1
|
Lubman DI, Manning V, Arunogiri S, Hall K, Reynolds J, Stragalinos P, Petukhova R, Gerhard R, Tyler J, Bough A, Harris A, Grigg J. A structured, telephone-delivered intervention to reduce methamphetamine use: study protocol for a parallel-group randomised controlled trial. Trials 2023; 24:235. [PMID: 36991490 DOI: 10.1186/s13063-023-07172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/14/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Australia has one of the highest rates of methamphetamine (MA) use in the world; however, uptake of in-person psychological treatment remains extremely low due to numerous individual (e.g. stigma, shame) and structural (e.g. service accessibility, geographical location) barriers to accessing care. Telephone-delivered interventions are ideally placed to overcome many of the known barriers to treatment access and delivery. This randomised controlled trial (RCT) will examine the efficacy of a standalone, structured telephone-delivered intervention to reduce MA problem severity and related harms. METHODS This study is a double-blind, parallel-group RCT. We will recruit 196 ± 8 individuals with mild to moderate MA use disorder from across Australia. After eligibility and baseline assessments, participants will be randomly allocated to receive either the Ready2Change-Methamphetamine (R2C-M) intervention (n = 98 ± 4; four to six telephone-delivered intervention sessions, R2C-M workbooks and MA information booklet) or control (n = 98 ± 4; four to six ≤5-min telephone check-ins and MA information booklet including information on accessing further support). Telephone follow-up assessments will occur at 6 weeks and 3, 6 and 12 months post-randomisation. The primary outcome is change in MA problem severity (Drug Use Disorders Identification Test, DUDIT) at 3 months post-randomisation. Secondary outcomes are as follows: MA problem severity (DUDIT) at 6 and 12 months post-randomisation, amount of methamphetamine used, methamphetamine use days, methamphetamine use disorder criteria met, cravings, psychological functioning, psychotic-like experiences, quality of life and other drug use days (at some or all timepoints of 6 weeks and 3, 6 and 12 months post-randomisation). Mixed-methods program evaluation will be performed and cost-effectiveness will be examined. DISCUSSION This study will be the first RCT internationally to assess the efficacy of a telephone-delivered intervention for MA use disorder and related harms. The proposed intervention is expected to provide an effective, low-cost, scalable treatment for individuals otherwise unlikely to seek care, preventing future harms and reducing health service and community costs. TRIAL REGISTRATION ClinicalTrials.gov NCT04713124 . Pre-registered on 19 January 2021.
Collapse
Affiliation(s)
- Dan I Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia.
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Drug use, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Peta Stragalinos
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rachel Petukhova
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Robyn Gerhard
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Tyler
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Anna Bough
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Fisher A, Eugene Dit Rochesson S, Harvey LR, Marel C, Mills KL. Development and pilot of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT). ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Purpose
Evidence is lacking as to the superiority of dual-focused versus single-focused approaches in treating depression and alcohol use comorbidity. Different people may also value the different features of treatment options differently, necessitating a decision-support tool. This study aims to test the acceptability, feasibility, safety and potential usefulness of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT).
Design/methodology/approach
ADDAPT was developed according to International Patient Decision-Aid Standards and in consultation with potential end users. Adults with depression and alcohol use comorbidity, who were considering/recently considered psychological treatments, were recruited via online advertisements. After clicking on the study URL, participants accessed the ADDAPT e-book and completed validated and purpose-designed questionnaires.
Findings
Of the 24 participants, most would recommend ADDAPT to others (79.2% agree) and endorsed it as easy-to-use (75%), useful in decision-making (79.2%), presenting balanced (87.5%), up-to-date (91.7%), easy-to-understand (79.2%) and trustworthy information (83.3%), which did not provoke anxiety (i.e. safety; 75%). Post-use, participants felt well prepared to decide on treatment (M = 3.48/5) and demonstrated good treatment knowledge (M = 65.83%). All but one participant indicated a treatment choice supported by best available evidence, and decisional conflict scores except for the uncertainty subscale were below the threshold for decisional delay (all M < 37.5/100).
Originality/value
ADDAPT is the first decision-aid of its kind, with pilot findings supporting its acceptability, feasibility, safety and potential usefulness for improving decision-making quality among people considering psychological treatment options for depression and alcohol use comorbidity.
Collapse
|
3
|
Knock E, Johnson MP, Baker A, Thornton L, Kay-Lambkin F. Therapeutic alliance in psychological treatment for depression and alcohol use comorbidity: The client's perspective. Bull Menninger Clin 2021; 85:177-203. [PMID: 34032464 DOI: 10.1521/bumc.2021.85.2.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This qualitative study explored the treatment experience and the therapeutic relationship of participants receiving an integrated psychological treatment for comorbid alcohol use problems and depressive disorders. Semistructured interviews targeting experience of therapy and the relationship with the therapist were carried out with seven participants. Transcripts were analyzed using Interpretive Phenomenological Analysis to reveal major themes. Four major themes were identified. "Nature of the relationship" describes the importance of the client's perception of the therapeutic relationship experienced, "Confidence in therapy" and "Acknowledgment of experience" address components assisting the development of a positive alliance, and "Meeting unmet needs for connection" illustrates the importance of a positive therapeutic relationship for this population. Participants thought that clinicians would benefit from a good understanding of the role the alliance relationship plays within comorbidity treatment, of the need this relationship meets for this population, and the importance of engendering confidence in therapy and recognizing client perspectives.
Collapse
Affiliation(s)
- Elizabeth Knock
- Clinical Psychologist in the School of Psychology, University of Newcastle, Callaghan, NSW, Australia
| | - Martin P Johnson
- Senior Lecturer in the School of Psychology, University of Newcastle, Callaghan, NSW, Australia
| | - Amanda Baker
- Professor/Senior Clinical Psychologist and a Clinical Psychologist, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Louise Thornton
- Lecturer at The Matilda Centre, University of Sydney, Camperdown, NSW, Australia
| | - Frances Kay-Lambkin
- Professor/Senior Research Fellow, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| |
Collapse
|
4
|
Fisher A, Marel C, Teesson M, Mills K. Assessing patient information and decision-support needs in problematic alcohol use and co-occurring depression to inform shared decision-making interventions. Bull Menninger Clin 2021; 85:143-176. [PMID: 34032461 DOI: 10.1521/bumc.2021.85.2.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors assessed the informational and decision-support needs of patients, families, and clinicians when deciding on treatment for problematic alcohol use and depression. Patients (n = 56), family members (n = 16), and clinicians (n = 65) with experience deciding on treatment for problematic alcohol use and depression were eligible. Participants completed an online decisional needs assessment survey. Stakeholder groups identified numerous difficult patient-level treatment decisions and elevated decisional conflict. Participants preferred patient-led or shared treatment decision-making (75%-95.4%). Patients (32.6%) reported not being as involved in treatment decision-making as preferred, a higher proportion than reported by clinicians (16.4%; p = .056). More patients (19.6%) than clinicians (3.6%) reported clinician-led treatment decision-making, with little or no patient involvement (p = .022). Stakeholder preferences for future decision-support resources included online information for use outside consultations.
Collapse
Affiliation(s)
| | | | | | - Katherine Mills
- Matilda Centre for Research in Mental Health and Substance Use, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Australia
| |
Collapse
|
5
|
Taylor GM, Baker AL, Fox N, Kessler DS, Aveyard P, Munafò MR. Addressing concerns about smoking cessation and mental health: theoretical review and practical guide for healthcare professionals. BJPSYCH ADVANCES 2021; 27:85-95. [PMID: 34513007 PMCID: PMC7611646 DOI: 10.1192/bja.2020.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Smoking rates in people with depression and anxiety are twice as high as in the general population, even though people with depression and anxiety are motivated to stop smoking. Most healthcare professionals are aware that stopping smoking is one of the greatest changes that people can make to improve their health. However, smoking cessation can be a difficult topic to raise. Evidence suggests that smoking may cause some mental health problems, and that the tobacco withdrawal cycle partly contributes to worse mental health. By stopping smoking, a person's mental health may improve, and the size of this improvement might be equal to taking anti-depressants. In this theoretical review and practical guide we outline ways in which healthcare professionals can raise the topic of smoking compassionately and respectfully to encourage smoking cessation. We draw on evidence-based methods like cognitive behavioural therapy, and outline approaches that healthcare professionals can use to integrate these methods into routine care.
Collapse
Affiliation(s)
- Gemma M.J. Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Amanda L. Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2298, Australia
| | - Nadine Fox
- Talking Space Plus, Oxford Health NHS Foundation Trust, Oxford, OX3 7JH, UK
| | - David S. Kessler
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, BS8 2BN, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK
| | - Marcus R. Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
| |
Collapse
|
6
|
Kaczmarek T, Van Netten JJ, Lazzarini PA, Kavanagh D. Effects of training podiatrists to use imagery-based motivational interviewing when treating people with diabetes-related foot disease: a mixed-methods pilot study. J Foot Ankle Res 2021; 14:12. [PMID: 33568218 PMCID: PMC7877056 DOI: 10.1186/s13047-021-00451-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/26/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Self-care in diabetes related foot disease (DFD) is challenging and contributes to poor outcomes. Motivational Interviewing (MI) can engage people in self-care and modifying it by integrating imagery may further improve its outcomes. No previous studies have trained podiatrists in using MI to address DFD self-care. This was the first study on training podiatrists to conduct imagery-based motivational interviewing (MI) when treating people with DFD, and to examine impacts on MI related skills, job satisfaction and subjective experiences in a mixed-methods pilot study. METHODS Eleven recruited podiatrists (median age: 35 years, 9 female and 2 male) received two 4-h training sessions, and three received subsequent mentoring. MI and imagery skills were rated using validated tools during two clinical sessions per participant at baseline, and 2- and 12-weeks post-training. Job satisfaction was assessed at baseline and 12 weeks. Semi-structured interviews at 12 weeks were analysed using the framework approach. RESULTS Significant improvements over time (p = .006-.044) with substantial effect sizes (η2 = .50-.67) were found in three of four global MI related communication skills and two of four MI behaviours. However, effects on these indices were not sustained to 12 weeks, and imagery was rarely used. Job satisfaction was high at baseline and unchanged at follow-up (p = 0.34, η2 = .100). In qualitative interviews, MI training and skills were valued, but significant challenges in using MI when treating people with DFD were reported. CONCLUSION Training podiatrists in MI may have potential but more training, observation and mentoring appear needed to obtain sustained communication changes in practice.
