Integrated Cognitive Behavioral Treatment for Substance Use and Depressive Symptoms: a Homeless Case Series
Condition: Cognitive Behavioral Therapy
MeSH terms: Substance-Related Disorders; Depression
Study type: Interventional

Summary: 
      This case series and feasibility trial evaluated a novel integrated cognitive behavioral
      treatment, which was adapted specifically for homeless individuals and developed to treat
      substance use and depressive symptoms simultaneously. The integrated cognitive behavioral
      treatment was delivered among four homeless individuals enrolled in the Treatment First
      program (a social services program where treatment is offered in conjunction with temporary
      transitional housing), who had access to stable and sober housing milieus.
    

Detailed description: 
      All study participants were clients at the social welfare office for the homeless, a
      specialized unit within the social services in Stockholm, Sweden. The participants were
      referred to outpatient treatment at Pelarbacken, a specialized primary care center for
      homeless patients.

      The integrated cognitive behavioral treatment was developed as part of a collaborate
      treatment program between the social welfare office for the homeless and Pelarbacken. Post
      treatment interviews and individual behavioral analyses of prior patients showed that the far
      most common reason for alcohol or drug use, was coping with negative affect (46% reported
      this reason). The integrated cognitive behavioral treatment was developed emanating from the
      following analysis (1) being homeless often implicates having lost contact with several
      important life areas, substance use might be the only reinforcing activity left; (2) common
      reactions are stress and depressive symptoms, and avoidance based strategies such as
      passivity, isolation, avoidance of social contact, or substance use; (3) when decreasing
      substance use, a transient approximate 3 month period of increased "depression-like" symptoms
      occurs, which might lead to lapses or relapses (this period is also called post-acute
      abstinence, or protracted abstinence). The ICBT (5-15 sessions) was developed to extend over
      this time period, with the overall aim of participants to (1) access a stable, sober housing
      milieu, and decrease substance use; (2) learn strategies to cope with negative affect; and
      (3) learn strategies to cope with life changes, increase activities such as work, social
      contact, exercise or leisure activities.

      Measures were administered at pre treatment, weekly during treatment, after treatment, and at
      3-, 6- and 12-month following treatment cessation.
    

Intervention name(s): Integrated cognitive behavioral treatment
Intervention type(s): Behavioral
Intervention description(s): Integrated cognitive behavioral treatment adapted specifically for homeless individuals and developed to treat substance use and depressive symptoms simultaneously
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment