Duke University School of Medicine, Durham, North Carolina.
Alcohol Research Center, University of Connecticut, Farmington.
J Am Acad Child Adolesc Psychiatry. 2022 Apr;61(4):508-519. doi: 10.1016/j.jaac.2021.07.807. Epub 2021 Aug 6.
To investigate prevalence and predictors of early depression response (EDR) in adolescents with substance use and depression receiving cognitive-behavioral therapy (CBT) for substance use and to test the efficacy of supplemental CBT targeting depression (CBT-D) for non-EDR adolescents in an adaptive treatment approach.
At 2 sites, 95 youths (ages 14-21, mean [SD] = 17.4 [1.8]) with alcohol or cannabis use and depressive symptoms received up to 12 sessions of CBT for substance use over 14 weeks. Assessments were at baseline and weeks 4, 9, and 14. The Children's Depression Rating Scale-Revised was the primary depression measure, with a reduction of 50% or more on this scale at week 4 defining EDR. The primary substance use outcomes of alcohol use, heavy alcohol use, and cannabis use frequency were assessed via interview report on the Alcohol Consumption Questionnaire and the Drug Checklist. Urinalysis provided a secondary measure of cannabis use. Non-EDR adolescents were randomly assigned to supplemental CBT-D or enhanced treatment as usual (ETAU).
Thirty-five adolescents (37%; 95% CI, 27%-47%) demonstrated EDR. Fewer days of cannabis use (odds ratio 0.977; 95% CI, 0.961-0.992) and absence of conduct disorder (odds ratio 0.149; 95% CI, 0.031-0.716) predicted EDR. Frequency of drinking (F = 11.09, η = 0.119, p = .001), heavy drinking (F = 19.91, η = 0.195, p < .0001), and cannabis use (F = 35.01, η = 0.137, p < .001) decreased over time for EDR, CBT-D, and ETAU adolescents, with EDR adolescents evidencing earlier lower cannabis use (F = 4.16, η = 0.036, p = .0169). Negative (clean) urine screens increased over time (F = 5.10, η = 0.023, p = .0249). Comparison of CBT-D and ETAU indicated that depression significantly decreased over time in both groups (F = 64.20, η = 0.572, p < .001), with no advantage for CBT-D.
Approximately one-third of adolescents with substance use and depression attain EDR during substance use treatment. Less frequent cannabis use facilitates depression response. The relatively small sample may have precluded identification of additional EDR predictors.
Treatment for Teens With Alcohol Abuse and Depression; https://clinicaltrials.gov/; NCT02227589.
调查接受认知行为疗法（CBT）治疗物质使用和抑郁的物质使用和抑郁青少年早期抑郁反应（EDR）的发生率和预测因素，并在适应性治疗方法中测试针对非 EDR 青少年的补充 CBT 治疗抑郁（CBT-D）的疗效。
在 2 个地点，95 名（年龄 14-21 岁，平均[SD] 17.4 [1.8]）患有酒精或大麻使用和抑郁症状的青少年接受了最多 12 节为期 14 周的物质使用 CBT。评估在基线和第 4、9 和 14 周进行。儿童抑郁评定量表修订版是主要的抑郁测量工具，第 4 周时该量表降低 50%或更多定义为 EDR。通过酒精消费问卷和药物清单的访谈报告评估主要物质使用结果，包括酒精使用、大量饮酒和大麻使用频率。尿液分析提供了大麻使用的次要测量方法。非 EDR 青少年被随机分配接受补充 CBT-D 或增强的常规治疗（ETAU）。
35 名青少年（37%；95%CI，27%-47%）表现出 EDR。较少的大麻使用天数（优势比 0.977；95%CI，0.961-0.992）和不存在品行障碍（优势比 0.149；95%CI，0.031-0.716）预测 EDR。饮酒频率（F=11.09，η=0.119，p=0.001）、大量饮酒（F=19.91，η=0.195，p<.0001）和大麻使用（F=35.01，η=0.137，p<.001）随着时间的推移，EDR、CBT-D 和 ETAU 青少年的抑郁程度均有所下降，而 EDR 青少年的大麻使用下降更早（F=4.16，η=0.036，p=0.0169）。阴性（清洁）尿液检测随着时间的推移而增加（F=5.10，η=0.023，p=0.0249）。CBT-D 和 ETAU 的比较表明，两组的抑郁症状都随着时间的推移显著减轻（F=64.20，η=0.572，p<.001），CBT-D 并没有优势。
大约三分之一的物质使用和抑郁的青少年在物质使用治疗期间达到 EDR。较少的大麻使用有助于促进抑郁反应。相对较小的样本可能无法识别出其他 EDR 预测因素。
青少年酒精滥用和抑郁的治疗；https://clinicaltrials.gov/；NCT02227589。
