Depression Treatment for Low Income Substance Users
Condition: Substance Use Disorder
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      The objective of the current study is to evaluate the effects of a brief, behavioral
      activation treatment (the Life Enhancement Treatment for Substance Use; LET'S ACT) on long
      term outcomes of substance use, HIV risk behaviors and mechanisms of treatment response
      (depressive symptoms, environmental reward, behavioral activation).
    

Detailed description: 
      Approximately 22% of substance users suffer from elevated depressive symptoms, which is
      associated with higher rates of substance abuse treatment dropout, relapse to substance use,
      and HIV risk behavior. Few interventions targeting reinforcement principles have been
      developed to meet the specific needs of treatment seeking substance users. One approach that
      may be especially appropriate in this regard is behavioral activation (BA), which aims to
      increase individuals' engagement in pleasant events, thereby increasing contact with positive
      reinforcement and decreasing the frequency of aversive events. BA has been shown to be
      efficacious in the treatment of depression, and this uncomplicated and straightforward
      approach may be especially appropriate for the specific needs of an inner city low income
      substance abusing sample. Further, BA compliments standard substance abuse treatment in
      several key practical and theoretical ways as it is more easily adopted by staff in these
      settings, more time efficient (e.g., fewer and shorter sessions, group format), more easily
      understood by patients who suffer from cognitive limitations due to low education level and
      chronic drug use, and can incorporate aspects of sobriety into its treatment components. In
      an initial Stage 1 development project, a version of BA, the Life Enhancement Treatment for
      Substance Use (LETS ACT), was developed and specifically tailored for inner-city low income
      minority substance users with elevated depressive symptoms. Results demonstrated that LETS
      ACT led to a significantly greater reduction in self-reported depressive symptoms and a
      significant increase in enjoyment and reward value of activities as compared to the TAU
      control group (Daughters et al., 2008). While preliminary findings prove promising, many
      questions remain unanswered and several extensions of this work are necessary, including an
      assessment of post treatment substance use and HIV risk behavior, a contact-matched control,
      and a larger sample size to allow for more complex analyses of the mechanisms underlying
      these outcomes. Thus, the objective of the present proposal is to follow-up on our previous
      Stage 1 treatment development efforts and small scale randomized control trial (RCT) with a
      fully-powered Stage 2 RCT comparing LETS ACT to nondirective therapy (NDT) among a sample of
      263 low income depressed substance users currently receiving residential substance abuse
      treatment in inner-city Washington, DC.
    

Intervention name(s): LETS ACT Behavioral Activation Treatment; Nondirective Therapy (NDT)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): LETS ACT is based on the empirically validated Behavioral Activation Treatment for Depression (BAT-D; Lejuez, Hopko, & Hopko, 2001). Treatment includes eight sessions over a four-week period and is provided in small group format, with each group consisting of 3-5 patients.; The purpose of Nondirective Therapy (NDT) is to provide group therapy interaction, allowing for the development of a close therapeutic relationship and a safe and accepting environment to facilitate change. NDT will be conducted as outlined by Crits-Cristoph (1997). That is, the therapist will create an accepting, nonjudgmental, empathic environment to continuously direct client attention to primary feelings, and to facilitate accepting of affective experience using supportive statements, reflective listening, and empathic communications. Patients will received NDT in a small group format (3-5 participants) and will meet over the course of 4 weeks.
Other intervention name(s): LETS ACT; Behavioral Activation; Supportive Counseling
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment