Depression and alcohol use disorder respond to psychosocial interventions

Results from a study from Finland suggests behavioral activation combined with motivational interviews should be one of the treatment options for co-occurring depression and alcohol use disorder. The study, published in BMC Psychiatry, is a secondary analysis of the Ostrobothnian Depression Study, which was completed in June 2014. The original study sample (n = 242) comprised of 189 patients from specialist care outpatient clinics and 53 patients from one inpatient ward in what was then the South Ostrobothnia Hospital District, Finland. The study period was from 2009 to 2013 and included patients aged 18 to 64 (61.2% female).The main inclusion criterion was a Beck Depression Inventory Score ≥ 17. Patients with a baseline Alcohol Use Disorder Identification Test (AUDIT) score > 10 (n = 99, 61 males) were assigned to the Alcohol Use Disorder (AUD) group in this study. “The Ostrobothnian Depression Study (ODS) aimed to increase the systematic use of evidence-based methods, particularly among patients with comorbid depression and substance use in a naturalistic setting,” write the authors. The interventions included motivational interviewing (MI) for patients in the AUD group and behavioral activation (BA) for all patients.Antidepressive medication was prescribed for 206 patients and antipsychotic medication for 66 patients. The clinicians were responsible for medication management during the study. The latest study explores the predictors of treatment response (minimum of 50% reduction in depressive symptoms) during the first six months of the ODS intervention with a focus on the role of comorbid heavy alcohol use. Logistic regression models were used to analyze the data.“The data show that severity of disease and comorbidity are substantial predictors of better outcomes, suggesting BA and MI are more effective in severely affected patients,” write the authors.Behavioral activation, considered a well-established treatment for depression, is also emerging as a treatment option for substance use disorders. Although research is limited in its use to treat comorbid depression and alcohol use problems, existing results show promise, states the article. “MI is an effective method for treating substance use disorders,” the authors write.The study shows that depressive patients with comorbid heavy alcohol use benefit from psychosocial interventions along with pharmacotherapy. These interventions used in everyday clinical work may be beneficial in preventing treatment resistant depression and chronicity. Problematic alcohol use is one of the most common comorbidities seen in patients with depression. “Patients with this dual pathology suffer from a more severe symptom profile than those without AUD, and the probability of recovery has likewise been found to be associated with the extent of alcohol use,” write the authors. “Addressing alcohol consumption immediately at the beginning of treatment may increase patients’ chances of benefiting from depression treatment.”Depressive symptoms may be influenced by heavy drinking and reducing alcohol consumption alleviates these symptoms. “Treatment of depression co-occurring with alcohol use disorder has been found to be associated with significant early improvement in the depressive symptoms, regardless of whether the depression is considered to be independent or due to heavy drinking,” write the authors.A limitation of the study is the small patient population of the AUD and non-AUD groups, which limits the generalizability of the results. The skewed gender distribution within these groups, and the drop-out also need to be considered, write the authors. Patients who dropped out within the first six months had higher AUDIT-C scores, which includes assessment of the amount and frequency of alcohol consumption, than those who remained in treatment. The heterogeneity of the patient population was a strength of the study but made interpretation of the results challenging.In this study design, it’s not possible to distinguish the role of the medication in alleviating depressive symptoms, write the authors. Antidepressant medications varied between patients and were adjusted by clinicians as necessary. This impacts the generalizability of the results for predictors of BA outcomes. The effects of BA and MI in the AUD group also could not be distinguished. The setting for the study corresponds to the actual clinical work.

Depression and alcohol use disorder respond to psychosocial interventions

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