Past year treatment status and alcohol abuse symptoms among US adults with alcohol dependence

Objective

We tested whether the number and type of alcohol abuse symptoms were associated with an increased likelihood of treatment seeking among respondents with alcohol dependence.

Methods

Data from 4027 adult respondents from 2006 and 2007 National Survey on Drug Use and Health (NSDUH) who met DSM-IV criteria for the past year alcohol dependence were used. Respondents were classified according to the number of past year alcohol abuse symptoms endorsed, as well as type of abuse symptom. Associations were estimated using weighted multivariate logistic regressions that controlled for severity of alcohol dependence, other drug use disorders and other characteristics.

Results

Twenty-eight percent of individuals with alcohol dependence had one alcohol abuse symptom, 20% had two and 19% had three or four. Individuals with more alcohol abuse symptoms differed from those without alcohol abuse symptoms in a number of sociodemographic characteristics and severity of alcohol and drug dependence. Even after adjusting for these factors, individuals with three or four alcohol abuse symptoms had 2.67 times increased odds of treatment seeking, as compared to those without alcohol abuse symptoms [95% CI = 1.65–4.30]. However, individuals with one or two alcohol abuse symptoms were no more likely to seek treatment than those without alcohol abuse symptoms. Majority of those with one or two alcohol abuse symptoms endorsed the hazardous abuse symptom.

Conclusion

Alcohol abuse symptoms are important factors for treatment seeking in individuals with alcohol dependence, but only among certain subset of individuals with three or four alcohol abuse symptoms. Examining structural and psychosocial differences across these subgroups may help inform and reduce barriers to treatment seeking among this population.     

Brief screens for detecting alcohol use disorder among 18-20 year old young adults in emergency departments: Comparing AUDIT-C,CRAFFT, RAPS4-QF,FAST, RUFT-Cut,and DSM-IV 2-Item Scale

Background

This study compared six of the briefest screening instruments for detecting DSM-IV-defined Alcohol Use Disorder (AUD) among older adolescents treated in Emergency Departments (ED).

Methods

The AUDIT-C, the RAPS4-QF, the FAST, the CRAFFT, the RUFT-Cut, and 2-Items from the Diagnostic and Statistical Manual IV of the American Psychiatric Association [American Psychiatric Association (1994). Diagnostic and Statistical Manual of Psychiatric Disorders, (1994) (DSM-IV). 4th ed. Washington D.C.: American Psychiatric Association] criteria for AUD (heretofore referred to as the DSM-IV 2-Item Scale) were evaluated against the criterion of a current DSM-IV diagnosis of either alcohol abuse or dependence. The instruments were administered to 181 alcohol-using older adolescents (57% males; age range 18–20 years) in an ED and compared using Receiver Operator Characteristic (ROC) analyses against the criterion of a current DSM-IV diagnosis of alcohol abuse or dependence.

Results

Of these instruments, the DSM-IV 2-Item Scale performed best for identifying AUD (88% sensitivity and 90% specificity), followed by the FAST and the AUDIT-C.

Conclusions

Two items from the DSM-IV criteria for AUD performed best for identifying ED-treated older adolescents with alcohol use disorders. The FAST and AUDIT-C performed well, but are longer and more difficult to score in the hectic environment of the Emergency Department.     

Comparative performance of the AUDIT-C in screening for DSM-IV and DSM-5 alcohol use disorders

Objective

Under the proposed DSM-5 revision to the criteria for alcohol use disorder (AUD), a substantial proportion of DSM-IV AUD cases will be lost or shifted in terms of severity, with some new cases added. Accordingly, the performance of the AUDIT-C in screening for DSM-IV AUD cannot be assumed to extend to DSM-5 AUD. The objective of this paper is to compare the AUDIT-C in screening for DSM-IV and DSM-5 AUD.

Methods

Using a broad range of performance metrics, the AUDIT-C was tested and contrasted as a screener for DSM-IV AUD (any AUD, abuse and dependence) and DSM-5 AUD (any AUD, moderate AUD and severe AUD) in a representative sample of U.S. adults aged 21 and older and among past-year drinkers.

Results

Optimal AUDIT-C cutpoints were identical for DSM-IV and DSM-5 AUD: ≥4 for any AUD, ≥3 or ≥4 for abuse/moderate AUD and ≥4 or ≥5 for dependence/severe AUD. Screening performance was slightly better for DSM-5 severe AUD than DSM-IV dependence but did not differ for other diagnoses. At optimal screening cutpoints, positive predictive values were slightly higher for DSM-5 overall AUD and moderate AUD than for their DSM-IV counterparts. Sensitivities were slightly higher for DSM-5 severe AUD than DSM-IV dependence. Optimal screening cutpoints shifted upwards for past-year drinkers but continued to be identical for DSM-IV and DSM-5 disorders.

