Pott Sophie L, Kellett Stephen, Green Stuart, Daughters Stacey, Delgadillo Jaime
Department of Psychology, University of Sheffield, UK.
Department of Psychology, University of Sheffield, UK.
J Subst Abuse Treat. 2022 Aug;139:108769. doi: 10.1016/j.jsat.2022.108769. Epub 2022 Mar 24.
One in two patients seeking help for substance use disorders (SUDs) has clinically significant depression symptoms. This co-occurrence impairs treatment outcomes, but limited evaluation of the implementation of evidence-based interventions has taken place.
This pilot randomized controlled trial (RCT) assessed the feasibility and potential efficacy of a brief, protocol-driven behavioral activation (BA) intervention delivered by drug and alcohol workers in a community drug and alcohol treatment (CDAT) service. Eligible participants (n = 34) were randomly allocated to either BA (n = 17) or treatment as usual (n = 17) and assessed at baseline and 6-, 12-, and 24-week follow-up. Feasibility outcomes were participant engagement and worker protocol adherence. The primary pilot outcome was severity of depression symptoms (PHQ-9) at 12-week follow-up. Secondary outcomes included percent days abstinent (PDA) in the past month, severity of dependence (SDS), anxiety symptoms (GAD-7), and valued living (VQ) at all follow-up points.
Fifty-nine percent of BA participants attended at least one session and there was 95% adherence to the treatment protocol. BA was associated with significantly reduced depression at 12-week follow-up (PHQ-9 mean difference - 5.69, 95% CI -10.07 to -1.31). BA participants had significantly greater improvements in PDA (mean difference 17.9, 95% CI 0.99 to 34.82) and VQ-Progress (mean difference 5.34, 95% CI 1.47 to 9.22) at 6-week follow-up and PDA (mean difference 27.69, 95% CI 4.44 o 50.95) at 12-week follow-up. The study found no significant between-group differences at 24-week follow-up.
BA implemented by drug and alcohol treatment workers in CDAT appears feasible and may add clinical benefit to usual care for SUD patients with elevated depressive symptoms accessing CDAT. Fully powered RCTs are warranted to better investigate the replicability of these preliminary findings. Methodological limitations are discussed and suggestions for future research are provided.
在寻求物质使用障碍（SUDs）帮助的患者中，每两人就有一人有临床上显著的抑郁症状。这种共病会损害治疗效果，但对循证干预措施实施情况的评估有限。
这项试点随机对照试验（RCT）评估了由社区药物和酒精治疗（CDAT）服务中的药物和酒精工作人员提供的简短的、基于方案的行为激活（BA）干预的可行性和潜在疗效。符合条件的参与者（n = 34）被随机分配到BA组（n = 17）或常规治疗组（n = 17），并在基线以及6周、12周和24周随访时进行评估。可行性结果是参与者的参与度和工作人员对方案的依从性。主要试点结果是12周随访时的抑郁症状严重程度（PHQ - 9）。次要结果包括过去一个月的戒断天数百分比（PDA）、依赖严重程度（SDS）、焦虑症状（GAD - 7）以及所有随访点的有价值生活（VQ）。
59%的BA参与者至少参加了一次治疗，对治疗方案的依从率为95%。在12周随访时，BA与抑郁症状显著减轻相关（PHQ - 9平均差异 - 5.69，95% CI -10.07至 -1.31）。在6周随访时，BA参与者的PDA（平均差异17.9，95% CI 0.99至34.82）和VQ - 进展（平均差异5.34，95% CI 1.47至9.22）有显著更大的改善，在12周随访时PDA（平均差异27.69，95% CI 4.44至50.95）有显著更大的改善。该研究在24周随访时未发现组间有显著差异。
CDAT中的药物和酒精治疗工作人员实施的BA似乎是可行的，对于有抑郁症状且寻求CDAT治疗的SUD患者，可能会给常规护理增加临床益处。有必要进行全面的RCT以更好地研究这些初步结果的可重复性。讨论了方法学局限性并提供了未来研究的建议。
