title: Neuropsychological functioning and outcomes of treatment for co-occurring depression and substance use disorders.
abstract: BACKGROUND
  We previously published findings from our clinical trial comparing treatment outcomes for substance-dependent veterans with co-occurring depression who received Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation (TSF) Therapy.
  
  
  OBJECTIVE
  This study is a secondary analysis that examined whether neuropsychological functioning at baseline moderated substance use and depression outcomes in ICBT relative to TSF.
  
  
  METHODS
  This study was a randomized clinical trial in which 164 veterans with major depressive disorder and comorbid alcohol, cannabinol, and/or stimulant dependence were randomly assigned to either ICBT or TSF group therapy. A comprehensive neuropsychological test battery was administered at baseline.
  
  
  RESULTS
  Contrary to our hypothesis, participants with poor neuropsychological functioning had better substance use outcome in ICBT than in TSF, whereas participants with good neuropsychological functioning had comparable substance use outcomes in TSF and ICBT by 18-month follow-up. Depression outcomes, in contrast, were not moderated by neuropsychological functioning by 18-month follow-up.
  
  
  CONCLUSIONS
  The substance use outcomes may suggest that substance-dependent depressed adults with poorer neuropsychological functioning should be offered ICBT over TSF. These individuals may be less able to develop and use novel coping skills for managing substance use and depressive symptoms on their own without formal structured training in cognitive and behavioral skills provided in ICBT.
authors.affiliation: VA San Diego Healthcare System, CA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Granholm
authors.forename: Susan R
authors.initials: SR
authors.lastname: Tate
authors.forename: Peter C
authors.initials: PC
authors.lastname: Link
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Lydecker
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Cummins
authors.forename: John
authors.initials: J
authors.lastname: McQuaid
authors.forename: Chris
authors.initials: C
authors.lastname: Shriver
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Brown
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry) / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011615:Psychotherapy, Group / Q000379:methods; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy*; D014728:Veterans / Q000523:psychology