Sequenced versus coordinated treatment for adolescents with comorbid depressive and substance use disorders.
OBJECTIVE
We evaluated 3 methods of integrating interventions for depression (Adolescent Coping With Depression Course; CWD) and substance use disorders (Functional Family Therapy; FFT), examining (a) treatment sequence effects on substance use and depression outcomes and (b) whether the presence of major depressive disorder (MDD) moderated effects.


METHODS
Participants were 170 adolescents (ages 13-18; 22% female; 61% non-Hispanic White) with comorbid depressive disorder (54% MDD, 18% dysthymia) and substance use disorders who were randomized to (a) FFT followed by CWD (FFT/CWD), (b) CWD followed by FFT (CWD/FFT), or (c) coordinated FFT and CWD (CT). Acute treatment (24 treatment sessions provided over 20 weeks) and 6- and 12-month follow-up effects are presented for substance use (percentage of days of substance use; Timeline Followback) and depression (Children's Depression Rating Scale-Revised).


RESULTS
FFT/CWD achieved better substance use outcomes than CT at posttreatment, and 6- and 12-month follow-ups; substance use effects for CWD/FFT were intermediate. For participants with baseline MDD, the CWD/FFT sequence resulted in lower substance use than either FFT/CWD or CT. Depressive symptoms decreased significantly in all 3 treatment sequences with no evidence of differential effectiveness during or following treatment. Attendance was lower for the second of both sequenced interventions. A large proportion of the sample received treatment outside the study, which predicted better outcomes in the follow-up.


CONCLUSIONS
Depression reductions occurred early in all 3 treatment sequences. Of the examined treatment sequences, FFT/CWD appeared most efficacious for substance use reductions but addressing depression early in treatment may improve substance use outcomes in the presence of MDD.
Oregon Research Institute.
Paul
P
Rohde
Oregon Research Institute.
Holly B
HB
Waldron
Oregon Research Institute.
Charles W
CW
Turner
Oregon Research Institute.
Janet
J
Brody
Oregon Research Institute.
Jenel
J
Jorgensen
D000223:Adaptation, Psychological; D000293:Adolescent; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome