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Depression precipitated by alcohol use in patients with co-occurring bipolar and substance use disorders.

ABSTRACT: OBJECTIVE:Bipolar disorder and substance use disorder frequently co-occur. However, little is known about the near-term effects of substance use on bipolar disorder. Thus, the present study tests whether alcohol use precipitates depression among patients with co-occurring bipolar disorder and substance use disorder. METHOD:This study uses data collected as part of 2 clinical trials (the first study was conducted from March 1999 through March 2004 and the second study was conducted from August 2003 through May 2007) of a manualized group therapy for patients with co-occurring bipolar disorder and substance dependence. One hundred fifteen participants were assessed at baseline and each month through month 8. Baseline diagnoses were made using the Structured Clinical Interview for DSM-IV, and monthly substance use and mood data were collected using the Longitudinal Interval Follow-Up Evaluation and the Addiction Severity Index. Generalized estimating equation methodology was used to analyze these longitudinal data. RESULTS:Our primary hypotheses were supported: days of alcohol use and an increase in days of alcohol use each significantly predicted the presence of a depressive episode in the subsequent month when controlling for current depression and current drug use. CONCLUSION:These data suggest that alcohol use in patients with bipolar disorder and substance dependence increases the risk of a depressive episode in the near term. TRIAL REGISTRATION:This study draws on data generated during 2 clinical trials. One was exempt from trial registration; clinicaltrials.gov Identifier for other trial: NCT00227838.

SUBMITTER: Jaffee WB

PROVIDER: S-EPMC2713748 | biostudies-literature | 2009 Feb

REPOSITORIES: biostudies-literature

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Depression precipitated by alcohol use in patients with co-occurring bipolar and substance use disorders.

Jaffee William B WB Griffin Margaret L ML Gallop Robert R Meade Christina S CS Graff Fiona F Bender Rachel E RE Weiss Roger D RD

The Journal of clinical psychiatry 20081230 2

<h4>Objective</h4>Bipolar disorder and substance use disorder frequently co-occur. However, little is known about the near-term effects of substance use on bipolar disorder. Thus, the present study tests whether alcohol use precipitates depression among patients with co-occurring bipolar disorder and substance use disorder.<h4>Method</h4>This study uses data collected as part of 2 clinical trials (the first study was conducted from March 1999 through March 2004 and the second study was conducted ...[more]

PMID: 19192456

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Project description:BackgroundIntegrated Treatment (IT) has proved effective in treating patients with Substance Use Disorders (SUD) co-occurring with severe Mental Disorders (MD), less is known about the effectiveness of IT for patients with SUD co-occurring with less severe MD.The aim of this study was to investigate the effectiveness of IT for patients with SUD co-occurring with anxiety and/or depression on the following parameters:1. The use of substances, as measured by the Alcohol Use Identification Test (AUDIT), the Drug Use Identification Test (DUDIT), and the Addiction Severity Index (EuropASI).2. The severity of psychiatric symptoms, as measured by the Symptom Check List 90 r (SCL 90R).3. The client's motivation for changing his/her substance use behaviour, as measured by the Substance Abuse Treatment Scale (SATSr).MethodsThis is a group randomized clinical trial comparing the effectiveness of IT to treatment as usual in Community Mental Health Centres (CMHCs). Five CMHCs were drawn to the Intervention Group (IG) and four CMHCs to the Control Group (CG). The allocation to treatment conditions was not blinded. New referrals were screened with the AUDIT and the DUDIT. Those who scored above the cut-off level of these instruments were assessed with the Structured Clinical Interview for DSM-IV 1 and 2. We included patients with anxiety and/or depression together with one or more SUDs.ResultsWe included 55 patients in the IG and 21 in the CG. A linear multilevel model was used. Both groups reduced their alcohol and substance use during the trial, while there was no change in psychiatric symptoms in either group. However, the IG had a greater increase in motivation for substance use treatment after 12 months than had the CG with an estimate of 1.76, p = 0.043, CI95% (0.08; 3.44) (adjusted analyses). There were no adverse events.ConclusionsIntegrated treatment is effective in increasing the motivation for treatment amongst patients with anxiety and/or depression together with SUD in outpatient clinics.Trial registrationClinicalTrials.gov: NCT00447733.

Project description:BackgroundThe current study identifies predictors and moderators of substance use outcomes for 111 adolescents with co-occurring substance use and psychiatric disorders who participated in a randomized controlled trial that compared the effectiveness of two home-based treatments: an integrated cognitive behavioral therapy (I-CBT) protocol, in which masters-level clinic staff received intensive training and ongoing supervision in the use of this protocol versus a treatment-as-usual (TAU) comparison condition in which therapists received a continuing education-style CBT workshop in the same protocol.MethodThe study conducted exploratory predictor and moderator analyses of marijuana and heavy alcohol use outcomes using candidate variables across four domains of psychological characteristics: adolescent substance use, adolescent psychiatric symptoms, parent, and family.ResultsRegardless of treatment condition, low parental monitoring at baseline, as assessed by a videotaped interaction task, but not self-report, predicted greater percentage of marijuana use and heavy alcohol use days over the 6-month follow-up period. If parents entered treatment with low levels of parental monitoring, adolescents in the I-CBT condition reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU over the 6-month follow-up period. Greater adolescent aggression and parental emotion dysregulation at baseline also predicted greater percentage of marijuana use days over the 6-month follow-up period for the sample as a whole. Adolescents in the I-CBT condition who reported low positive urgency at baseline reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU care over the 6-month follow-up period.ConclusionThe article discusses implications for clinical decision-making, improving treatment effectiveness, and tailoring interventions for adolescents with co-occurring substance use and psychiatric disorders.

Project description:Post-traumatic stress disorder (PTSD) is common among people with substance use disorders, and the comorbidity is associated with negative outcomes. We report on a randomized controlled trial comparing the effect of integrated cognitive-behavioral therapy (ICBT) plus standard care, individual addiction counseling plus standard care and standard care alone on substance use and PTSD symptoms.Three-group, multi-site randomized controlled trial.Seven addiction treatment programs in Vermont and New Hampshire, USA.Recruitment took place between December 2010 and January 2013. In this single-blind study, 221 participants were randomized to one of three conditions: ICBT plus standard care (SC) (n = 73), individual addiction counseling (IAC) plus SC (n = 75) or SC only (n = 73). One hundred and seventy-two patients were assessed at 6-month follow-up (58 ICBT; 61 IAC; 53 SC). Intervention and comparators: ICBT is a manual-guided therapy focused on PTSD and substance use symptom reduction with three main components: patient education, mindful relaxation and flexible thinking. IAC is a manual-guided therapy focused exclusively on substance use and recovery with modules organized in a stage-based approach: treatment initiation, early abstinence, maintaining abstinence and recovery. SC are intensive out-patient program services that include 9-12 hours of face-to-face contact per week over 2-4 days of group and individual therapies plus medication management.Primary outcomes were PTSD severity and substance use severity at 6 months. Secondary outcomes were therapy retention.PTSD symptoms reduced in all conditions with no difference between them. In analyses of covariance, ICBT produced more favorable outcomes on toxicology than IAC or SC [comparison with IAC, parameter estimate: 1.10; confidence interval (CI)?= 0.17-2.04; comparison with SC, parameter estimate: 1.13; CI = 0.18-2.08] and had a greater reduction in reported drug use than SC (parameter estimate: -9.92; CI =?-18.14 to -1.70). ICBT patients had better therapy continuation versus IAC (P<0.001). There were no unexpected or study-related adverse events.Integrated cognitive behavioral therapy may improve drug-related outcomes in post-traumatic stress disorder sufferers with substance use disorder more than drug-focused counseling, but probably not by reducing post-traumatic stress disorder symptoms to a greater extent.

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Depression precipitated by alcohol use in patients with co-occurring bipolar and substance use disorders.

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Depression precipitated by alcohol use in patients with co-occurring bipolar and substance use disorders.

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