Individuals with alcohol and other drug (AOD) disorders frequently suffer from depression, leading to reduced quality of life and poorer AOD treatment outcomes. Efficacious treatments for depression do exist and could improve outcomes; but national data suggest that fewer than 7% of people with co-occurring disorders who are in AOD treatment have received appropriate treatment. Group cognitive behavioral therapy (CBT) is an effective and inexpensive treatment for depression. We propose to investigate whether group CBT for depression, with AOD counselors leading the groups, is effective and cost effective in treating depression. If so, it could substantially increase access to appropriate mental health care. We propose a 5-year quasi-experimental study with the following specific aims:
Aim 1. To evaluate the effectiveness of group CBT for depression provided by AOD counselors in improving depressive symptoms and AOD outcomes, among clients being treated in public sector residential AOD treatment settings;
Aim 2. To evaluate the cost-effectiveness of group CBT conducted by trained AOD counselors compared to usual care AOD treatment;
Aim 3. To document the implementation of the intervention at each of the four sites, and to determine whether the AOD counselors are delivering the group CBT intervention with fidelity to the model, and whether treatment fidelity is a significant predictor of client outcomes. We will enroll and follow 480 clients with Beck Depression Inventory-ll scores > 15 and AUDIT-C scores >3 who are being treated in a single public sector AOD treatment organization at four residential sites in LA County. Subjects will receive one of two conditions: (1) usual care residential AOD treatment (UC); (2) usual care AOD residential treatment plus a 16-session course of group CBT delivered by trained AOD counselors (CBT). Subjects will complete: (1) a baseline interview; (2) a post-treatment interview (at the conclusion of the CBT treatment) and (3) a follow-up interview (3 months after CBT treatment ends). Data will be analyzed using an intent-to-treat model. We will collect data on the service-level costs and health effects associated with UC and CBT, and will calculate the incremental cost per unit of depression and AOD improvement, compared to UC.. The implementation analysis will involve two related sets of activities: (1) a series of key informant interviews to provide a context in which to understand intervention implementation and (2) an assessment of treatment fidelity and it's relationship to client outcomes.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA014699-04
Application #
7458101
Study Section
Health Services Research Review Subcommittee (AA)
Program Officer
Lowman, Cherry
Project Start
2005-09-20
Project End
2010-06-30
Budget Start
2008-07-01
Budget End
2009-06-30
Support Year
4
Fiscal Year
2008
Total Cost
$756,942
Indirect Cost
Name
Rand Corporation
Department
Type
DUNS #
006914071
City
Santa Monica
State
CA
Country
United States
Zip Code
90401
Paddock, Susan M; Leininger, Thomas J; Hunter, Sarah B (2016) Bayesian restricted spatial regression for examining session features and patient outcomes in open-enrollment group therapy studies. Stat Med 35:97-114
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Paddock, Susan M; Hunter, Sarah B; Leininger, Thomas J (2014) Does group cognitive-behavioral therapy module type moderate depression symptom changes in substance abuse treatment clients? J Subst Abuse Treat 47:78-85
Woo, Stephanie M; Hepner, Kimberly A; Gilbert, Elizabeth A et al. (2013) Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance. Cogn Behav Pract 20:232-244
Hunter, Sarah B; Paddock, Susan M; Zhou, Annie et al. (2013) Do client attributes moderate the effectiveness of a group cognitive behavioral therapy for depression in addiction treatment? J Behav Health Serv Res 40:57-70
Savitsky, Terrance D; Paddock, Susan M (2013) Bayesian Non-Parametric Hierarchical Modeling for Multiple Membership Data in Grouped Attendance Interventions. Ann Appl Stat 7:
Paddock, Susan M; Savitsky, Terrance D (2013) Bayesian Hierarchical Semiparametric Modelling of Longitudinal Post-treatment Outcomes from Open Enrolment Therapy Groups. J R Stat Soc Ser A Stat Soc 176:
Watkins, Katherine E; Hunter, Sarah; Hepner, Kimberly et al. (2012) Group cognitive-behavioral therapy for clients with major depression in residential substance abuse treatment. Psychiatr Serv 63:608-11
Hunter, Sarah B; Witkiewitz, Katie; Watkins, Katherine E et al. (2012) The moderating effects of group cognitive-behavioral therapy for depression among substance users. Psychol Addict Behav 26:906-16
Watkins, Katherine E; Hunter, Sarah B; Hepner, Kimberly A et al. (2011) An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment. Arch Gen Psychiatry 68:577-84

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