The efficacy of behavioural activation therapy in treating depression among dependent illicit drug users: The Activate study

Project Members: 
image - Maree Teesson Square
Professor
Ph EA Jasmin Bartlett: 02 9385 0167 / j.bartlett@unsw.edu.au
image - 1314150220 Joanne Ross 06
Senior Lecturer
Ph 9385 0333
image - Kath Mills Sq
Senior Res Fellow (NH&MRC)
Ph +612 9385 0253
image - 1354254213 Sharlene Kaye Square
Conjoint Senior Lecturer
Ph 9385 0279
image - Katrina Prior
Research Officer
Ph 02 8936 1009
image - Ivana Square
Research Officer
Ph 02 8936 1243
Ms Joanne Cassar
Psychologist
image - 1314157633 Philippa Farrugia 012
Ms Philippa Ewer
Research Assistant
image - Sarah Masters 300 Square
Research Assistant
Ph 02 9385 0333
image - Sonja Memedovic  Square
Research Officer
Ph 9385 0326
Project Main Description: 

Drug dependence is a chronic relapsing condition, associated with high levels of psychopathology. On entry to drug and alcohol treatment approximately 25% of heroin users and 40% of methamphetamine users meet criteria for Major Depression (MD), and this comorbidity has been linked to poorer treatment outcomes. Despite this, the development and assessment of behavioural interventions for depression among substance users in treatment has received little empirical attention. One treatment approach that has shown promise among residential rehabilitation clients in the United States is Behavioural Activation Therapy for Depression (Lejuez et al, 2011). BATD-R is a structured treatment that aims to activate clients in specific ways that will increase rewarding experiences in their lives. BATD-R is more time efficient and less complex than most other treatments for depression. The current study seeks to examine the feasibility of using BATD-R among depressed opioid replacement therapy (ORT) and residential rehabilitation clients. 

Project Collaborators: External: 

Professor Carl Lejuez
University of Maryland

Professor Kathleen Brady
Medical University of South Carolina

Dr Glenys Dore
Northern Sydney Drug & Alcohol Service

Aims: 

i) To determine the efficacy of Behavioural Activation Treatment for Depression (BATD-R) among  ORT and residential rehabilitation clients by comparing the treatment outcomes of those who receive the intervention with those who receive standard care for their drug dependence. 

ii) To identify factors that influence the efficacy of BATD-R including

  • Client characteristics: demographic, drug use and psychological factors
  • Treatment characteristics: treatment compliance.

 

iii) To assess the feasibility of implementing the intervention, as measured by treatment retention, client satisfaction and therapist competence.

 

Design and Method: 

Drug users reporting symptoms of mild to severe depression will be recruited through opioid replacement therapy and residential rehabilitation services, and will be randomly allocated to either treatment as usual (TAU = Control group; N=100) or usual treatment plus the BATD-R intervention (Treatment group; N=100). Participants will be interviewed at baseline, and again at three months and 12 months post baseline.

Progress/Update: 

The cohort consists of 132 substance users recruited from alcohol and other drug treatment services.  Interviews for the 3 and 12 month follow up are now complete, with follow-up rates of 93.2% and 87.9%, respectively. Data analysis is currently underway. 

Output: 

Oral presentation: 

Prior, K.  (2016) Depressed, Substance Dependent Individuals with and without Social Anxiety:  Occurrence and  Clinically Important Differences. 8th World Congress of Behavioural and Cognitive Therapies, Melbourne, June 2016.

Prior, K. (2016) Does Comorbid Social Anxiety. Moderate Treatment Outcomes for Depressed Substance Users? 8th World Congress of Behavioural and Cognitive Therapies, Melbourne, June 2016.

Ross, J., Teesson, M., Lejuez, C., Mills, K., Kaye, S., Brady, K. & Dore, G. (2016) The Efficacy of Behavioural Activation Treatment for Co-occurring Depression and Substance Use Disorder: The Activate Study. 8th World Congress of Behavioural and Cognitive Therapies, Melbourne, June 2016.

Prior, K., Ross, J., Mills, K., & Teesson, M. (2015). Depressed substance users in treatment: How common and concerning is social anxiety? Oral Presentation. The Inaugural Postgraduate Research Symposium, August 2015.

Prior, K., Ross, J., Mills, K., & Teesson, M. (2015). Depressed substance users in treatment: How common and concerning is social anxiety? National Drug and Alcohol Research Centre Seminar Series, September 2015

Prior, K. , Ross, J., Mills, K., & Teesson, M. (2015). Depressed, substance dependent individuals with and without social anxiety: Occurrence and clinically important differences. Society for Mental Health Research, Brisbane, December, 2015.

Ross, J. (2015). Behavioural activation for the treatment of co-occurring depression and substance use disorder: Baseline characteristics of the Activate Study cohort. National Drug and Alcohol Research Centre Seminar Series, August 2015.

Larkin, X., Prior, K., Ross, J., Lejuez, C., Mills, K., Kaye, S., Brady, K., Dore, G., Kay-Lambkin, F., Ewer, P., Gilsenan, J. & Teesson, M. (2014). Behaviour activation treatment for co-occurring depression and substance use disorder: The Activate Study protocol.  The Society for Mental Health Research Conference, Adelaide Oval, 3-5 December 2014.  

Poster presentations:

Kihas, I., Prior, K., Ross, J., Lejuez, C., Mills, K., Kaye, S., Cassar, J., Masters, S., Larkin, X., Ewer, P., Memedovic, S., Dore, G., Brady, K. & Teesson, M. (2015) Behavioural Activation Treatment for Co-occurring Depression and Substance Use Disorder: Baseline characteristics of the Activate Study.  National Drug and Alcohol Research Centre Annual Symposium, September 2015

Prior, K., Ross, J., Mills, K., & Teesson, M. (2015). Depressed substance users in treatment: How common and concerning is social anxiety? E-Poster. Centre for Research Excellence in Mental Health and Substance Use Colloquium. August 2015

Prior, K., Ross, J., Mills, K., & Teesson, M. (2015). Depressed substance users in treatment: How common and concerning is social anxiety? National Drug and Alcohol Research Centre Annual Symposium, September 2015

Larkin, X., Prior, K., Ross, J., Lejuez, C., Mills, K., Kaye, S., Brady, K., Dore, G., Kay-Lambkin, F., Ewer, P., Gilsenan, J. & Teesson, M. (2013). Behaviour activation treatment for co-occuring depression and substance use disorder: The Activate Study protocol. NDARC Annual Symposium, Sydney, 4 September 2013. 

Benefits: 

The findings of this study will be of importance to clinicians and policy makers both in Australia and internationally. Integrated treatment is recommended in people with severe psychiatric illness and alcohol and other drug problems, but there are currently few evidence based treatment options for dependent drug users suffering from depression. The BATD-R is a manualised treatment that has shown promise among drug and alcohol residential rehabilitation clients, and among psychiatric inpatients, but large randomised controlled trials are needed to broaden its’ evidence base. The current study will be the first to assess the efficacy of this intervention among outpatient opioid dependent clients suffering comorbid depression, and will be one of the few randomised controlled trials of psychosocial treatments for comorbid depression and drug dependence to be conducted internationally.

Project Status: 
Current