Collapse
Affiliation(s)
- Tracey Kaczmarek
- School of Clinical Sciences, Queensland University of Technology, The Prince Charles Hospital Rhode Road, Brisbane, Queensland, 4032, Australia.
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, QLD, Australia.
| | - Jaap J Van Netten
- School of Clinical Sciences, Queensland University of Technology, The Prince Charles Hospital Rhode Road, Brisbane, Queensland, 4032, Australia
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Peter A Lazzarini
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - David Kavanagh
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Child Health Research and School of Psychology & Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
7
|
Cannon TD. Delivering on the public health promise of the psychosis risk paradigm. World Psychiatry 2020; 19:391-392. [PMID: 32931123 PMCID: PMC7491612 DOI: 10.1002/wps.20785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
8
|
Pedrelli P, Borsari B, Merrill JE, Fisher LB, Nyer M, Shapero BG, Farabaugh A, Hayden ER, Levine MT, Fava M, Weiss RD. Evaluating the combination of a Brief Motivational Intervention plus Cognitive Behavioral Therapy for Depression and heavy episodic drinking in college students. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:308-319. [PMID: 31855009 PMCID: PMC7064381 DOI: 10.1037/adb0000538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
[Correction Notice: An Erratum for this article was reported in Vol 34(2) of Psychology of Addictive Behaviors (see record 2020-16883-001). In the original article the order of authorship was incorrect. The correct second and third authors should appear instead as Brian Borsari and Jennifer E. Merrill.] Heavy episodic drinking (HED) and depressive symptoms often co-occur among college students and are associated with significant impairment. However, evidence-based treatments for these common co-occurring conditions are not available for college students. The current study compared the effectiveness of a treatment combining Cognitive-Behavioral Therapy for Depression and Brief Motivational Interviewing (CBT-D + BMI) versus Cognitive-Behavioral Therapy for Depression (CBT-D) alone among 94 college students with HED and depressive symptoms. Both treatment programs were associated with significant reductions of similar magnitude in HED, alcohol-related problems (ARP), and depressive symptoms at the end of treatment and at the 1-month follow-up assessment. Moderation analyses indicated that, among college students with fewer depressive symptoms at baseline, CBT-D was associated with greater sustained reduction in heavy drinking relative to CBT-D + BMI at the 1-month follow-up. Although the study did not include a no-treatment condition, the magnitude of improvement during treatment in both groups was greater than what is expected with passage of time. Although clinicians in college counseling centers may lack specialty training for co-occurring conditions, CBT-D is widely implemented in college settings. Our findings suggest that CBT-D may reduce both depressive symptoms and HED in college students and may be used to address a significant public health problem. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
- Paola Pedrelli
- Depression Clinical and Research Program, Massachusetts General Hospital
- Harvard Medical School
| | - Brian Borsari
- San Francisco Veteran Affairs Health Care System
- Department of Psychiatry, University of California-San Francisco
| | - Jennifer E. Merrill
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Lauren B. Fisher
- Depression Clinical and Research Program, Massachusetts General Hospital
- Harvard Medical School
| | - Maren Nyer
- Depression Clinical and Research Program, Massachusetts General Hospital
- Harvard Medical School
| | - Benjamin G. Shapero
- Depression Clinical and Research Program, Massachusetts General Hospital
- Harvard Medical School
| | - Amy Farabaugh
- Depression Clinical and Research Program, Massachusetts General Hospital
- Harvard Medical School
| | - Emma R. Hayden
- Depression Clinical and Research Program, Massachusetts General Hospital
| | - M Taylor Levine
- Depression Clinical and Research Program, Massachusetts General Hospital
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital
| | - Roger D. Weiss
- Harvard Medical School
- Division of Alcohol and Drug Abuse, McLean Hospital
| |
Collapse
|
9
|
Pouyanfard S, Mohammadpour M, ParviziFard AA, Sadeghi K. Effectiveness of mindfulness-integrated cognitive behavior therapy on anxiety, depression and hope in multiple sclerosis patients: a randomized clinical trial. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 42:55-63. [DOI: 10.1590/2237-6089-2018-0105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 06/26/2019] [Indexed: 11/22/2022]
|
10
|
Allswede DM, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Mathalon DH, McGlashan T, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cannon TD. Characterizing Covariant Trajectories of Individuals at Clinical High Risk for Psychosis Across Symptomatic and Functional Domains. Am J Psychiatry 2020; 177:164-171. [PMID: 31509005 PMCID: PMC7002249 DOI: 10.1176/appi.ajp.2019.18111290] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to characterize differences in outcomes among help-seeking individuals at clinical high risk for psychosis by identifying covariant longitudinal patterns of symptoms and functioning. METHODS Group-based multitrajectory modeling was applied to longitudinal ratings of four symptom domains (positive, negative, disorganized, general) and general functioning among clinical high-risk individuals in an initial discovery sample (N=422). An independent sample (N=133) was used to test replicability. RESULTS Three trajectory groups were identified among clinical high-risk individuals in the discovery sample: group 1 (30%) exhibited substantial improvement across all domains, with half reaching positive outcomes for both functioning and positive symptoms; group 2 (49%) exhibited moderate impairments across domains, with approximately one-quarter meeting criteria for positive outcomes; the remaining participants (group 3; 22%) exhibited consistent levels of severe impairment across domains and did not experience positive outcomes. These trajectory groups and remission patterns were replicated in an independent sample. CONCLUSIONS Replicable subgroups of help-seeking clinical high-risk cases can be ascertained based on distinctive profiles of change over time in symptoms and functioning. Within each of the three identified subgroups, similar patterns of change (i.e., rapid, moderate, or no improvement) were observed across the four symptom domains and functioning. This consistency of change over time across domains within each subgroup is a novel observation supporting the syndrome consistency of clinical high-risk symptoms and signs. The observed trajectory subgroups are suggestive of different degrees of need for clinical interventions, ranging from minimal or supportive for about one-third of cases to increasingly intensive among the remainder.
Collapse
Affiliation(s)
- Dana M. Allswede
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Jean Addington
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Carrie E. Bearden
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Kristin S. Cadenhead
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Barbara A. Cornblatt
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Daniel H. Mathalon
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Thomas McGlashan
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Diana O. Perkins
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Larry J. Seidman
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Ming T. Tsuang
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Elaine F. Walker
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Scott W. Woods
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Tyrone D. Cannon
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| |
Collapse
|
11
|
Hesse M, Thylstrup B, Seid AK, Skogen JC. Suicide among people treated for drug use disorders: a Danish national record-linkage study. BMC Public Health 2020; 20:146. [PMID: 32005222 PMCID: PMC6995113 DOI: 10.1186/s12889-020-8261-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background Substance use disorders are a major risk factor for suicide. However, less is known about specific risk factors for suicide in people with substance use disorders. Methods This population cohort study assessed suicide among people treated for drug use disorders in Denmark 2000–2010, and described risk factors for completed suicide. Data from 27,942 individuals enrolled in treatment were linked to national registers and matched with controls without drug use disorder and with (n = 138,136) or without psychiatric history (n = 1574). Competing risk regression was used to identify risk factors of completed suicide. Results There were 163 suicides among patients with a history of drug treatment (0.6% of patients). Increased risk was associated with younger age at enrolment (hazard ratio [HR] = 0.97, 95% confidence interval (CI): 0.95, 0.98), history of psychiatric care (HR = 1.96, CI 95%: 1.39, 2.77), opioid use (HR = 1.81, 95% CI: 1.23, 2.68), and alcohol use (HR = 1.56, 95% CI: 1.09, 2.23). Lower risk was associated with cannabis use (HR = 0.69, 95% CI: 0.50, 0.96). Compared with age- and gender-matched controls without a history of treatment for substance use disorders or recent psychiatric care, the standardized mortality ratio due to suicide was 7.13 for people with drug use disorder without a history of psychiatric care (95% CI: 5.81, 8.44), 13.48 for people with drug use disorder and psychiatric history (95% CI: 9.75, 17.22), and 13.61 for people with psychiatric history only (95% CI: 6.72, 20.50). Conclusions Risk of suicide is increased among people with drug use disorders. Access to treatment for co-morbid mental health problems for people with drug use disorders could potentially reduce risk of suicide.
Collapse
Affiliation(s)
- Morten Hesse
- Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark.
| | - Birgitte Thylstrup
- Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Abdu Kedir Seid
- Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Alcohol & Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
12
|
Meque I, Betts KS, Salom CL, Scott JG, Clavarino A, Mamun A, Najman JM, Alati R. Social Drinking Contexts and Their Influence on Problematic Drinking at Age 30. Subst Use Misuse 2020; 55:188-199. [PMID: 31519127 DOI: 10.1080/10826084.2019.1660679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: Understanding the social contexts in which problematic drinking occurs can inform prevention strategies. In this article, we investigate gender-specific social contexts associated with problematic drinking and depression among adults aged 30 years. Because depression has been consistently linked with harmful alcohol consumption, we will also examine its association with drinking contexts. Methods: We used data from 2490 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exploratory and confirmatory factor analyses were used to identify latent constructs of drinking contexts stratified by gender, with subsequent regression analysis to assess the role of these contexts in problematic drinking (measured using the Alcohol Use Disorders Identification Test). Results: Six distinct drinking contexts were identified, which differed by gender, three for men and three for women. For both men and women, "social drinking", was associated with problematic drinking. "Home drinking" was also common to men and women but associations with problematic drinking differed, being risky only among men. "Daytime drinking" (women) was associated with risk but "work-related drinking" (men) was not. Both "home drinking" (men) and "daytime drinking" (women) were linked to depression symptoms. Conclusion: Specific contexts appeared to be associated with problematic drinking for both sexes. Among both men and women, "social drinking" was associated with problematic drinking. Both "home drinking" (men) and "daytime drinking" (women) contexts, were associated with problematic drinking and depressive symptoms. Targeted alcohol-focused interventions need to address co-occurring mental health issues.
Collapse
Affiliation(s)
- Ivete Meque
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Kim S Betts
- School of Public Health, Curtin University, Perth, Australia
| | - Caroline L Salom
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - James G Scott
- School of Public Health, University of Queensland, Brisbane, Australia
| | | | - Abdulla Mamun
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Jake M Najman
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Rosa Alati
- Institute for Social Science Research, University of Queensland, Brisbane, Australia.,School of Public Health, Curtin University, Perth, Australia
| |
Collapse
|
13
|
Hides L, Quinn C, Stoyanov S, Kavanagh D, Baker A. Psychological interventions for co-occurring depression and substance use disorders. Cochrane Database Syst Rev 2019; 2019:CD009501. [PMID: 31769015 PMCID: PMC6953216 DOI: 10.1002/14651858.cd009501.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Comorbid depression and substance use disorders are common and have poorer outcomes than either disorder alone. While effective psychological treatments for depression or substance use disorders are available, relatively few randomised controlled trials (RCTs) have examined the efficacy of these treatments in people with these comorbid disorders. OBJECTIVES To assess the efficacy of psychological interventions delivered alone or in combination with pharmacotherapy for people diagnosed with comorbid depression and substance use disorders. SEARCH METHODS We searched the following databases up to February 2019: Cochrane Central Register of Controlled Trials, PubMed, Embase, CINAHL, Google Scholar and clinical trials registers. All systematic reviews identified, were handsearched for relevant articles. SELECTION CRITERIA The review includes data from RCTs of psychological treatments for people diagnosed with comorbid depression and substance use disorders, using structured clinical interviews. Studies were included if some of the sample were experiencing another mental health disorder (e.g. anxiety); however, studies which required a third disorder as part of their inclusion criteria were not included. Studies were included if psychological interventions (with or without pharmacotherapy) were compared with no treatment, delayed treatment, treatment as usual or other psychological treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Seven RCTs of psychological treatments with a total of 608 participants met inclusion criteria. All studies were published in the USA and predominately consisted of Caucasian samples. All studies compared different types of psychological treatments. Two studies compared Integrated Cognitive Behavioural Therapy (ICBT) with Twelve Step Facilitation (TSF), another two studies compared Interpersonal Psychotherapy for Depression (IPT-D) with other treatment (Brief Supportive Therapy (BST) or Psychoeducation). The other three studies compared different types or combinations of psychological treatments. No studies compared psychological interventions with no treatment or treatment as usual control conditions. The studies included a diverse range of participants (e.g. veterans, prisoners, community adults and adolescents). All studies were at high risk of performance bias, other main sources were selection, outcome detection and attrition bias. Due to heterogeneity between studies only two meta-analyses were conducted. The first meta-analysis focused on two studies (296 participants) comparing ICBT to TSF. Very low-quality evidence revealed that while the TSF group had lower depression scores than the ICBT group at post-treatment (mean difference (MD) 4.05, 95% confidence interval (CI) 1.43 to 6.66; 212 participants), there was no difference between groups in depression symptoms (MD 1.53, 95% CI -1.73 to 4.79; 181 participants) at six- to 12-month follow-up. At post-treatment there was no difference between groups in proportion of days abstinent (MD -2.84, 95% CI -8.04 to 2.35; 220 participants), however, the ICBT group had a greater proportion of days abstinent than the TSF group at the six- to 12-month follow-up (MD 10.76, 95% CI 3.10 to 18.42; 189 participants). There were no differences between the groups in treatment attendance (MD -1.27, 95% CI -6.10 to 3.56; 270 participants) or treatment retention (RR 0.95, 95% CI 0.72 to 1.25; 296 participants). The second meta-analysis was conducted with two studies (64 participants) comparing IPT-D with other treatment (Brief Supportive Psychotherapy/Psychoeducation). Very low-quality evidence indicated IPT-D resulted in significantly lower depressive symptoms at post-treatment (MD -0.54, 95% CI -1.04 to -0.04; 64 participants), but this effect was not maintained at three-month follow-up (MD 3.80, 95% CI -3.83 to 11.43) in the one study reporting follow-up outcomes (38 participants; IPT-D versus Psychoeducation). Substance use was examined separately in each study, due to heterogeneity in outcomes. Both studies found very low-quality evidence of no significant differences in substance use outcomes at post-treatment (percentage of days abstinent, IPD versus Brief Supportive Psychotherapy; MD -2.70, 95% CI -28.74 to 23.34; 26 participants) or at three-month follow-up (relative risk of relapse, IPT-D versus Psychoeducation; RR 0.67, 95% CI 0.30 to 1.50; 38 participants). There was also very low-quality evidence for no significant differences between groups in treatment retention (RR 1.00, 95% CI 0.81 to 1.23; 64 participants). No adverse events were reported in any study. AUTHORS' CONCLUSIONS The conclusions of this review are limited due to the low number and very poor quality of included studies. No conclusions can be made about the efficacy of psychological interventions (delivered alone or in combination with pharmacotherapy) for the treatment of comorbid depression and substance use disorders, as they are yet to be compared with no treatment or treatment as usual in this population. In terms of differences between psychotherapies, although some significant effects were found, the effects were too inconsistent and small, and the evidence of too poor quality, to be of relevance to practice.
Collapse
Affiliation(s)
- Leanne Hides
- The University of QueenslandSchool of PsychologySt Lucia, BrisbaneQueenslandAustralia4072
| | - Catherine Quinn
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Stoyan Stoyanov
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - David Kavanagh
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Amanda Baker
- University of Newcastle, CallaghanCentre for Brain and Mental Health ResearchNewcomen Street, James Fletcher HospitalNewcastleNew South WalesAustralia2300
| | | |
Collapse
|
14
|
Strid C, Hallgren M, Forsell Y, Kraepelien M, Öjehagen A. Changes in alcohol consumption after treatment for depression: a secondary analysis of the Swedish randomised controlled study REGASSA. BMJ Open 2019; 9:e028236. [PMID: 31712330 PMCID: PMC6858246 DOI: 10.1136/bmjopen-2018-028236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Mental health problems and hazardous alcohol consumption often co-exist. Hazardous drinking could have a negative impact on different aspects of health and also negatively influence the effect of mental health treatment. The aims of this study were to examine if alcohol consumption patterns changed after treatment for depression and if the changes differed by treatment arm and patient sex. METHODS This study of 540 participants was conducted in a large randomised controlled trial (RCT) that aimed to compare the effect of internet-based cognitive behavioural therapy, physical exercise and treatment as usual on 945 participants with mild-to-moderate depression. Treatment lasted for 12 weeks; alcohol consumption (Alcohol Use Disorder Identification Test (AUDIT)) and depression (Montgomery Åsberg Depression Rating Scale (MADRS)) were assessed at baseline and 12-month follow-up. Changes in alcohol consumption were examined in relation to depression severity, treatment arm and patient sex. RESULTS The AUDIT distribution for the entire group remained unchanged after treatment for depression. Hazardous drinkers exhibit decreases in AUDIT scores, although they remained hazardous drinkers according to the cut-off scores. Hazardous drinkers experienced similar improvements in symptoms of depression compared with non-hazardous drinkers, and there was no significant relation between changes in AUDIT score and changes in depression. No differences between treatment arm and patient sex were found. CONCLUSION The alcohol consumption did not change, despite treatment effects on depression. Patients with depression should be screened for hazardous drinking habits and offered evidence-based treatment for hazardous alcohol use where this is indicated. TRIAL REGISTRATION NUMBER DRKS00008745.
