title: Stepping through treatment: reflections on an adaptive treatment strategy among methamphetamine users with depression.
abstract: OBJECTIVE
  Stepped-care has been recommended in the alcohol and other drug field and adopted in a number of service settings, but few research projects have examined this approach. This article aims to describe a pilot trial of stepped-care methods in the treatment of methamphetamine use and depression comorbidity.
  
  
  METHODS
  An adaptive treatment strategy was developed based on recommendations for stepped-care among methamphetamine users, and incorporating cognitive behaviour therapy/motivational intervention for methamphetamine use and depression. The adaptive treatment strategy was compared with a fixed treatment, comprising an extended integrated cognitive behaviour therapy/motivational intervention treatment. Eighteen participants across two study sites were involved in the trial, and were current users of methamphetamines (at least once weekly) exhibiting at least moderate symptoms of depression (score of 17 or greater on the Beck Depression Inventory II).
  
  
  RESULTS
  Treatment delivered via the adaptive treatment (stepped-care) model was associated with improvement in depression and methamphetamine use, however, was not associated with more efficient delivery of psychological treatment to this population relative to the comparison treatment.
  
  
  CONCLUSIONS
  This pilot trial attests to the potential for adaptive treatment strategies to increase the evidence base for stepped-care approaches within the alcohol and other drug field. However, in order for stepped-care treatment in this trial to be delivered efficiently, specific training in the delivery and philosophy of the model is required.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, New South Wales, Australia. frances.kaylambkin@newcastle.edu.au
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Kay-Lambkin
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Baker
authors.forename: Rebecca
authors.initials: R
authors.lastname: McKetin
authors.forename: Nicole
authors.initials: N
authors.lastname: Lee
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*; D008875:Middle Aged; D009042:Motivation; D010865:Pilot Projects; D055815:Young Adult
chemical_list: D008694:Methamphetamine