Kay-Lambkin Frances J, Baker Amanda L, Lewin Terry J, Carr Vaughan J
Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia.
Addiction. 2009 Mar;104(3):378-88. doi: 10.1111/j.1360-0443.2008.02444.x.
To evaluate computer- versus therapist-delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems.
Randomized controlled trial.
Community-based participants in the Hunter Region of New South Wales, Australia.
Ninety-seven people with comorbid major depression and alcohol/cannabis misuse.
All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment 'live' (i.e. delivered by a psychologist) or via a computer-based program (with brief weekly input from a psychologist).
Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post-baseline assessment.
(i) Depression responded better to intensive MI/CBT compared to BI alone, with 'live' treatment demonstrating a strong short-term beneficial effect which was matched by computer-based treatment at 12-month follow-up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer-based therapy showing the largest treatment effect.
Computer-based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12-month outcomes relative to a 'live' intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer-based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress.
评估针对患有抑郁症且伴有酒精/大麻使用问题的患者，计算机辅助心理治疗与治疗师提供的心理治疗的效果。
随机对照试验。
澳大利亚新南威尔士州猎人地区的社区参与者。
97名患有重度抑郁症且伴有酒精/大麻滥用的患者。
所有参与者均接受了针对抑郁症状和物质滥用的简短干预（BI），随后被随机分配至：不再接受进一步治疗（仅接受BI）；或接受九节动机性访谈和认知行为疗法（强化MI/CBT）。被分配至强化MI/CBT组的参与者被随机选择接受“现场”治疗（即由心理学家提供）或通过基于计算机的程序接受治疗（每周由心理学家进行简短指导）。
在基线时以及基线评估后的3、6和12个月测量抑郁、酒精/大麻使用及有害物质使用指数得分。
（i）与仅接受BI相比，强化MI/CBT对抑郁症的治疗效果更好，“现场”治疗显示出强烈的短期有益效果，在12个月随访时基于计算机的治疗效果与之相当；（ii）有问题的酒精使用对仅接受BI反应良好，对强化MI/CBT干预反应更佳；（iii）强化MI/CBT在减少大麻使用和有害物质使用方面明显优于仅接受BI，基于计算机的疗法显示出最大的治疗效果。
同时针对抑郁症和物质使用的基于计算机的治疗，在12个月的治疗效果上至少与“现场”干预相当。对于治疗患有抑郁症且伴有酒精问题的临床医生而言，针对这两个问题的简短干预似乎是一种合适且有效的治疗选择。对于患有抑郁症且伴有大麻使用问题的患者，初级保健可采用针对抑郁症和大麻使用的基于计算机的综合干预措施，并定期与临床医生进行简短沟通以检查进展情况。