Collapse
Affiliation(s)
| | - Mats Hallgren
- Department of Public Health Science, Section of Epidemiology and Public Health Intervention Research, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Forsell
- Department of Public Health Science, Section of Epidemiology and Public Health Intervention Research, Karolinska Institutet, Stockholm, Sweden
| | - Martin Kraepelien
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Öjehagen
- Department of Clinical Science, Lund, Division of Psychiatry, Lund University, Lund, Sweden
| |
Collapse
|
15
|
Schulte B, Kaner EFS, Beyer F, Schmidt CS, O'Donnell A. Study protocol for a systematic review of evidence for digital interventions for comorbid excessive drinking and depression in community-dwelling populations. BMJ Open 2019; 9:e031503. [PMID: 31628128 PMCID: PMC6803077 DOI: 10.1136/bmjopen-2019-031503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Excessive drinking and depression are frequently comorbid and make a substantial contribution to the global non-communicable disease burden. A range of effective interventions and treatments exist for either excessive drinking or depression alone, including a positive emerging evidence base for the use of digital interventions. Computerised and/or smartphone delivered advice could provide flexible, coordinated support for patients with comorbid excessive drinking and depression. However, to date, no systematic review of the evidence has been conducted focused on the effectiveness of digital interventions for this specific comorbid population. This systematic review will identify and evaluate the effectiveness of digital interventions for reducing comorbid excessive drinking and depression in community-dwelling populations. METHODS AND ANALYSIS We will search MEDLINE, The Cochrane Library, CENTRAL, CINAHL, PsycINFO, ERIC and SCI from inception to end of July 2019 for randomised controlled trials that evaluate any personalised digital intervention for comorbid excessive drinking and depression and published in any language. Primary outcomes will be changes in quantity of alcohol consumed and depressive symptoms. Screening, data extraction and risk of bias assessment will be undertaken independently by two reviewers, with disagreements resolved through discussion. Meta-analytic methods will be used to synthesise the data collected relating to the primary outcomes of interest. ETHICS AND DISSEMINATION As a systematic review, ethical approval is not needed. Findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER CRD42019130134.
Collapse
Affiliation(s)
- Bernd Schulte
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eileen F S Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christiane S Schmidt
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amy O'Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
16
|
Satre DD, Anderson AN, Leibowitz AS, Levine-Hall T, Slome S, Flamm J, Hare CB, McNeely J, Weisner CM, Horberg MA, Volberding P, Silverberg MJ. Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial. Contemp Clin Trials 2019; 84:105833. [PMID: 31446142 PMCID: PMC6760257 DOI: 10.1016/j.cct.2019.105833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care. METHODS The Promoting Access to Care Engagement (PACE) trial currently in process examines the impact of self-administered electronic screening for SUD risk, depression and anxiety in three large Kaiser Permanente Northern California primary care clinics serving over 5000 PWH. Screening uses validated measures (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]; and the Adult Outcomes Questionnaire [AOQ], which includes the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-2]) delivered via three modalities (secure messaging, tablets in waiting rooms, and desktop computers in exam rooms). Results are integrated automatically into the electronic health record. Based on screening results and physician referrals, behavioral health specialists embedded in primary care initiate motivational interviewing- and cognitive behavioral therapy-based brief treatment and link patients to addiction and psychiatry clinics as needed. Analyses examine implementation (screening and treatment rates) and effectiveness (SUD, depression and anxiety symptoms; HIV viral control) outcomes using a stepped-wedge design, with a 12-month intervention phase implemented sequentially in the clinics, and a 24-month usual care period prior to implementation in each clinic functioning as sequential observational phases for comparison. We also evaluate screening and treatment costs and implementation barriers and facilitators. DISCUSSION The study examines innovative, technology-facilitated strategies for improving assessment and treatment in primary care. Results may help to inform substance use, mental health, and HIV services. TRIAL REGISTRATION NCT03217058.
Collapse
Affiliation(s)
- Derek D Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Alexandra N Anderson
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Amy S Leibowitz
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Sally Slome
- Kasier Permanente Oakland Medical Center, 3801 Howe St, Oakland, CA 94611, United States of America
| | - Jason Flamm
- Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave, Sacramento, CA 95825, United States of America
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, 2238 Geary Blvd, San Francisco, CA 94115, United States of America
| | - Jennifer McNeely
- New York University School of Medicine, 550 1st Ave., New York, NY 10016, United States of America
| | - Constance M Weisner
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson, Rockville, MD 20852, United States of America
| | - Paul Volberding
- AIDS Research Institute, University of California San Francisco, San Francisco, CA, 94158, United States of America
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| |
Collapse
|
17
|
Lubman DI, Grigg J, Manning V, Hall K, Volpe I, Dias S, Baker A, K Staiger P, Reynolds J, Harris A, Tyler J, Best D. A structured telephone-delivered intervention to reduce problem alcohol use (Ready2Change): study protocol for a parallel group randomised controlled trial. Trials 2019; 20:515. [PMID: 31426835 PMCID: PMC6701125 DOI: 10.1186/s13063-019-3462-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Current population surveys suggest around 20% of Australians meet diagnostic criteria for an alcohol use disorder. However, only a minority seek professional help due to individual and structural barriers, such as low health literacy, stigma, geography, service operating hours and wait lists. Telephone-delivered interventions are readily accessible and ideally placed to overcome these barriers. We will conduct a randomised controlled trial (RCT) to examine the efficacy of a standalone, structured telephone-delivered intervention to reduce alcohol consumption, problem severity and related psychological distress among individuals with problem alcohol use. Methods/design This is a single site, parallel group, two-arm superiority RCT. We will recruit 344 participants from across Australia with problem alcohol use. After completing a baseline assessment, participants will be randomly allocated to receive either the Ready2Change (R2C) intervention (n = 172, four to six sessions of structured telephone-delivered intervention, R2C self-help resource, guidelines for alcohol consumption and stress management pamphlets) or the control condition (n = 172, four phone check-ins < 5 min, guidelines for alcohol consumption and stress management pamphlets). Telephone follow-up assessments will occur at 4–6 weeks, 3 months, 6 months and 12 months post-baseline. The primary outcome is the Alcohol Use Disorders Identification Test (AUDIT) score administered at 3 months post-baseline. Secondary outcomes include change in AUDIT score (6 and 12 months post-baseline), change in number of past-month heavy drinking days, psychological distress, health and wellbeing, quality of life, client treatment evaluation and cost effectiveness. Discussion This study will be one of the first RCTs conducted internationally to examine the impact of a standalone, structured telephone-delivered intervention to address problem alcohol use and associated psychological morbidity. The proposed intervention is expected to contribute to the health and wellbeing of individuals who are otherwise unlikely to seek treatment through mainstream service models, to reduce the burden on specialist services and primary care providers and to provide an accessible and proportionate response, with resulting cost savings for the health system and broader community. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618000828224. Pre-registered on 16 May 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3462-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Dan I Lubman
- Eastern Health Clinical School, Monash University, Box Hill, Australia. .,Turning Point, Eastern Health, Richmond, Australia.
| | - Jasmin Grigg
- Eastern Health Clinical School, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Australia.,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Melbourne, Australia
| | | | | | - Amanda Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia.,Centre of Drug, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Melbourne, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Clayton, Australia
| | | | - David Best
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
18
|
Bailey KA, Baker AL, McElduff P, Kay-Lambkin F, Kavanagh DJ. Do outcomes of cognitive-behaviour therapy for co-occurring alcohol misuse and depression differ for participants with symptoms of posttraumatic stress? J Ment Health 2019; 30:12-19. [PMID: 30862293 DOI: 10.1080/09638237.2019.1581354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although post-traumatic stress disorder (PTSD) often co-occurs with depression and alcohol use disorder (AUD), treatment settings may not screen for PTSD symptoms. AIMS To explore the effects of PTSD symptoms in participants seeking treatment for depression and alcohol misuse by capitalising on the DAISI (Depression and Alcohol Integrated and Single focussed Interventions) project. METHODS Participants (N = 220) with current depressive symptoms and alcohol misuse were recruited from the DAISI project, a randomised controlled trial with four treatment arms. PTSD symptoms were assessed at baseline by the Posttraumatic Stress Diagnostic Scale and again at the 3-month assessment. RESULTS McNemars t-test assessed for changes in PTSD symptom severity and PTSD symptom clusters at the 3-month assessment. Repeated measures multivariate analysis of variance assessed for changes in PTSD symptoms, by DAISI treatment allocation. At the 3-month assessment, participants with PTSD reported significant reductions in PTSD symptoms (except intrusion) and a lower rate of PTSD, and responded better to integrated depression-alcohol misuse CBT than to the alcohol/depression single-focussed or brief interventions. CONCLUSION Integrated depression and alcohol misuse CBT may be effective for PTSD symptoms, but intrusions may need to be addressed specifically.
Collapse
Affiliation(s)
- Kylie A Bailey
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - David J Kavanagh
- Child Health Research. Institute of Health and Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
19
|
Taylor G, Aveyard P, Bartlem K, Shaw A, Player J, Metcalfe C, Kessler D, Munafò M. IntEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): protocol for a randomised and controlled, multicentre, acceptability, feasibility and implementation trial. Pilot Feasibility Stud 2019; 5:16. [PMID: 30693096 PMCID: PMC6343330 DOI: 10.1186/s40814-018-0385-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND People with depression/anxiety are twice as likely to smoke and are less responsive to standard tobacco treatments, leading to a reduced life expectancy of up to 13.6 years compared to people without depression/anxiety. However, this group of smokers is motivated to quit, and as a result of quitting smoking, their depression/anxiety is likely to improve. In England, people with depression/anxiety are referred to a primary care-based psychological therapies service known as 'Improving Access to Psychological Therapies' (IAPT), which could offer smoking cessation treatment as part of usual care but currently does not. In this study, we aim (1) to establish the feasibility and acceptability of delivering a smoking cessation treatment alongside IAPT usual care and (2) to establish the feasibility of a multi-centre randomised trial to compare the combined smoking cessation and IAPT treatment to usual IAPT treatment alone. METHODS A randomised and controlled, multi-centre trial to test the acceptability, feasibility and implementation of smoking cessation treatment as offered alongside usual IAPT care, compared to usual care alone, with nested qualitative methods. We will include adult daily smokers with depression/anxiety, who would like help to quit smoking and are about to start IAPT treatment. Follow-up will be conducted at 3-months after baseline. The main outcome will be retention in the smoking cessation treatment. Secondary outcomes are smoking-related (biochemically-verified 7-day point prevalence smoking cessation, number of cigarettes smoked per day, Heaviness of Smoking Index), mental health-related (PHQ-9), service-related (number of 'Did Not Attends', number of planned and completed IAPT sessions), acceptability and feasibility (participant and clinician acceptability and satisfaction of intervention as assessed by questionnaires and qualitative interviews, interviews will also explore acceptability and feasibility of data collection procedures and impact of smoking cessation treatment on usual care and mental health recovery) and implementation-related (intervention delivery checklist, qualitative analysis of intervention delivery). DISCUSSION If the intervention is shown to be acceptable, feasible and suitably implemented, we can conduct a randomised controlled trial. In a future trial, we would examine whether adding smoking cessation treatment increases smoking abstinence and improves depression and anxiety more than usual care, which would lead to long-term health improvement. TRIAL REGISTRATION ISRCTN99531779.