Conclusions

Clinicians should not face any major overhaul of their current screening procedures as a result of the DSM-5 revision and should benefit from fewer false positive screening results.     

Dimensionality of hallucinogen and inhalant/solvent abuse and dependence criteria: implications for the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition

Background

Prior research has demonstrated the dimensionality of Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV) alcohol, nicotine, cannabis, cocaine and amphetamine abuse and dependence criteria. The purpose of this study was to examine the dimensionality of hallucinogen and inhalant/solvent abuse and dependence criteria. In addition, we assessed the impact of elimination of the legal problems abuse criterion on the information value of the aggregate abuse and dependence criteria, another proposed change for DSM-IV currently lacking empirical justification.

Methods

Factor analyses and item response theory (IRT) analyses were used to explore the unidimisionality and psychometric properties of hallucinogen and inhalant/solvent abuse and dependence criteria using a large representative sample of the United States (U.S.) general population.

Results

Hallucinogen and inhalant/solvent abuse and dependence criteria formed unidimensional latent traits. For both substances, IRT models without the legal problems abuse criterion demonstrated better fit than the corresponding model with the legal problem abuse criterion. Further, there were no differences in the information value of the IRT models with and without the legal problems abuse criterion, supporting the elimination of that criterion. No bias in the new diagnoses was observed by sex, age and race-ethnicity.

Conclusion

Consistent with findings for alcohol, nicotine, cannabis, cocaine and amphetamine abuse and dependence criteria, hallucinogen and inhalant/solvent criteria reflect underlying dimensions of severity. The legal problems criterion associated with each of these substance use disorders can be eliminated with no loss in informational value and an advantage of parsimony. Taken together, these findings support the changes to substance use disorder diagnoses recommended by the DSM-V Substance and Related Disorders Workgroup, that is, combining DSM-IV abuse and dependence criteria and eliminating the legal problems abuse criterion.     

Vitamin D deficiency in alcohol-use disorders and its relationship to comorbid major depression: A cross-sectional study of inpatients in Nepal

Background

Mounting evidence suggests that deficiency of vitamin D may be associated with major health problems, including alcohol-use disorders (AUD) and major depression (MD). This study aimed to identify the vitamin D status of Nepalese inpatients with an AUD. We explored socio-demographic and alcohol-use related correlates and the relationship between vitamin D deficiency and comorbid MD.

Methods

A cross-sectional study was conducted on AUD inpatients (N = 174) at eight alcohol/drug treatment centres around Kathmandu. Structured questionnaires were administered to assess the socio-demographic and alcohol-use parameters and to establish DSM-IV diagnoses of AUD and MD. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25(OH)D) concentration of <50 nmol/L.

Results

The prevalence of vitamin D deficiency was 64%. Higher age, having a stable job or business, shorter time since last alcohol intake and winter serum samples were related to having lower 25(OH)D levels. Several features of AUD severity were associated with low vitamin D levels: guilt about drinking, using alcohol as eye-opener, and history of relapse after alcohol treatment (p ≤ 0.03). Patients with a comorbid major depression, in particular secondarily depressed cases, were less likely to have vitamin D deficiency (X² = 6.8; p = 0.01).

Conclusions

This study confirms high rates of vitamin D deficiency in alcohol treatment sample and shows a positive association between vitamin D deficiency and severity of alcohol-use disorders. Competing risk and other confounders may help explain the vitamin D status among patients with alcohol-use disorders and comorbid major depression.     

Alcohol stigma and persistence of alcohol and other psychiatric disorders: A modified labeling theory approach

Background

We sought to apply modified labeling theory in a cross-sectional study of alcohol use disorder (AUD) to investigate the mechanisms through which perceived alcohol stigma (PAS) may lead to the persistence of AUD and risk of psychiatric disorder.

Methods

We conducted structural equation modeling (SEM) including moderated mediation analyses of two waves (W1 and W2) of data from the National Epidemiologic Survey on Alcohol and Related Conditions. We analyzed validated measures of PAS, perceived social support, social network involvement, and psychiatric disorders among (n = 3608) adults with two or more DSM-5 AUD symptoms in the first two of the three years between the W1 and W2 survey. Cross-sectional analyses were conducted owing to the assessment of PAS only at W2.

