The landmark NESARC has not only confirmed that mood disorders and substance use disorders are prevalent among American adults today, but also that their rates of co-occurrence are clinically significant. The traditional separation of treatment approaches and facilities for mood disorders versus alcohol and other substance use disorders is inadequate to meet the treatment needs of the large numbers of patients with problems in both areas. Furthermore, even when both types of disorders are acknowledged and addressed in a given patient, the notion of "primary versus secondary" disorder may also miss the mark, because mood disorders and substance use disorder tend to exacerbate each other in a vicious cycle. Thus, treatment for such comorbidity needs to be comprehensive to maximize the chances of success.

CT is demonstrably efficacious as a treatment for depression, but only a relatively sparse body of work supports its use in the treatment of substance use disorders. Nonetheless, evidence that CT is more effective than alternative treatments for substance use disorders, specifically when the patients are also depressed, demonstrates the promise of CT as a treatment for "dual-diagnosis" patients.

To adapt CT to the treatment of comorbid mood and substance use disorders, therapists need to keep the following factors in mind. First, a good case conceptualization and a well-established therapeutic alliance are essential to address the sensitive area of alcohol and other substance use. Second, it will likely take therapeutic finesse to engage patients in a therapeutic agenda that places the substance use problem on a par with the depressive disorder. One way of achieving this is to encourage patients to collect data on their use of alcohol and other drugs as part of their ongoing self-monitoring homework. Third, ongoing assessment is vital, because patients' alcohol and other drug-using status can change rapidly, perhaps interfering with treatment itself and increasing the risk of suicidality. Fourth, the risk of premature dropout from therapy is high and must be addressed assertively and preemptively, if possible. Finally, as the case study illustrated, CT can work in a complementary fashion with other treatment approaches, such as medications, group therapy, family therapy, and 12SF. CT can effectively modify the faulty beliefs that may needlessly pit one treatment approach against the other.


Alcoholics Anonymous. (1976). Alcoholics Anonymous: The story of how many thousands of men and women have recovered from alcoholism (3rd ed.). New York: Author.

Alverson, H., Alverson, M., & Drake, R. E. (2001). Social patterns of substance-use among people with dual diagnoses. Mental Health Services Research, 3, 3—14. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Anton, R. F, Moak, D. H., Waid, L. R., Latham, P. K., Malcolm, R. J., & Dias, J. K. (1999). Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics: Results of a placebo-controlled trial. American Journal of Psychiatry, 156, 1758-1764. Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77-100.

Beck, A. T., Wright, F D., Newman, C. F, & Liese, B. S. (1993). Cognitive therapy of substance abuse. New York: Guilford Press. Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press. Brown, R. A., Evans, D. M., Miller, I. W, Burgess, E. S., & Mueller, T. I. (1997). Cognitive-behavioral treatment for depression in alcoholism. Journal of Consulting and Clinical Psychology, 65, 715-726. Brown, R. A., Monti, P. M., Myers, M. G., Martin, R. A., Rivinus, T., Dubreuil, M. E., et al. (1998). Depression among cocaine abusers in treatment: Relation to cocaine and alcohol use and treatment outcome. American Journal of Psychiatry, 155, 220-225.

Carroll, K. M. (2004). Behavioral therapies for co-occuring substance use and mood disorders. Biological Psychiatry, 56(10), 778-784. Carroll, K. M., Nich, C., Ball, S. A., McCance, E., & Rounsaville, B.J. (1998). Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction, 93, 713-728.

Carroll, K. M., Rounsaville, B. J., Nich, C., Gordon, L. T., Wirtz, P. W, & Gawm, F. H. (1994). Psychotherapy and pharmacotherapy for ambulatory cocaine abusers: Delayed emergence of psychotherapy effects. Archives of General Psychiatry, 51, 989-997.

Cornelius, J. R., Salloum, I. M., Mezzich, J., Cornelius, M. D., Fabreago, H., Ehler, J. G., et al. (1995). Disproportionate suicidality in patients with comorbid major depression and alcoholism. Psychopharmacology Bulletin, 34, 117-121.

Dixon, L., McNary, S., & Lehman, A. (1995). Substance abuse and family relationships of persons with severe mental illness. American Journal of Psychiatry, 148, 224-230.

Evans, K., & Sullivan, M.J. (2001). Dual diagnosis: Counseling the mentally ill substance abuser (2nd ed.). New York: Guilford Press.

Fichter, M. M., Glynn, S. M., Weyer, S., Liberman, R. P, & Frick, U. (1997). Family climate and expressed emotion in the course of alcoholism. Family Process, 36, 203-221.

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I Disorder with Psychotic Screen. New York: Psychiatric Institute.

Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, P., Dufour, M. C., Compton, W, et al. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61, 807-816.

Marlatt, G. A. (Ed.). (1998). Harm reduction: Pragmatic strategies for managing high-risk behaviors. New York: Guilford Press.

Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.

Maude-Griffin, P. M., Hohenstein,J. M., Humfleet, G. L., Reilly, P. M., Tusel, D. J., & Hall, S. M. (1998). Superior efficacy of cognitive-behavioral therapy for urban crack cocaine abusers: Main and matching effects. Journal of Consulting and Clinical Psychology, 66(5), 832-837.

McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., et al. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, 199-213.

Moore, R. G., & Garland, A. (2003). Cognitive therapy for chronic and persistent depression. Chichester, UK: Wiley.

Morgenstern, J., LaBouvie, E., McCrady, B. S., Kahler, C. W, & Frey, R. M. (1997). Affiliation with Alcoholics Anonymous: A study of its therapeutic effects and mechanisms of action. Journal of Consulting and Clinical Psychology, 65,768-777.

Mueser, K. T., Drake, R. E., & Wallach, M. A. (1998). Dual diagnosis: A review of etiological theories. Addictive Behaviors, 23(6), 717-734.

Mueser, K. T., & Glynn, S. M. (1999). Behavioral family therapy for psychiatric disorders (2nd ed.). Oakland, CA: New Harbinger.

Mueser, K. T., Noordsby, D. L., Drake, R. E., & Fox, L. (2003). Integrated treatment for dual disorders: A guide to effective practice. New York: Guilford Press.

Newman, C. F. (2004). Substance abuse. In R. L. Leahy (Ed.), New Advances in cognitive therapy (pp. 206-227). New York: Guilford Press.

Nishith, P., Mueser, K. T., Srsic, C. S., & Beck, A. T. (1997). Differential response to cognitive therapy in parolees with primary and secondary substance use disorders. Journal of Nervous and Mental Disease, 185(12), 763-766.

O'Brien, C. P., Charney, D. S., Lewis, L., Cornish,J. W, Post, R. M., Woody, G. E., et al. (2004). Priority actions to improve the care of persons with co-occurring substance abuse and other mental disorders: A call to action. Biological Psychiatry, 56(10), 703-713.

Ouimette, P. C., Finney, J. W, & Moos, R. H. (1997). Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness. Journal of Consulting and Clinical Psychology, 65, 230-240.

Petrakis, I. L., Poling, J., Levinson, C., Nich, C., Carroll, C., & Rounsaville, B. J. (2005). Naltrexone and disulfiram in patients with alcohol dependence and comorbid psychiatric disorders. Biological Psychiatry, 57(10), 1128-1137.

Prochaska,J. O., DiClemente, C. C., & Norcross,J. C. (1992). In search of how people change: Applications of addictive behaviors. American Psychologist, 47,11021114.

Ramsey, S. E., Brown, R. A., Stuart, G. L., Burgess, E. S., & Miller, I. W (2002). Cognitive variables in alcohol dependent patients with elevated depressive symptoms: Changes and predictive utility as a function oftreatment. Substance Abuse, 23(3), 171-182.

Ramsey, S. E., Kahler, C. W, Read, J. P., Stuart, G. L., & Brown, R. A. (2004). Discriminating between substance-induced and independent depressive episodes in alcohol dependent patients. Journal of Studies on Alcohol, 65(5), 672-676.

Rosenberg, S. D., Drake, R. E., Wolford, G. L., Mueser, K. T., Oxman, T. E., Vidaver, R. M., et al. (1998). The Dartmouth Assessment of Lifestyle Instrument (DALI): A substance use disorder screen for people with severe mental illness. American Journal of Psychiatry, 155, 232-238.

Rounsaville, B. J. (2004). Treatment ofcocaine dependence and depression. Biological Psychiatry, 56(10), 803-809.

Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente,J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption II. Addiction, 88, 791-804.

Siqueland, L., Crits-Christoph, P., Gallop, R., Barber, J. P., Griffin, M. L., Thase, M. E., et al. (2002). Retention in psychosocial treatment of cocaine dependence: Predictors and impact on outcome. American Journal on Addictions, 11(1), 24-40.

Trimpey, J. (1996). Rational Recovery: The new cure for substance addiction. New York: Pocket Books.

Drug Addiction Report

Drug Addiction Report

You're going to discover so many things on addiction with little effort Not only will you discover the thrill of breaking free from your addiction, but you'll also learn extra bonus tips to actually help other people This new breakthrough book is a guide, really. A guide as a result of years of searching, studying, and scouring hundreds of websites, stores, and magazines.

Get My Free Ebook

Post a comment