Review Of Efficacy Research

Despite the paucity of efficacy research on cognitive-behavioral treatments for dually diagnosed depression and substance use problems (see O'Brien et al., 2004; Rounsaville, 2004), at least two rigorous studies suggest that CT demonstrates superior efficacy in treating substance abuse and dependence compared to alternative treatment approaches, specifically when the patients are also clinically depressed (Carroll et al., 1994; Maude-Griffin et al., 1998). Another study compared a cognitive-behavioral intervention and relaxation training for alcoholics with depressive symptoms (who were simultaneously receiving "standard alcohol treatment"). The cognitive-behavioral treatment had superior results on multiple measures of decreased alcohol consumption at follow-up, suggesting better staying power than relaxation training (Brown, Evans, Miller, Burgess, & Mueller, 1997). In a similarly designed study, alcohol-dependent individuals with elevated depressive symptoms who received cognitive-behavioral therapy had better outcomes on alcohol use when they experienced an increased sense of self-efficacy in coping with negative mood states (Ramsey et al., 2002), the likes of which have been known to trigger substance use episodes (Brown et al., 1998).

In an uncontrolled study of parolees receiving mandated treatment for substance abuse relapse prevention, the patient population was divided (post hoc) into those who showed low distress versus high distress on measures of depression and anxiety at intake (Nishith, Mueser, Srsic, & Beck, 1997). The authors report that patients in the high-distress group showed significant decreases in substance use, whereas those in the low-distress group did not. Nishith and her colleagues conclude that these data support the hypothesis that CT may be a more potent intervention for substance-abusing patients whose depression is prominent.

On a broader scale, Mueser et al. (2003) summarized a number of studies that seem to suggest an integrative treatment package for patients with dual disorders requires a long-term program with extended follow-up, which, the authors argue, is superior to a short-term intensive approach to care. Mueser and his colleagues went on to state that much more research is needed to study dually diagnosed patients on variables such as gender, trauma history, polysubstance use versus alcohol use alone, and the presence or absence of antisocial personality disorder.

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