Depression is the most common comorbid psychiatric disorder in opiate dependent patients along with antisocial personality disorder. Depression has been associated with both severity of addiction and poor treatment outcome. This suggests that effective treatment of depression would improve outcome for opiate addicts. However, standard antidepressant medication trials in depressed methadone maintenance patients have yielded mixed results indicating that antidepressant medication treatment by itself is limited in this population. Several reasons for poor treatment response include: 1) poor compliance; 2) ongoing substance abuse; 3) ongoing stresses with which patients do not cope effectively; and 4) the absence of pleasurable, satisfying activities in patients' lives. A high rate of aversive circumstances and a low frequency of positive reinforcement are classic components in a behavioral model of depression. This suggests that a behavioral therapy could be an alternative or a complement to antidepressant medication treatment in this population. We propose a Stage I development project to design and pilot test a Behavioral Therapy for Depression in Drug Dependence (BTDD) that is based on behavioral model of depression. The primary goals of BTDD are to decrease depressive symptomatology by increasing the frequency of response-contingent positive reinforcement and to build a base of behaviors that can compete with illicit substance use. Aspects of three operant conditioning based treatment programs demonstrated to be effective for treating depression or reducing illicit substance use in other drug using populations will be incorporated in BTDD. These programs include: the Coping with Depression Course, the Community Reinforcement Approach and Treatment-plan contingency management. The latter techniques will be adapted so that reduction in depression is the primary goal.
The specific aims over the four years of proposal are: 1. To develop a preliminary BTDD treatment manual through the treatment of 20 depressed methadone maintained patients in an uncontrolled trial. 2. To explore the efficacy and acceptability of BTDD with a randomized controlled pilot trial. 3. To test the theory that an increase in response-contingent reinforcement will produce an improvement in depression and reduced drug use.
| Carpenter, Kenneth M; Smith, Jennifer L; Aharonovich, Efrat et al. (2008) Developing therapies for depression in drug dependence: results of a stage 1 therapy study. Am J Drug Alcohol Abuse 34:642-52 |
| Carpenter, Kenneth M; Aharonovich, Efrat; Smith, Jennifer L et al. (2006) Behavior therapy for depression in drug dependence (BTDD): results of a stage Ia therapy development pilot. Am J Drug Alcohol Abuse 32:541-8 |