Results

Per mediation analyses, lower levels of perceived social support explained the association of PAS with past-year AUD and past-year internalizing psychiatric disorder at W2. The size of the mediated relationship was significantly larger for those classified as labeled (i.e., alcoholic) per their prior alcohol treatment or perceived need (n = 938) as compared to unlabeled (n = 2634), confirming a hypothesis of moderated mediation. Unexpectedly, mediation was also present for unlabeled individuals.

Conclusions

Lower levels of social support may be an important intermediate outcome of alcohol stigma. Longitudinal data are needed to establish the temporal precedence of PAS and its hypothesized intermediate and distal outcomes. Research is needed to evaluate direct measures of labeling that could replace proxy measures (e.g., prior treatment status) commonly employed in studies of the stigma of psychiatric disorders.     

Double-blind placebo-controlled trial of fluoxetine in adolescents with comorbid major depression and an alcohol use disorder

Objective

This study compared the acute phase (12-week) efficacy of fluoxetine versus placebo for the treatment of the depressive symptoms and the drinking of adolescents with comorbid major depression (MDD) and an alcohol use disorder (AUD). We hypothesized that fluoxetine would demonstrate efficacy versus placebo for the treatment of both the depressive symptoms and the drinking of comorbid MDD/AUD adolescents.

Methods

We conducted the first double-blind placebo-controlled study of fluoxetine in adolescents with comorbid MDD/AUD. All participants in both treatment groups also received intensive manual-based Cognitive Behavioral Therapy (CBT) and Motivation Enhancement Therapy (MET).

Results

Fluoxetine was well tolerated in this treatment population. No significant group-by-time interactions were noted for any depression-related or drinking-related outcome variable. Subjects in both the fluoxetine group and the placebo group showed significant within-group improvement in both depressive symptoms and level of alcohol consumption. End-of-study levels of depression and drinking were low in both treatment groups.

Conclusions

The lack of a significant between-group difference in depressive symptoms and in drinking may reflect limited medication efficacy, or may result from limited sample size or from efficacy of the CBT/MET psychotherapy. Large multi-site studies are warranted to further clarify the efficacy of SSRI medications in this adolescent MDD/AUD population.     

The clinical course of alcohol use disorders: Using joinpoint analysis to aid in interpretation of growth mixture models

Background

The clinical course of alcohol use disorders (AUD) is marked by great heterogeneity both within and between individuals. One approach to modeling this heterogeneity is latent growth mixture modeling (LGMM), which identifies a number of latent subgroups of drinkers with drinking trajectories that are similar within a latent subgroup but different between subgroups. LGMM is data-driven and uses an iterative process of testing a sequential number researcher-selected of latent subgroups then selecting the best fitting model. Despite the advantages of LGMM (e.g., identifying subgroups among heterogeneous longitudinal data), one limitation is the lack of precision of LGMM to model abrupt changes in drinking during treatment that are often observed by clinicians. Joinpoint analysis (JPA) is a data analysis procedure that is used to identify discrete change points in longitudinal data (e.g., changes from increasing to decreasing or decreasing to increasing).

Method

This study presents a demonstration of using JPA as a post hoc procedure for LGMM to improve accuracy in modeling abrupt changes in clinical course of AUD.

Results

Results from this secondary data analysis of 549 AUD participants participating in the NIAAA sponsored relapse replication and extension project uncovered four latent classes of drinking trajectories.

Discussion

Within these trajectories the addition of JPA improved precision in modeling the clinical course of AUDs.     

Cannabis dimensionality: Dependence,abuse and consumption

Aims

Genetic research on substance use disorders usually defines phenotypes as a binary diagnosis, resulting in a loss of information if the disorder is inherently dimensional. The DSM-IV criteria for drug dependence were based on a theoretically dimensional (linear) model. Considerable investigation has been conducted on DSM-IV alcohol criteria, but less is known about the dimensionality of DSM-IV cannabis criteria for abuse and dependence. The aim of this study is to assess whether DSM-IV cannabis dependence (including withdrawal) and abuse criteria fit a linear measure of severity and whether a consumption criterion adds linearly to severity.

