals entering substance abuse treatment have access to effective depression treatment.

Objective: The Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study is a community-based effectiveness trial that compared residential substance abuse treatment with residential treatment plus group cognitive behavioral therapy for depression delivered by substance abuse treatment counselors. We hypothesized that intervention clients would have improved depression and substance use outcomes compared with those of clients receiving usual care.

Design: A nonrandomized controlled trial using a quasi-experimental intent-to-treat design in which 4 sites were assigned to alternate between the intervention and usual care conditions every 4 months for 2½ years.

Setting: Four treatment programs in Los Angeles County.

Participants: We screened 1262 clients for persistent depressive symptoms (Beck Depression Inventory-II score >17). We assigned 299 clients to receive either usual care (n = 159) or usual care plus the intervention (n = 140). Follow-up rates at 3 and 6 months after the baseline interview were 88.1% and 86.2%, respectively, for usual care and 85.7% and 85.0%, respectively, for the intervention group.

Intervention: Sixteen 2-hour group sessions of cognitive behavioral therapy for depression.

Main outcome measures: Change in depression symptoms, mental health functioning, and days of alcohol and problem substance use.

Results: Intervention clients reported significantly fewer depressive symptoms (P < .001 at 3 and 6 months) and had improved mental health functioning (P < .001 at 3 months and P < .01 at 6 months). At 6 months, intervention clients reported fewer drinking days (P < .05) and fewer days of problem substance use (P < .05) on days available.

Conclusions: Providing group cognitive behavioral therapy for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes. These results provide support for a new model of integrated care.

Trial registration: clinicaltrials.gov Identifier: NCT01191788.

Conflict of interest statement

Financial disclosures:Dr. Katherine Watkins reports no competing interests

Dr. Sarah Hunter reports no competing interests

Dr. Kimberly Hepner reports no competing interests

Dr. Susan Paddock reports no competing interests

Erin de la Cruz reports no competing interests

Annie Zhou reports no competing interests

Jim Gilmore reports no competing interests

Figures

Figure 1

Study Enrollment Process * If more than a 2 week period passed between the assessment for eligibility by research staff and the baseline interview, clients were re-assessed for persistent depressive symptoms using the BDI-II. ** If client had other known commitment (e.g., court date, pregnancy, specialty group) that would prevent them from attending intervention, they were deemed ineligible.

Figure 2

Conditional change in BDI-II score over time

Figure 3

Conditional change in SF-12 mental health score over time

Figure 4

Substance use at 6 months