Collapse
Affiliation(s)
- Gemma Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, 10 West, Bath, BA2 7AY UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, UK Centre for Tobacco and Alcohol Studies, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter Woodstock Road, Oxford, OX2 6GG UK
| | - Kate Bartlem
- School of Psychology, University of Newcastle, Behavioural Sciences Building, University Drive, Callaghan, 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Booth Building, Longworth Avenue, Wallsend, NSW 2287 Australia
| | - Alison Shaw
- Centre for Academic Primary Care, Bristol Medical School, Department of Population Health Sciences, Canynge Hall, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jeremy Player
- Jeremy Player, Solutions 4 Health, 7200 The Quorum, Oxford Business Park, Garsington Road, Oxford, OX4 2JZ UK
| | - Chris Metcalfe
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David Kessler
- Centre for Academic Primary Care, Bristol Medical School, Department of Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Marcus Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| |
Collapse
|
20
|
McCrabb S, Baker AL, Attia J, Balogh ZJ, Lott N, Palazzi K, Naylor J, Harris IA, Doran CM, George J, Wolfenden L, Skelton E, Bonevski B. Comorbid tobacco and other substance use and symptoms of anxiety and depression among hospitalised orthopaedic trauma patients. BMC Psychiatry 2019; 19:28. [PMID: 30654783 PMCID: PMC6337866 DOI: 10.1186/s12888-019-2021-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 01/09/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND No study has examined the prevalence of tobacco, other substance use, and symptoms of anxiety and depression, and rates of comorbidities among the orthopaedic trauma population, despite the impact they have on recovery from surgery. This study aims to 1) describe the rates of symptoms and substance use; 2) compare rates of symptoms and substance use among smokers versus non-smokers; and 3) examine the relationship between symptoms and substance use with smoking status. METHODS A cross-sectional survey of orthopaedic trauma patients was conducted in two Australian public hospitals. Demographic characteristics, smoking status, alcohol consumption, recent cannabis use, and symptoms of anxiety and/or depression were examined. Differences between current and non-smokers were compared using Pearson Chi2 tests. Multivariate logistic regression explored variables related to tobacco smoking. RESULTS Eight hundred nineteen patients participated. Over one-fifth (21.8%) identified as a current smoker, half (51.8%) reported consuming alcohol at hazardous levels in the last 12 months, and about 10% stated that they had used cannabis in the last 30 days (9.7%), or experienced symptoms of either anxiety (12.4%), or depression (12.9%) in the last two weeks. Over one-fifth of current tobacco smokers (21.8%) reported drinking heavily in the last 12 months and using cannabis recently. Males, with a lower educational attainment, who were unmarried, had used cannabis recently, and report drinking heavily were more likely to be current smokers. CONCLUSIONS Health behaviour interventions addressing comorbidities are warranted among the orthopaedic trauma population given the high rate of comorbidity and impact these may have on recovery.
Collapse
Affiliation(s)
- Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.
| | - Amanda L. Baker
- 0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308 Australia
| | - John Attia
- 0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308 Australia ,0000 0000 8831 109Xgrid.266842.cHunter Medical Research Institute, University of Newcastle, New Lambton, New South Wales 2305 Australia ,0000 0004 0577 6676grid.414724.0Department of General Medicine, John Hunter Hospital, New Lambton Heights, New South Wales 2305 Australia
| | - Zsolt J. Balogh
- 0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308 Australia ,0000 0004 0577 6676grid.414724.0Department of Traumatology, John Hunter Hospital, New Lambton, New South Wales 2305 Australia
| | - Natalie Lott
- 0000 0004 0577 6676grid.414724.0Department of Traumatology, John Hunter Hospital, New Lambton, New South Wales 2305 Australia
| | - Kerrin Palazzi
- 0000 0000 8831 109Xgrid.266842.cHunter Medical Research Institute, University of Newcastle, New Lambton, New South Wales 2305 Australia
| | - Justine Naylor
- 0000 0004 0527 9653grid.415994.4Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales 2170 Australia ,0000 0004 4902 0432grid.1005.4South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, New South Wales 2170 Australia
| | - Ian A. Harris
- 0000 0004 0527 9653grid.415994.4Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales 2170 Australia ,0000 0004 4902 0432grid.1005.4South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, New South Wales 2170 Australia
| | - Christopher M. Doran
- 0000 0001 2193 0854grid.1023.0School of Human, Health and Social Sciences, Central Queensland University, Brisbane, Queensland 4000 Australia
| | - Johnson George
- 0000 0004 1936 7857grid.1002.3Centre for Medicine Use and Safety, Monash University, Parkville, Victoria 3052 Australia
| | - Luke Wolfenden
- 0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308 Australia ,Hunter New England Population Health, Wallsend, NSW 2287 Australia
| | - Eliza Skelton
- 0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Billie Bonevski
- 0000 0000 8831 109Xgrid.266842.cSchool of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308 Australia
| |
Collapse
|
21
|
Boniface S, Malet-Lambert I, Coleman R, Deluca P, Donoghue K, Drummond C, Khadjesari Z. The Effect of Brief Interventions for Alcohol Among People with Comorbid Mental Health Conditions: A Systematic Review of Randomized Trials and Narrative Synthesis. Alcohol Alcohol 2018; 53:282-293. [PMID: 29293882 DOI: 10.1093/alcalc/agx111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/30/2017] [Indexed: 11/12/2022] Open
Abstract
Aims To review the evidence on the effect of brief interventions (BIs) for alcohol among adults with risky alcohol consumption and comorbid mental health conditions. Methods A systematic review of randomized controlled trials (RCTs) published before May 2016 was undertaken and reported according to PRISMA guidelines. The findings were combined in a narrative synthesis. The risk of bias was assessed for included trials. Results Seventeen RCTs were included in the review and narrative synthesis: 11 in common mental health problems, and 6 in severe mental illness. There was considerable heterogeneity in study populations, BI delivery mode and intensity, outcome measures and risk of bias. Where BI was compared with a minimally active control, BI was associated with a significant reduction in alcohol consumption in four out of nine RCTs in common mental disorders and two out of five RCTs in severe mental illness. Where BI was compared with active comparator groups (such as motivational interviewing or cognitive behavioural therapy), findings were also mixed. Differences in the findings may be partly due to differences in study design, such as the intensity of BI and possibly the risk of bias. Conclusions Overall, the evidence is mixed regarding the effects of alcohol BI in participants with comorbid mental health conditions. Future well-designed research is required to answer this question more definitively.
Collapse
Affiliation(s)
- Sadie Boniface
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Addiction Sciences Building PO 48, 16 De Crespigny Park, London SE5 8AF, UK
| | - Isabella Malet-Lambert
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Addiction Sciences Building PO 48, 16 De Crespigny Park, London SE5 8AF, UK
| | - Rachel Coleman
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Addiction Sciences Building PO 48, 16 De Crespigny Park, London SE5 8AF, UK
| | - Paolo Deluca
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Addiction Sciences Building PO 48, 16 De Crespigny Park, London SE5 8AF, UK
| | - Kim Donoghue
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Addiction Sciences Building PO 48, 16 De Crespigny Park, London SE5 8AF, UK
| | - Colin Drummond
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Addiction Sciences Building PO 48, 16 De Crespigny Park, London SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham BR3 3BX, UK
| | - Zarnie Khadjesari
- Centre for Implementation Science, Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| |
Collapse
|
22
|
Hobden B, Bryant J, Carey M, Baker AL, Farrell M, Oldmeadow C, Mattick RP, Shakeshaft A, Sanson-Fisher R. Finding the optimal treatment model: A systematic review of treatment for co-occurring alcohol misuse and depression. Aust N Z J Psychiatry 2018; 52:737-750. [PMID: 29466868 DOI: 10.1177/0004867418758922] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Alcohol misuse and depression are commonly co-occurring conditions. To date, no review has examined the most efficacious treatment model for psychosocial treatment of co-occurring alcohol misuse and depression. This systematic review determined the: (i) methodological quality of publications examining psychosocial treatment of co-occurring alcohol misuse and depression using a sequential, parallel or integrated treatment model; and (ii) effectiveness of each dual treatment model compared to single treatment for those with co-occurring alcohol misuse and depression. METHODS PubMed, Medline and PsycInfo databases were searched for studies which were included if they involved treatment for alcohol misuse and depression and could be classified into one of the three treatment models. Included studies were assessed using the Cochrane's Effective Practice and Organisation of Care risk of bias criteria. Relevant study characteristics and outcomes were extracted and are presented in a narrative review format. RESULTS Seven studies met inclusion criteria. None were categorised as low risk on the risk of bias criteria. No studies examined a sequential model of treatment, three examined a parallel model and four examined an integrated model of dual-focussed treatment. The studies examining the parallel model and two out of four studies examining the effectiveness of an integrated model demonstrated greater improvement for alcohol or depression outcomes compared to control conditions. CONCLUSION Evidence for the psychosocial treatment of co-occurring alcohol misuse and depression is limited to a handful of studies. The evidence has several methodological limitations, which impact the interpretation of the findings. Therefore, while international guidelines recommend integrated dual-focussed treatment for co-occurring conditions, there is little evidence supporting the superiority of this treatment format for co-occurring alcohol misuse and depression. High-quality research demonstrating improvements in patient outcomes is required to ensure recommendations for clinical practice are based on strong empirical evidence.