Design/setting/participants/measurements

Participants were 8172 in the National Epidemiologic Survey on Alcohol and Related Conditions who had ever used cannabis. Wald statistics were used to test whether categorical, dimensional or hybrid forms best fit the data. We examined the following as criterion sets: (1) dependence; (2) dependence and abuse; and (3) dependence, abuse and frequency of use. Validating variables included family history of drug problems, early onset of cannabis use, and antisocial personality disorder.

Findings

For cannabis dependence, no evidence was found for categorical or hybrid models; Wald tests indicated that models representing the seven DSM-IV dependence criteria as a linear severity measure best described the association between the criteria and validating variables. However, significant differences from linearity occurred after adding the four cannabis abuse criteria (p = 0.03) and the use indicator (p = 0.01) for family history and antisocial personality disorder.

Conclusion

With ample power to detect non-linearity, cannabis dependence was shown to form an underlying continuum of severity. However, adding abuse criteria, with and without a measure of consumption, resulted in a model that differed significantly from linearity for two of the three validating variables.     

Are subthreshold alcohol dependence symptoms a risk factor for developing DSM-IV alcohol use disorders? A three-year prospective study of ‘diagnostic orphans’ in a national sample

Aims

Research suggests that diagnostic orphans (i.e., individuals experiencing only 1–2 criteria for DSM-IV alcohol dependence) may be at increased risk for developing more severe alcohol problems. This study aimed to: (i) investigate the course of diagnostic orphans in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), and (ii) explore whether a specific symptom endorsement pattern(s) could identify diagnostic orphans at Wave 1 who remitted or progressed to alcohol dependence at Wave 2.

Methods

Current drinkers (n = 15,751) were divided into diagnostic groups at Waves 1 and 2: no-alcohol use disorder (AUD); one-criterion orphans, two-criterion orphans, alcohol abuse, or alcohol dependence. Multinomial logistic regression analysis explored the association between diagnostic status at Wave 1 and Wave 2. Chi-square tests investigated differences in the criteria endorsement patterns of diagnostic orphans.

Results

Compared to the no-AUD group, one-criterion orphans at Wave 1 were twice as likely to be in the abuse group and four times more likely to be dependent at Wave 2. Two-criterion orphans were three times more likely to be in the abuse group and eight times more likely to have progressed to dependence. Criterion endorsement patterns of diagnostic orphans at baseline did not significantly differentiate between those who remitted and those who progressed to dependence at follow-up.

Conclusions

Like previous research, diagnostic orphans are at increased for developing to more severe alcohol problems. Relying solely on the DSM-IV AUD diagnostic criteria, however, may not be sufficient to identify those diagnostic orphans who are at risk for progressing to dependence.     

The role of cannabis use within a dimensional approach to cannabis use disorders

Context

Cannabis consumption is central to diagnosis of cannabis use disorders; yet, most research on cannabis disorders has focused just on diagnosis or criteria. The present study examines the ability of a frequency and quantity measure of cannabis use as well as cannabis abuse and dependence criteria to discriminate between individuals across the cannabis use disorder continuum.

Method

A representative sample of USA adults in 2001–2002 (N = 43,093) were queried about the past year frequency of cannabis use and each Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) cannabis abuse and dependence criterion. Factor analysis and item response theory (IRT) models were used to define the relationship between observed responses and the underlying unobserved latent trait (cannabis use disorder severity) among past year cannabis users (n = 1603).

Results

Factor analyses demonstrated a good fit for a one-factor model both with and without the cannabis use criterion and no differential criterion functioning was demonstrated across sex. The IRT model including the cannabis use criterion had discriminatory power comparable to the model without the cannabis use criterion and exceeded the informational value of the model without the cannabis use criterion in mild and moderate ranges of the severity continuum.

Discussion

Factor and IRT analyses disprove the validity of the DSM-IV abuse and dependence distinction: A single dimension represented the criteria rather than the two implied by the separate abuse/dependence categories. IRT models identified some dependence criteria to be among the mildest and some abuse criteria to be among the most severe—results inconsistent with the interpretation of DSM-IV cannabis abuse as a milder disorder or prodrome of cannabis dependence. The consumption criterion defined the mild end of the cannabis use disorder continuum and its excellent psychometric properties supported its consideration for inclusion in the next edition of DSM as a criterion for cannabis use disorders. Additional work is needed to identify candidate consumption criteria across all drugs that apply to the milder end of the severity continuum while also improving overall model performance and clinical diagnostic utility.     

