Vujanovic Anka A, Meyer Thomas D, Heads Angela M, Stotts Angela L, Villarreal Yolanda R, Schmitz Joy M
a Department of Psychology, University of Houston , Houston , TX , USA.
b Department of Psychiatry and Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , TX , USA.
Am J Drug Alcohol Abuse. 2017 Jul;43(4):402-415. doi: 10.1080/00952990.2016.1199697. Epub 2016 Aug 5.
The co-occurrence of depression and substance use disorders (SUD) is highly prevalent and associated with poor treatment outcomes for both disorders. As compared to individuals suffering from either disorder alone, individuals with both conditions are likely to endure a more severe and chronic clinical course with worse treatment outcomes. Thus, current practice guidelines recommend treating these co-occurring disorders simultaneously.
The overarching aims of this narrative are two-fold: (1) to provide an updated review of the current empirical status of integrated psychotherapy approaches for SUD and depression comorbidity, based on models of traditional cognitive-behavioral therapy (CBT) and newer third-wave CBT approaches, including acceptance- and mindfulness-based interventions and behavioral activation (BA); and (2) to propose a novel theoretical framework for transdiagnostic CBT for SUD-depression, based upon empirically grounded psychological mechanisms underlying this highly prevalent comorbidity.
Traditional CBT approaches for the treatment of SUD-depression are well-studied. Despite advances in the development and evaluation of various third-wave psychotherapies, more work needs to be done to evaluate the efficacy of such approaches for SUD-depression.
Informed by this summary of the evidence, we propose a transdiagnostic therapy approach that aims to integrate treatment elements found in empirically supported CBT-based interventions for SUD and depression. By targeting shared cognitive-affective processes underlying SUD-depression, transdiagnostic treatment models have the potential to offer a novel clinical approach to treating this difficult-to-treat comorbidity and relevant, co-occurring psychiatric disturbances, such as posttraumatic stress.
抑郁症与物质使用障碍（SUD）共病的情况非常普遍，且与这两种障碍的不良治疗结果相关。与仅患有一种障碍的个体相比，同时患有这两种疾病的个体可能会经历更严重和慢性的临床病程，治疗结果更差。因此，当前的实践指南建议同时治疗这些共病障碍。
本叙述性综述的总体目标有两个：（1）基于传统认知行为疗法（CBT）模型和更新的第三波CBT方法，包括基于接纳和正念的干预措施以及行为激活（BA），对SUD与抑郁症共病的综合心理治疗方法的当前实证状况进行更新综述；（2）基于这种高度普遍的共病背后的实证心理机制，为SUD-抑郁症的跨诊断CBT提出一个新的理论框架。
用于治疗SUD-抑郁症的传统CBT方法已得到充分研究。尽管在各种第三波心理治疗的开发和评估方面取得了进展，但仍需要做更多工作来评估这些方法对SUD-抑郁症的疗效。
基于这一证据总结，我们提出一种跨诊断治疗方法，旨在整合基于CBT的SUD和抑郁症实证支持干预中发现的治疗要素。通过针对SUD-抑郁症潜在的共同认知-情感过程，跨诊断治疗模型有可能为治疗这种难以治疗的共病以及相关的共病精神障碍，如创伤后应激障碍，提供一种新的临床方法。