Collapse
Affiliation(s)
- Breanne Hobden
- 1 Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,2 Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,3 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jamie Bryant
- 1 Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,2 Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,3 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Mariko Carey
- 1 Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,2 Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,3 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Amanda L Baker
- 4 School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Michael Farrell
- 5 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Christopher Oldmeadow
- 4 School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,6 Clinical Research Design, Information Technology and Statistical Services, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Richard P Mattick
- 5 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Anthony Shakeshaft
- 5 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Rob Sanson-Fisher
- 1 Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,2 Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,3 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
23
|
Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions. J Addict Med 2018; 12:262-272. [DOI: 10.1097/adm.0000000000000410] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Kenney SR, Napper LE, LaBrie JW, Vaughn P. Reasons for Utilizing Mental Health Services as Predictors of College Students' Alcohol Risk. JOURNAL OF COLLEGE COUNSELING 2018; 21:125-138. [PMID: 34456554 DOI: 10.1002/jocc.12092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The authors examined college student drinkers' (N = 153) reasons for seeking counseling services and risk for alcohol problems. Students seeking help for impulse- or anger-related issues and depression were at heightened risk for alcohol problems. Only 10% of students sought alcohol-related help despite high rates of hazardous alcohol use (80%) and dependence (39%). Targeted screening and intervention in college counseling centers may enable providers to effectively identify and treat students in need of alcohol treatment.
Collapse
Affiliation(s)
- Shannon R Kenney
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | - Joseph W LaBrie
- Department of Psychology, Loyola Marymount University, Los Angeles
| | - Paige Vaughn
- Department of Psychology, Loyola Marymount University, Los Angeles
| |
Collapse
|
25
|
Pharmacological and Psychological Treatments for Comorbid Alcohol Use Disorder and Depressive Disorder: a Review. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0213-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
26
|
Thylstrup B, Bloomfield K, Hesse M. Incremental predictive validity of the Addiction Severity Index psychiatric composite score in a consecutive cohort of patients in residential treatment for drug use disorders. Addict Behav 2018; 76:201-207. [PMID: 28846941 DOI: 10.1016/j.addbeh.2017.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Addiction Severity Index (ASI) is a widely used assessment instrument for substance abuse treatment that includes scales reflecting current status in seven potential problem areas, including psychiatric severity. The aim of this study was to assess the ability of the psychiatric composite score to predict suicide and psychiatric care after residential treatment for drug use disorders after adjusting for history of psychiatric care. METHODS All patients treated for drug use disorders in residential treatment centers in Denmark during the years 2000-2010 with complete ASI data were followed through national registers of psychiatric care and causes of death (N=5825). Competing risks regression analyses were used to assess the incremental predictive validity of the psychiatric composite score, controlling for previous psychiatric care, length of intake, and other ASI composite scores, up to 12years after discharge. RESULTS A total of 1769 patients received psychiatric care after being discharged from residential treatment (30.3%), and 27 (0.5%) committed suicide. After adjusting for all covariates, psychiatric composite score was associated with a higher risk of receiving psychiatric care after residential treatment (subhazard ratio [SHR]=3.44, p<0.001), and of committing suicide (SHR=11.45, p<0.001). CONCLUSIONS The ASI psychiatric composite score has significant predictive validity and promises to be useful in identifying patients with drug use disorders who could benefit from additional mental health treatment.
Collapse
|
27
|
Ramo DE, Bahorik AL, Delucchi KL, Campbell CI, Satre DD. Alcohol and Drug Use, Pain and Psychiatric Symptoms among Adults Seeking Outpatient Psychiatric Treatment: Latent Class Patterns and Relationship to Health Status. J Psychoactive Drugs 2017; 50:43-53. [PMID: 29199899 DOI: 10.1080/02791072.2017.1401185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Substance use, psychiatric problems, and pain frequently co-occur, yet clinical profiles of treatment-seeking patients are poorly understood. To inform service and treatment planning, substance use and symptom patterns were examined in an outpatient psychiatry clinic, along with the relationship of these patterns to demographic characteristics and physical health. METHODS Patients (N = 405; age M = 38; 69% White; 60% female) presenting for intake in a psychiatry outpatient clinic completed a computerized assessment of psychiatric problems, drinking, and drug use. Substance use and psychiatric symptom patterns among the sample were identified using latent class analysis. RESULTS A 4-class model fit the data best: Class (1) Moderate symptoms/wide-range users (22.0%) had moderate depression and panic; tobacco, cocaine, hallucinogen, and ecstasy use; and high cannabis use. Class (2) Moderate depression/panic (37.8%) had moderate depression and panic. Class (3) Depression/anxiety, tobacco, and cannabis users (28.0%) had high depression, obsessions, and panic, and moderate pain severity, social phobia, compulsions, trauma, tobacco, and cannabis use. Class (4) Severe/wide range symptoms/users (12.0%) had high panic, depression, social phobia, obsessions, drug use, and moderate pain. Gender, ethnicity, and health status varied by class. CONCLUSIONS Findings highlight the preponderance of substance use (particularly cannabis) and its relationship to psychiatric symptom severity, pain, and health status among those presenting for mental health treatment.
Collapse
Affiliation(s)
- Danielle E Ramo
- a Assistant Professor of Psychiatry, Department of Psychiatry , Weill Institute for Neurosciences, and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco , San Francisco , CA , USA
| | - Amber L Bahorik
- b Postdoctoral Scholar, Department of Psychiatry and Weill Institute for Neurosciences , University of California, San Francisco , San Francisco , CA , USA
| | - Kevin L Delucchi
- c Professor of Psychiatry, Department of Psychiatry, Weill Institute for Neurosciences, and Helen Diller Family Comprehensive Cancer Center , University of California, San Francisco , San Francisco , CA , USA
| | - Cynthia I Campbell
- d Research Scientist II, Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
| | - Derek D Satre
- e Associate Professor of Psychiatry, Department of Psychiatry, Weill Institute for Neurosciences , University of California, San Francisco , San Francisco , CA , USA
| |
Collapse
|
28
|
Pilot Study of an Exercise Intervention for Depressive Symptoms and Associated Cognitive-Behavioral Factors in Young Adults With Major Depression. J Nerv Ment Dis 2017; 205:647-655. [PMID: 27805982 DOI: 10.1097/nmd.0000000000000611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study assesses the feasibility of integrating motivational interviewing (MI) with an exercise intervention. It also explores patterns of depressive symptom changes (cognitive, affective, and somatic subscales) and their relationship to cognitive, behavioral, and immunological factors (interleukin 6, IL-6, a marker for inflammation) across the exercise intervention. Twelve young adults (20.8 ± 1.7 years) meeting DSM-IV criteria for major depressive disorder received a brief MI intervention followed by a 12-week exercise intervention. Assessments were conducted preintervention, postintervention, throughout the intervention, and at follow-up. Preliminary results show differential effects of exercise, with the largest standardized mean improvements for the affective subscale (-1.71), followed by cognitive (-1.56) and somatic (-1.39) subscales. A significant relationship was observed between increased behavioral activation and lower levels of IL-6. Despite study limitations, the magnitude of changes suggests that natural remission of depressive symptoms is an unlikely explanation for the findings. A randomized controlled trial has commenced to evaluate effectiveness of the intervention.
Collapse
|
29
|
Bailey KA, Baker AL, McElduff P, Jones MA, Oldmeadow C, Kavanagh DJ. Effects of Assault Type on Cognitive Behaviour Therapy for Coexisting Depression and Alcohol Misuse. J Clin Med 2017; 6:jcm6070072. [PMID: 28753976 PMCID: PMC5532580 DOI: 10.3390/jcm6070072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022] Open
Abstract
Although assault exposure is common in mental health and substance misusing populations, screening for assaults in treatment settings is frequently overlooked. This secondary analysis explored the effects of past sexual (SA) and physical (PA) assault on depression, alcohol misuse, global functioning and attrition in the Depression and Alcohol Integrated and Single focussed Intervention (DAISI) project, whose participants (N = 278) received cognitive behaviour therapy (CBT) for their depression and/or alcohol misuse. Of the 278 DAISI participants, 220 consented to screening for past assault (either by a stranger or non-stranger) at baseline. Depression, alcohol, and global functioning assessments were administered at baseline and 3, 12, 24, and 36 months post baseline. A between-group analysis was used to assess differences between SA and No SA, and PA and No PA groupings, on adjusted mean treatment outcomes across all assessment periods. SA and PA participants had similar mean symptom reductions compared to No SA and No PA participants except for lower depression and global functioning change scores at the 12-month follow-up. People with coexisting depression and alcohol misuse reporting SA or PA can respond well to CBT for depression and alcohol misuse. However, follow-up is recommended in order to monitor fluctuations in outcomes.
