EFFICACY OF DEPRESSION SKILLS TREATMENT WITH ALCHOLICS

Butler Hospital (Providence, Ri), Providence RI

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Abstract

APPLICANT S ABSTRACT: Alcoholism and depression are major public health problems. The co-occurrence of these disorders is well-documented in both community and clinical samples, and raises significant public health concerns in terms of costs due to personal suffering, health care utilization, lost productivity, and increased risk of suicide. Despite the frequent remission of depressive symptoms within the first 3-4 weeks of abstinence, comorbid depression has been associated with poor outcome following alcohol treatment across a variety of alcohol use and psychosocial domains. These findings extend not only to alcoholics with clinical depression, but to those with subsydromal depressive symptoms as well. Innovative treatment programs that target the unique needs of alcoholics with comorbid depressive symptoms hold the promise of improved treatment outcomes. The proposed study will test the hypothesis that adding cognitive behavioral treatment for depression to standard partial hospital alcohol treatment will enhance treatment outcomes relative to adding a relaxation training control in patients with concomitant depressive symptoms. We will also examine individual difference variables (both depression-specific and general) as predictors of treatment outcome, and we will explore potential mediating mechanisms of the hypothesized treatment effects. The study is a randomized (by cohort), two-group design with repeated measures over time, comparing the incremental efficacy of: (a) cognitive-behavioral treatment for depression, and (b) relaxation training control in a standard partial hospital alcohol treatment program. A sample of 150 subjects meeting structured diagnostic criteria (SCID-P) for alcohol dependence and having a HAM-D score > 14 at pretreatment will be recruited. Subjects will receive 8 individual treatment sessions, and will be followed for 12 months. Current and past psychiatric diagnoses, and family history diagnoses will be assessed, as will changes in depressive symptoms. Alcohol use outcomes will be validated by breathalyzer and significant other reports. We expect that the results of this study will enhance the effectiveness of alcohol treatment programs for a significant subpopulation of patients, those with comorbid depressive symptoms, while increasing our basic knowledge about the role of depressive symptoms and the effects of selected cognitive and behavioral mediators in the process of recovery from alcoholism. These findings may also have significant application to our understanding of the comorbid of mood disorders and other substance use disorders.