Cognitive Behavioral Therapy: Help for Co-Morbid Depression and Substance Abuse

By Elizabeth Stannard Gromisch HERWriter

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Depression and substance abuse are two serious mental health issues. In the United States, about 14 million adults have major depressive disorder and 3.3 million adults have dysthymic disorder, a mild type of depression that lasts at least two years, according to the National Institute of Mental Health. Results from the US Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration’s 2009 National Survey on Drug Use and Health showed that about 21.8 million people in the United States ages 12 and over had used drugs within the past month; this statistic did not include alcohol or drug use.

Oftentimes, patients can have both depression and substance abuse. Having either condition increases the risk for the other.

Depending on the substance used, people may experience symptoms when they are intoxicated, having withdrawal symptoms, or use the substance chronically. For example, cocaine, a stimulant, can cause low energy and appetite when a person is intoxicated; depressed mood, insomnia and fatigue during withdrawal; and depressed mood from chronic use.

When caring for a patient with both conditions, the health care provider needs an effective intervention. In “Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery: A Treatment Improvement Protocol,” the US Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration noted that different psychological interventions can help patients, which include cognitive behavioral therapy, supportive therapy, motivational interviewing, expressive therapies and behavioral interventions. Research published in the June 6 issue of the Archives of General Psychiatry found that cognitive behavioral therapy can be an effective treatment for co-morbid depression and substance abuse.

The National Institute of Mental Health stated that in cognitive behavioral therapy, “the therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.”

The study on patients with co-morbid depression and substance abuse took place at four different treatment programs located in Los Angeles County. Authors Watkins et al. had 299 participants: 159 underwent usual care, which was a residential substance abuse treatment program, and 140 underwent usual care plus the cognitive behavioral therapy. Participants who received the cognitive behavioral therapy attended 16 group sessions, which lasted two hours. The authors found that at three months, 55.8 percent of the intervention group had minimal depressive symptoms, which increased to 63.9 percent at six months; the control group was at 33.6 percent at three months and 43.8 percent at six months.

References

National Institute of Mental Health. The Numbers Count: Mental Disorders in America. National Institutes of Health, 2008. Web. 27 July 2011
http://wwwapps.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml#Mood

US Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration. Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings. 2009. Web. 27 July 2011
http://www.oas.samhsa.gov/NSDUH/2k9NSDUH/2k9Results.htm#Ch2

US Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration. Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery: A Treatment Improvement Protocol. 2008. Web. 27 July 2011
http://kap.samhsa.gov/products/manuals/tips/pdf/TIP48.pdf

National Institute of Mental Health. Psychotherapies. National Institutes of Health, 2010. Web. 27 July 2011
http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml

JAMA and Archives. For the Media: June 6, 2011 — Embargoed Content. 2011. Web. 27 July 2011
http://pubs.ama-assn.org/media/2011a/0606.dtl#4

Watkins et al. An Effectiveness Trial of Group Cognitive Behavioral Therapy for Patients With Persistent Depressive Symptoms in Substance Abuse Treatment. Archives of General Psychiatry, 6 June 2011. Web. 27 July 2011
http://archpsyc.ama-assn.org/cgi/content/short/68/6/577

Reviewed July 28, 2011
by Michele Blacksberg R.N.
Edited by Shannon Koehle

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.