Collapse
Affiliation(s)
- Kylie A Bailey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW 2308, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW 2308, Australia.
| | - Patrick McElduff
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW 2308, Australia.
| | - Mark A Jones
- Hunter Medical Research Institute, 1/1 Kookaburra circuit, New Lambton Heights NSW 2305, Australia.
| | - Christopher Oldmeadow
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan NSW 2308, Australia.
- Hunter Medical Research Institute, 1/1 Kookaburra circuit, New Lambton Heights NSW 2305, Australia.
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4000, Australia.
| |
Collapse
|
30
|
The Influence of Parental Emotional Neglect on Assault Victims Seeking Treatment for Depressed Mood and Alcohol Misuse: A Pilot Study. J Clin Med 2016; 5:jcm5100088. [PMID: 27735838 PMCID: PMC5086590 DOI: 10.3390/jcm5100088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/16/2016] [Accepted: 09/20/2016] [Indexed: 11/21/2022] Open
Abstract
This study explores the relationship between reported parental emotional neglect when a child, assault type experienced, posttraumatic stress symptoms (PTSS), depression, and alcohol consumption in treatment seekers for comorbid depressive symptoms and alcohol misuse. Participants (n = 220) with concurrent depression and alcohol misuse were recruited from the DAISI (Depression and Alcohol Integrated and Single-focussed Interventions) project. Assault type and PTSS were retrospectively assessed by the Posttraumatic Stress Diagnostic Scale. The Measure of Parenting Style is a self-report measure that retrospectively assessed emotional neglect experienced as a child. An exploratory factor analysis using the tetrachoric correlation matrix (applying principal factor extraction with a varimax rotation) identified the two assault factors of sexual assault (SA) and physical assault (PA). A path analysis revealed that Maternal Emotional Neglect increased the impact of PTSS and depression. Paternal Emotional Neglect increased the impact of PA on PTSS and alcohol dependence symptoms. There appears to be differential effects of assault type and Maternal/Paternal emotional neglect on depression and alcohol misuse, suggesting that parenting roles serve distinct protective functions.
Collapse
|
31
|
Ordóñez AE, Ranney R, Schwartz M, Mathews CA, Satre DD. Hazardous drinking among young adults seeking outpatient mental health services. Addict Sci Clin Pract 2016; 11:12. [PMID: 27506832 PMCID: PMC4977754 DOI: 10.1186/s13722-016-0060-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 08/02/2016] [Indexed: 11/10/2022] Open
Abstract
Background Alcohol use can have a significant negative impact on young adults in mental health treatment. This cross-sectional study examined prevalence and factors associated with hazardous drinking among young adults seeking outpatient mental health services, rate of alcohol use disorders (AUDs), and the relationship between hazardous drinking and other types of substance use. Methods Participants were 487 young adults ages 18–25 who completed self-administered computerized screening questions for alcohol and drug use. Alcohol use patterns were assessed and predictors of hazardous drinking (≥5 drinks on one or more occasions in the past year) were identified using logistic regression. Results Of the 487 participants, 79.8 % endorsed prior-year alcohol use, 52.3 % reported one or more episodes of hazardous drinking in the prior year and 8.2 % were diagnosed with an AUD. Rates of recent and lifetime alcohol, tobacco and marijuana use were significantly greater in those with prior-year hazardous drinking. In logistic regression, prior-year hazardous drinking was associated with lifetime marijuana use (OR 3.30, p < 0.001; 95 % CI 2.05, 5.28), lifetime tobacco use (OR 1.88, p = 0.004; 95 % CI 1.22, 2.90) and older age (OR 1.18 per year, p < 0.001; 95 % CI 1.08, 1.29). Conclusions In an outpatient mental health setting, high rates of hazardous drinking were identified, and drinking was associated with history of other substance use. Results highlight patient characteristics associated with hazardous drinking that mental health providers should be aware of in treating young adults, especially older age and greater use of tobacco and marijuana.
Collapse
Affiliation(s)
- Anna E Ordóñez
- Department of Psychiatry and UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA. .,Office of Clinical Research, National Institute of Mental Health, 6001 Executive Blvd. MSC 9669, Bethesda, MD, 20892, USA.
| | - Rachel Ranney
- Department of Psychiatry and UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Maxine Schwartz
- Department of Psychiatry and UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Carol A Mathews
- Department of Psychiatry and UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.,Department of Psychiatry, University of Florida, 100 S Newell Drive, Gainesville, FL, 32610, USA
| | - Derek D Satre
- Department of Psychiatry and UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.,Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, USA
| |
Collapse
|
32
|
McCarter KL, Halpin SA, Baker AL, Kay-Lambkin FJ, Lewin TJ, Thornton LK, Kavanagh DJ, Kelly BJ. Associations between personality disorder characteristics and treatment outcomes in people with co-occurring alcohol misuse and depression. BMC Psychiatry 2016; 16:210. [PMID: 27389521 PMCID: PMC4936287 DOI: 10.1186/s12888-016-0937-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Personality disorders are highly comorbid with alcohol misuse and depressive symptomatology; however, few studies have investigated treatment outcomes in this population. The aim of this study was to examine relationships between baseline personality disorder cluster profiles and overall and treatment-related changes for those with co-occurring alcohol misuse and depression. METHODS Secondary analysis was conducted using a subset of data (N = 290) from two randomised controlled trials of psychological interventions for co-occurring alcohol misuse and depression, which did not specifically target personality disorders. Baseline dimensional personality disorder cluster scores were derived from the International Personality Disorder Examination Questionnaire (IPDEQ). Four treatment conditions were compared: a brief integrated intervention, followed by no further treatment, or nine further sessions of integrated-, alcohol-, or depression-focused treatment. Associations between IPDEQ scores and changes in alcohol use, depressive symptoms and functioning from baseline to the 6- and the 12-month follow-ups were of primary interest. RESULTS Personality disorder cluster scores moderately negatively impacted on overall change (primarily Cluster C), as well as treatment-related outcomes (primarily Cluster A), particularly changes in depressive symptoms and psychosocial functioning. Longer interventions appeared to be more effective in the longer-term (e.g., at 12-month follow-up), with integrated interventions relatively more effective than single-focused ones for individuals with higher personality disorder cluster scores. CONCLUSIONS Greater attention needs to be paid to particular personality disorder clusters during the assessment and treatment of individuals with co-occurring alcohol misuse and depression. Integrated interventions, incorporating motivational interviewing and cognitive behaviour therapy, may provide a useful therapeutic framework. Integrated interventions also provide opportunities for adjunctive components focussing on other issues and coping strategies (e.g., to offset negative affective states), potentially tailored to the characteristics and needs of individual participants.
Collapse
Affiliation(s)
- Kristen L. McCarter
- School of Psychology, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Sean A. Halpin
- School of Psychology, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Frances J. Kay-Lambkin
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052 Australia ,Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Terry J. Lewin
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, PO Box 833, Newcastle, NSW 2300 Australia
| | - Louise K. Thornton
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052 Australia ,Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308 Australia
| | - David J. Kavanagh
- Centre for Children’s Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology, Brisbane City, QLD 4000 Australia
| | - Brian J. Kelly
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia ,Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308 Australia
| |
Collapse
|
33
|
Satre DD, Leibowitz A, Sterling SA, Lu Y, Travis A, Weisner C. A randomized clinical trial of Motivational Interviewing to reduce alcohol and drug use among patients with depression. J Consult Clin Psychol 2016; 84:571-9. [PMID: 26985728 DOI: 10.1037/ccp0000096] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined the efficacy of Motivational Interviewing (MI) to reduce hazardous drinking and drug use among adults in treatment for depression. METHOD Randomized controlled trial based in a large outpatient psychiatry program in an integrated health care system in Northern California. The sample consisted of 307 participants ages 18 and over who reported hazardous drinking, drug use (primarily cannabis) or misuse of prescription drugs in the prior 30 days, and who scored ≥5 on the Patient Health Questionnaire (PHQ-9). Participants were randomized to receive either 3 sessions of MI (1 in person and 2 by phone) or printed literature about alcohol and drug use risks (control), as an adjunct to usual outpatient depression care. Measures included alcohol and drug use in the prior 30 days and PHQ-9 depression symptoms. Participants completed baseline in-person interviews and telephone follow-up interviews at 3 and 6 months (96 and 98% of the baseline sample, respectively). Electronic health records were used to measure usual care. RESULTS At 6 months, MI was more effective than control in reducing rate of cannabis use (p = .037); and hazardous drinking (≥4 drinks in a day for women, ≥5 drinks in a day for men; p = .060). In logistic regression, assignment to MI predicted lower cannabis use at 6 months (p = .016) after controlling for covariates. Depression improved in both conditions. CONCLUSIONS MI can be an effective intervention for cannabis use and hazardous drinking among patients with depression. (PsycINFO Database Record
Collapse
Affiliation(s)
| | - Amy Leibowitz
- Division of Research, Kaiser Permanente Northern California Region
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California Region
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California Region
| | - Adam Travis
- Department of Psychiatry, Kaiser Permanente Southern Alameda
| | | |
Collapse
|
34
|
The iTreAD project: a study protocol for a randomised controlled clinical trial of online treatment and social networking for binge drinking and depression in young people. BMC Public Health 2015; 15:1025. [PMID: 26444863 PMCID: PMC4596310 DOI: 10.1186/s12889-015-2365-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 09/29/2015] [Indexed: 01/03/2023] Open
Abstract
Background Depression and binge drinking behaviours are common clinical problems, which cause substantial functional, economic and health impacts. These conditions peak in young adulthood, and commonly co-occur. Comorbid depression and binge drinking are undertreated in young people, who are reluctant to seek help via traditional pathways to care. The iTreAD project (internet Treatment for Alcohol and Depression) aims to provide and evaluate internet-delivered monitoring and treatment programs for young people with depression and binge drinking concerns. Methods Three hundred sixty nine participants will be recruited to the trial, and will be aged 18–30 years will be eligible for the study if they report current symptoms of depression (score 5 or more on the depression subscale of the Depression Anxiety Stress Scale) and concurrent binge drinking practices (5 or more standard drinks at least twice in the prior month). Following screening and online baseline assessment, participants are randomised to: (a) online monthly self-assessments, (b) online monthly self-assessments + 12-months of access to a 4 week online automated cognitive behaviour therapy program for binge drinking and depression (DEAL); or (c) online monthly assessment + DEAL + 12-months of access to a social networking site (Breathing Space). Independent, blind follow-up assessments occur at 26, 39, 52 and 64-weeks post-baseline. Discussion The iTreAD project is the first randomised controlled trial combining online cognitive behaviour therapy, social networking and online monitoring for young people reporting concerns with depression and binge drinking. These treatments represent low-cost, wide-reach youth-appropriate treatment, which will have significantly public health implications for service design, delivery and health policy for this important age group. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12614000310662. Date registered 24 March 2014.
