title: Feasibility randomized controlled trial of cognitive and behavioral interventions for depression symptoms in patients accessing drug and alcohol treatment.
abstract: Depressed mood often co-exists with frequent drug and alcohol use. This trial examined the feasibility of screening, recruitment, randomization and engagement of drug and alcohol users in psychological interventions for depression symptoms. A total of 50 patients involved in community drugs and alcohol treatment (CDAT) were randomly allocated to behavioral activation delivered by psychological therapists (n = 23) or to cognitive behavioral therapy based self-help introduced by CDAT workers (n = 27). We examined recruitment and engagement rates, as well as changes in depression (PHQ-9) symptoms and changes in percent days abstinent (PDA within last month) at 24 weeks follow-up. The ratio of screened to recruited participants was 4 to 1, and the randomization schedule successfully generated 2 groups with comparable characteristics. Follow-up was possible with 78% of participants post-treatment. Overall engagement in psychological interventions was low; only 42% of randomized participants attended at least 1 therapy session. Patients offered therapy appointments co-located in CDAT clinics were more likely to engage with treatment (odds ratio = 7.14, p = .04) compared to those offered appointments in community psychological care clinics. Intention-to-treat analyses indicated no significant between-group differences at follow-up in mean PHQ-9 change scores (p = .59) or in PDA (p = .08). Overall, it was feasible to conduct a pragmatic trial within busy CDAT services, maximizing external validity of study results. Moderate and comparable improvements in depression symptoms over time were observed for participants in both treatment groups.
authors.affiliation: Leeds Community Healthcare NHS Trust, Leeds, United Kingdom. Electronic address: jaime.delgadillo@nhs.net.
authors.forename: Jaime
authors.initials: J
authors.lastname: Delgadillo
authors.affiliation: St. Anne's Community Services, Leeds, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Gore
authors.affiliation: Department of Health Sciences and Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Shehzad
authors.initials: S
authors.lastname: Ali
authors.affiliation: Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton on Tees, United Kingdom. Electronic address: david.ekers@durham.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Ekers
authors.affiliation: Hull York Medical School and Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Gail
authors.initials: G
authors.lastname: Gilchrist
authors.affiliation: Hull York Medical School and Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Dean
authors.initials: D
authors.lastname: McMillan
authors.affiliation: University of Huddersfield and South West Yorkshire Partnership NHS Foundation Trust, Huddersfield, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hughes
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000379:methods; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D012648:Self Care / Q000379:methods*; D019966:Substance-Related Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Alcohol; Cognitive behavioral therapy; Comorbidity; Depression; Drugs