The construct and measurement equivalence of cocaine and opioid dependences: A National Drug Abuse Treatment Clinical Trials Network (CTN) study

Introduction

Although DSM-IV criteria are widely used in making diagnoses of substance use disorders, gaps exist regarding diagnosis classification, use of dependence criteria, and effects of measurement bias on diagnosis assessment. We examined the construct and measurement equivalence of diagnostic criteria for cocaine and opioid dependences, including whether each criterion maps onto the dependence construct, how well each criterion performs, how much information each contributes to a diagnosis, and whether symptom-endorsing is equivalent between demographic groups.

Methods

Item response theory (IRT) and multiple indicators–multiple causes (MIMIC) modeling were performed on a sample of stimulant-using methadone maintenance patients enrolled in a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN) (N = 383). Participants were recruited from six community-based methadone maintenance treatment programs associated with the CTN and major U.S. providers. Cocaine and opioid dependences were assessed by DSM-IV Checklist.

Results

IRT modeling showed that symptoms of cocaine and opioid dependences, respectively, were arrayed along a continuum of severity. All symptoms had moderate to high discrimination in distinguishing drug users between severity levels. “Withdrawal” identified the most severe symptom of the cocaine dependence continuum. MIMIC modeling revealed some support for measurement equivalence.

Conclusions

Study results suggest that self-reported symptoms of cocaine and opioid dependences and their underlying constructs can be measured appropriately among treatment-seeking polysubstance users.     

Prevalence and correlates of alcohol misuse among returning Afghanistan and Iraq veterans

Objective

Several studies have reported high rates of alcohol misuse and low rates of substance use treatment among OEF/OIF military service members. This study assessed the prevalence and correlates of alcohol misuse and the factors associated with treatment utilization among recently returned National Guard service members.

Methods

The sample included 585 members of the National Guard who volunteered to complete an anonymous survey assessing mental health and substance use problems, functional status, and past treatment experiences. Bivariate and multivariate logistic regression analyses were performed examining the significance of associations between alcohol misuse and mental health service use as outcomes and demographic variables, mental health symptoms, and military service characteristics as predictors. Barriers to treatment and factors facilitating treatment were also examined.

Results

Thirty-six percent of the service members met criteria for alcohol misuse. Of those misusing alcohol, 31% reported receiving any mental health treatment and 2.5% reported receiving specific substance use treatment in the past year. The barrier to treatment most commonly endorsed by those misusing alcohol was concern that the information about treatment would appear in their records. Among those misusing alcohol who had received services, spouses were most commonly endorsed as facilitating the pursuit of care.

Conclusions

Rates of alcohol misuse are high and rates of substance use treatment are low among National Guard service members. Additional research is needed to identify means of overcoming barriers to care and establish more effective approaches to facilitate linkage to care and receipt of appropriate interventions.     

Protective behavioral strategies mediate the effect of drinking motives on alcohol use among heavy drinking college students: gender and race differences

Objective

This study examined the extent to which protective behavioral strategies (PBS) mediated the influence of drinking motives on alcohol consumption, and if these hypothesized relationships were corroborated across subsamples of gender and race.

Method

Online surveys were completed by 1592 heavy drinking college undergraduates from two universities (49.9% male and 50.1% female; 76.9% Caucasian and 23.1% Asian). Independent samples t-tests compared males and females as well as Caucasians and Asians on measures of drinking motives, PBS use, and alcohol consumption, and structural equation models examined the mediating role of PBS.

Results

Consistent with predictions, t-tests revealed that males reported greater levels of consumption than females, but females reported greater use of PBS than males. Caucasians reported greater consumption levels, endorsed higher enhancement motives, and higher PBS related to serious harm reduction, but Asians endorsed higher coping and conformity motives, and PBS focused on stopping/limiting drinking. In multiple-sample SEM analyses, PBS were shown to largely mediate the relationship between motives and consumption in all demographic subsamples.

Conclusions

Findings indicate that PBS use leads to reductions in drinking despite pre-established drinking motives, hence pointing to the potential value of standalone PBS skills training interventions in lowering alcohol use among diverse groups of heavy drinking college students.     

Alcohol criteria endorsement and psychiatric and drug use disorders among DUI offenders: Greater severity among women and multiple offenders

Purpose

Data from the Collaborative Study on the Genetics of Alcoholism (COGA), a high-risk family study of alcohol dependence, were used to examine differences in alcohol diagnostic criteria endorsement and psychiatric and drug use disorders by gender and by number of DUI offenses.

Results

Individuals with two or more DUIs exhibited greater severity of alcohol dependence than those with none or one DUI. This severity was characterized in three ways: (1) higher endorsement of alcohol diagnostic criterion items, with evidence of greater severity among women, (2) higher prevalence of co-occurring lifetime psychiatric disorders, and (3) higher rates of drug use and of dependence on cocaine, stimulants, and, for women only, marijuana and opiates.

Conclusions

By examining gradations of disorder within a combination of two high-risk indicators, DUI and family vulnerability, this study provides useful information for clinical research about individuals with chronic and severe alcohol problems. In addition, the observed gender differences in this high-risk sample will contribute to the literature on alcohol dependence among women at the more severe end of the dependence spectrum.     

Alcohol and drug treatment outcome studies: new methodological review (2005–2010) and comparison with past reviews

Objective

Several methodological reviews of alcohol treatment outcome studies and one review of drug studies have been published over the past 40 years. Although past reviews demonstrated methodological improvements in alcohol studies, they also found continued deficiencies. The current review allows for an updated evaluation of the methodological rigor of alcohol and drug studies and, by utilizing inclusion criteria similar to previous reviews, it allows for a comparative review over time. In addition, this is the first review that compares the methodology of alcohol and drug treatment outcome studies published during the same time period.

Method

The methodology for 25 alcohol and 11 drug treatment outcome studies published from 2005 through 2010 that met the review's inclusion criteria was evaluated. The majority of variables evaluated were used in prior reviews.

Results

The current review found that more alcohol and drug treatment outcome studies are now using continuous substance use measures and assessing problem severity. Although there have been methodological improvements over time, the current reviews differed little from their most recent past counterpart. Despite this finding, some areas, particularly the continued low reporting of demographic data, needs strengthening.

Conclusions

Improvement in the methodological rigor of alcohol and drug treatment outcome studies has occurred over time. The current review found few differences between alcohol and drug study methodologies as well as few differences between the current review and the most recent past alcohol and drug reviews.     

Participation in Alcoholics Anonymous and post-treatment abstinence from alcohol and other drugs

Background

This study examined associations between two types of AA participation (i.e., meeting attendance, having a sponsor) and two types of post-treatment abstinence (i.e., abstinence from alcohol, abstinence from drugs).

Method

Respondents completed measures that assessed their demographic characteristics, the severity of their substance use, and their motivation to change when they enrolled in treatment (T1). They completed measures of AA participation at T1 and a 3 month follow-up assessment (T2), and measures of recent abstinence at T1 and a 6 month follow-up assessment (T3).

Results

T2 sponsor was associated prospectively with T3 abstinence from alcohol.

Conclusions

Having a sponsor served as a marker for subsequent abstinence. Future research can examine factors that may mediate or moderate the associations between having a sponsor and subsequent abstinence.     

Evaluation of cognitive behavioral therapy/motivational enhancement therapy (CBT/MET) in a treatment trial of comorbid MDD/AUD adolescents

Objective

Behavioral therapies developed specifically for co-occurring disorders remain sparse, and such therapies for comorbid adolescents are particularly rare. This was an evaluation of the long-term (2-year) efficacy of an acute phase trial of manualized cognitive behavioral therapy/motivation enhancement therapy (CBT/MET) vs. naturalistic treatment among adolescents who had signed consent for a treatment study involving the SSRI antidepressant medication fluoxetine and CBT/MET therapy for comorbid major depressive disorder (MDD) and an alcohol use disorder (AUD). We hypothesized that improvements in depressive symptoms and alcohol-related symptoms noted among the subjects who had received CBT/MET would exceed that of those in the naturalistic comparison group that had not received CBT/MET therapy.

Methods

We evaluated levels of depressive symptoms and alcohol-related symptoms at a two-year follow-up evaluation among comorbid MDD/AUD adolescents who had received an acute phase trial of manual-based CBT/MET (in addition to the SSRI medication fluoxetine or placebo) compared to those who had received naturalistic care.

Results

In repeated measures ANOVA, a significant time by enrollment status difference was noted for both depressive symptoms and alcohol-related symptoms across the two-year time period of this study, with those receiving CBT/MET demonstrating superior outcomes compared to those who had not received protocol CBT/MET therapy. No significant difference was noted between those receiving fluoxetine vs. those receiving placebo on any outcome at any time point.

Conclusions

These findings suggest long-term efficacy for an acute phase trial of manualized CBT/MET for treating comorbid MDD/AUD adolescents. Large multi-site studies are warranted to further clarify the efficacy of CBT/MET therapy among various adolescent and young adult comorbid populations.