Collapse
|
35
|
Foulds JA, Adamson SJ, Boden JM, Williman JA, Mulder RT. Depression in patients with alcohol use disorders: Systematic review and meta-analysis of outcomes for independent and substance-induced disorders. J Affect Disord 2015; 185:47-59. [PMID: 26143404 DOI: 10.1016/j.jad.2015.06.024] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 06/11/2015] [Accepted: 06/14/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with an alcohol use disorder, depression is commonly categorised as independent (ID) or substance-induced (SID). It is not established whether these conditions respond differently to treatment. METHODS MEDLINE, Embase and Cochrane databases from 1980 to 2014 were searched for studies on alcohol use disorders with coexisting depressive symptoms. Meta-analyses were conducted using random effects models, to derive pooled effect estimates of the change in depression during treatment and the effect of antidepressant therapy. RESULTS Twenty-two studies met inclusion criteria for the review, of which 11/22 were included in the meta-analysis. All studies reported a large improvement in depression symptom score, most of which occurred within the first 3-6 weeks of treatment. The amount of improvement during follow up was similar in studies on ID in comparison to those in undifferentiated depression. Evidence on the outcome for SID was limited. The effect size of antidepressant therapy compared to placebo was 0.25 (0.06, 0.44) for ID and 0.08 (-0.31, 0.47) for SID or undifferentiated depression. LIMITATIONS Few studies examined the natural history and treatment response of SID. There was heterogeneity between studies, which was partly explained by baseline depression severity. CONCLUSIONS Treatment for depression co-occurring with an alcohol use disorder is associated with a large early improvement in depression, even if depression is believed to be independent of drinking. The effect of antidepressant therapy on depression in patients with alcohol use disorders is modest, with stronger evidence in ID.
Collapse
Affiliation(s)
- James A Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
| | - Simon J Adamson
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Joseph M Boden
- Christchurch Health and Development Study, University of Otago, Christchurch, New Zealand
| | - Jonathan A Williman
- Biostatistics and Computational Biology, Department of Public Health and General Practise, University of Otago, Christchurch, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
36
|
Kenney S, Jones RN, Barnett NP. Gender Differences in the Effect of Depressive Symptoms on Prospective Alcohol Expectancies, Coping Motives, and Alcohol Outcomes in the First Year of College. J Youth Adolesc 2015; 44:1884-97. [PMID: 26036995 DOI: 10.1007/s10964-015-0311-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
Problematic alcohol use and risk for dependence peak during late adolescence, particularly among first-year college students. Although students matriculating into college with depressive symptoms experience elevated risk for alcohol problems, few studies have examined the intervening mechanisms of risk. In this study, we examined depressed mood at college entry on prospective alcohol expectancies, drinking motives, and alcohol outcomes during the first year of college, adjusting for pre-college factors. Participants (N = 614; 59% female, 33% non-White) were incoming college students from three universities who completed online self-report surveys prior to matriculating into college and at the end of their first year in college. We utilized path analysis to test our hypotheses. In women, the path that linked depressive symptoms to consequences was primarily attributable to the effect of pre-college drinking to cope on drinking to cope in college, which in turn was associated with alcohol consequences. In men, the effect of depressive symptoms on alcohol consequences in college was independent of pre-college and college factors, thus indicating the need for research that identifies mechanisms of risk in males. Interventions that address coping deficits and motivations for drinking may be particularly beneficial for depressed adolescent females during this high-risk developmental period.
Collapse
Affiliation(s)
- Shannon Kenney
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Box-G-S121-4, Providence, RI, 02912, USA,
| | | | | |
Collapse
|
37
|
Foulds JA, Douglas Sellman J, Adamson SJ, Boden JM, Mulder RT, Joyce PR. Depression outcome in alcohol dependent patients: an evaluation of the role of independent and substance-induced depression and other predictors. J Affect Disord 2015; 174:503-10. [PMID: 25554995 DOI: 10.1016/j.jad.2014.11.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/25/2014] [Accepted: 11/27/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Depression commonly co-occurs with alcohol use disorders but predictors of depression treatment outcome in patients with both conditions are not well established. METHODS Outpatients with alcohol dependence and major depression (n=138) were prescribed naltrexone and randomized to citalopram or placebo for 12 weeks, followed by a 12-week naturalistic outcome phase. General linear mixed models examined predictors of Montgomery Asberg Depression Rating Scale (MADRS) score over 24 weeks. Predictors included whether depression was independent or substance-induced, and demographic, alcohol use, and personality variables (Temperament and Character Inventory subscales). RESULTS Most improvement in drinking and depression occurred between baseline and week 3. During follow-up, patients with substance-induced depression reduced their drinking more and they had better depression outcomes than those with independent depression. However, greater reduction in drinking was associated with better depression outcomes for both independent and substance-induced groups, while antidepressant therapy had no effect for either group. Baseline demographic and alcohol use variables did not predict depression outcomes. Among personality variables, high self-directedness was a strong predictor of better depression outcomes. LIMITATIONS Subjects were not abstinent at baseline. The influence of naltrexone on depression outcomes could not be tested. CONCLUSION Alcohol dependent patients with substance-induced depression have better short term depression outcomes than those with independent depression, but this is largely because they reduce their drinking more during treatment.
Collapse
Affiliation(s)
- James A Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
| | - J Douglas Sellman
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Simon J Adamson
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Joseph M Boden
- Christchurch Health and Development Study, University of Otago, Christchurch, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
38
|
Geisner IM, Varvil-Weld L, Mittmann AJ, Mallett K, Turrisi R. Brief web-based intervention for college students with comorbid risky alcohol use and depressed mood: does it work and for whom? Addict Behav 2015; 42:36-43. [PMID: 25462652 DOI: 10.1016/j.addbeh.2014.10.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 08/02/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED College is a time of increased risk for problematic alcohol use and depressed mood. The comorbidity of these conditions is well documented, but is less well understood, with few interventions designed to prevent or reduce the related consequences. The current study evaluated a web-based personalized intervention for students (N=311) who reported an AUDIT score of 8 or more, a BDI-II score of 14 or more, and reported drinking four (women) or five (men) or more drinks on at least one occasion in the past month. METHOD Invited participants were randomly selected from all enrolled undergraduates at a large, public, Pacific Northwestern University. Participants completed a screening and baseline assessment, and those who met study eligibility criteria were randomized to one of four conditions (alcohol only, depressed mood only, integrated, and referral-only control). Follow-up occurred one-month post-intervention. RESULTS While no main effects for the interventions were found, there were moderation effects, such that students in the alcohol only and integrated conditions who had lower levels of depressed mood or alcohol-related problems at baseline showed greater reductions in alcohol-related problems at follow-up compared to students in the control condition. Implications for interventions are discussed.
Collapse
|
39
|
Kenney SR, Paves AP, Grimaldi EM, LaBrie JW. Sleep quality and alcohol risk in college students: examining the moderating effects of drinking motives. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2014; 62:301-8. [PMID: 24588270 PMCID: PMC4031278 DOI: 10.1080/07448481.2014.897953] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Sleep problems and alcohol misuse are common issues experienced by college students that can have detrimental effects on overall health. Previous work indicates a strong relationship between poor sleep quality and alcohol risk in this population. This study explored the moderating effect of drinking motives in the relationship between global sleep quality and experience of alcohol-related negative consequences. PARTICIPANTS College students (N = 1,878) who reported past-month drinking. METHODS Participants completed online surveys assessing sleep and alcohol-related behaviors. RESULTS Poorer sleep quality and higher drinking motives (coping, conformity, and enhancement) predicted greater alcohol-related consequences, controlling for drinking. Further, coping motives moderated the relationship between sleep quality and consequences such that participants reporting poor sleep and high coping motives experienced heightened levels of consequences. CONCLUSIONS These findings advance the understanding of the relationship between sleep problems and alcohol-related risk and provide implications for targeted campus-based health promotion interventions.
Collapse
Affiliation(s)
- Shannon R. Kenney
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| | - Andrew P. Paves
- Department of Psychology, University of Washington, Seattle, Washington
| | | | - Joseph W. LaBrie
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| |
Collapse
|