title: An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment.
abstract: BACKGROUND
  Although depression frequently co-occurs with substance abuse, few individuals entering substance abuse treatment have access to effective depression treatment.
  
  
  OBJECTIVE
  The Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study is a community-based effectiveness trial that compared residential substance abuse treatment with residential treatment plus group cognitive behavioral therapy for depression delivered by substance abuse treatment counselors. We hypothesized that intervention clients would have improved depression and substance use outcomes compared with those of clients receiving usual care.
  
  
  METHODS
  A nonrandomized controlled trial using a quasi-experimental intent-to-treat design in which 4 sites were assigned to alternate between the intervention and usual care conditions every 4 months for 2½ years.
  
  
  METHODS
  Four treatment programs in Los Angeles County.
  
  
  METHODS
  We screened 1262 clients for persistent depressive symptoms (Beck Depression Inventory-II score >17). We assigned 299 clients to receive either usual care (n = 159) or usual care plus the intervention (n = 140). Follow-up rates at 3 and 6 months after the baseline interview were 88.1% and 86.2%, respectively, for usual care and 85.7% and 85.0%, respectively, for the intervention group.
  
  
  METHODS
  Sixteen 2-hour group sessions of cognitive behavioral therapy for depression.
  
  
  METHODS
  Change in depression symptoms, mental health functioning, and days of alcohol and problem substance use.
  
  
  RESULTS
  Intervention clients reported significantly fewer depressive symptoms (P < .001 at 3 and 6 months) and had improved mental health functioning (P < .001 at 3 months and P < .01 at 6 months). At 6 months, intervention clients reported fewer drinking days (P < .05) and fewer days of problem substance use (P < .05) on days available.
  
  
  CONCLUSIONS
  Providing group cognitive behavioral therapy for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes. These results provide support for a new model of integrated care.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01191788.
authors.affiliation: MSHS, RAND Corporation, Santa Monica, CA 90401-2138, USA. kwatkins@rand.org
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Watkins
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Hunter
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Hepner
authors.forename: Susan M
authors.initials: SM
authors.lastname: Paddock
authors.forename: Erin
authors.initials: E
authors.lastname: de la Cruz
authors.forename: Annie J
authors.initials: AJ
authors.lastname: Zhou
authors.forename: Jim
authors.initials: J
authors.lastname: Gilmore
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000379:methods; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome