title: Mediational relations between 12-Step attendance, depression and substance use in patients with comorbid substance dependence and major depression.
abstract: OBJECTIVE
  Among patients with substance dependence and comorbid major depressive disorder (MDD) receiving treatment in a controlled trial, we examined if group differences in depression were mediated by 12-Step involvement, and if the effects of 12-Step involvement on future alcohol and drug use were mediated by reductions in depression.
  
  
  METHODS
  Controlled trial of Twelve-Step facilitation (TSF) and integrated cognitive-behavioral therapy (ICBT), delivered in out-patient groups for 6 months with adjunct pharmacotherapy.
  
  
  METHODS
  Out-patient dual diagnosis clinic in Veteran's Affairs Healthcare Center.
  
  
  METHODS
  Veterans (n = 209) diagnosed with alcohol, stimulant or marijuana dependence and substance-independent MDD.
  
  
  METHODS
  Twelve-Step attendance and affiliation, depression severity, percentage of days drinking and percentage of days using drugs assessed at baseline and months 3, 6 and 9.
  
  
  RESULTS
  In multi-level analyses greater 12-Step meeting attendance predicted lower depression and mediated the superior depression outcomes of the TSF group, explaining 24.3% of the group difference in depression. Independent of treatment group, lower depression severity predicted lower future alcohol use and mediated the effects of 12-Step meetings, explaining 15.7% of their effects on future drinking. Controlled, lagged models indicated these effects were not confounded by current substance use, suggesting that depression had unique associations with 12-Step meeting attendance and future drinking.
  
  
  CONCLUSIONS
  For patients with substance dependence and major depressive disorder, attendance at 12-Step meetings is associated with mental health benefits that extend beyond substance use, and reduced depression could be a key mechanism whereby 12-Step meetings reduce future drinking in this population.
authors.affiliation: San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92093-0043, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Worley
authors.forename: Susan R
authors.initials: SR
authors.lastname: Tate
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Brown
mesh_terms: D017024:Chemotherapy, Adjuvant / Q000379:methods; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000150:complications / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011615:Psychotherapy, Group / Q000379:methods; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology