2014. Major Depression in Addicted Patients: Effects on Self-help Involvement and Substance Use Outcomes
JF Kelly, Center for Health Care Evaluation & Stanford University School of Medicine, JD McKellar, Center for Health Care Evaluation & Stanford University School of Medicine, RH Moos, Center for Health Care Evaluation & Stanford University School of Medicine

Objectives: Many patients treated for substance use disorders (SUDs) who become involved in 12-step self-help groups, such as Alcoholics Anonymous (AA), have improved treatment outcomes. However, due to high rates of psychiatric comorbidity and major depressive disorder (MDD), in particular, among SUD patients, concerns have been raised over whether these benefits extend to dual diagnosis patients. This study examined the influence of comorbid MDD, among patients with SUDs, on 12-step self-help group involvement and its relation to treatment outcome.

Methods: A quasi-experimental, prospective, intact group design was used with assessments completed during treatment, and 1 and 2 years post-discharge. Participants were 2,161 male patients recruited from 15 different inpatient SUD treatment programs. Of these, 110 had a comorbid MDD diagnosis (SUD-MDD) and 2,051 were without psychiatric comorbidity (SUD-only).

Results: Despite similar levels of 12-step self-help group attendance, SUD-MDD patients were less socially involved in and derived progressively less benefit from such groups over time compared to the SUD-only group. However, substance use outcomes did not differ by diagnostic cohort.  In contrast, despite using substantially more professional outpatient services, the SUD-MDD cohort continued to suffer significant levels of depression.

Conclusions: VA treatment providers should allocate more resources to targeting depressive symptoms in SUD-MDD patients. Furthermore, SUD-MDD patients in the VA may not assimilate as readily into, nor benefit as much from, traditional 12-step self-help groups such as Alcoholics Anonymous, as psychiatrically non-comorbid patients. Newer, dual-diagnosis specific, self-help groups may be a better fit for these patients, but await further study.

Impact: Providers treating SUD-MDD patients may need to tailor their self-help facilitation efforts to help these patients maximize use of important social aspects of self-help groups such as AA. In addition, providers should consider referring patients to dual-diagnosis specific self-help groups where available, such as Dual Recovery Anonymous or Double Trouble in Recovery.