Depression is a serious problem that can lead to relapse in addicted clients.
The following article describes a specific application of cognitive therapy to the treatment of depression that significant reduces relapse rates to depression.
Adaptations of this method may prove effective in treating relapse prone addicts with coexisting depression.
Abstract From Archive of General Psychiatry
The book Depression and Relapse by Terence T. Gorski describes how to apply cognitive restructuring to the treatment of the coexisting disorders of depression and addiction.
DEPRESSION AND RELAPSE
Depression is a significant complicating factor in recovery from substance use disorders. Nearly all substance abusers show significant depression in the first several weeks of recovery.
In most cases, the depression quickly subsides. Others, however, suffer from serious bouts of depression throughout their recovery.
Fortunately, the recovery plans for addiction and depression are closely related. Many of the things that help people stay comfortably sober also help them manage their depression.
This means that a recovery plan that meets the needs of both addiction and depression can be developed. If a person is already in recovery from addiction, this is good news. They already know and have practiced many of the recovery skills needed to manage depression. All they need to do is learn the few additional techniques that are outlined in this book.
Below is the description of a study on the effectiveness of cognitive therapy and recurrent depression.
Preventing Recurrent Depression Using Cognitive Therapy With and Without a Continuation Phase: A Randomized Clinical Trial by Robin B. Jarrett, PhD; Dolores Kraft, PhD; Jeanette Doyle, MA; Barbara M. Foster, PhD; G. Greg Eaves, PhD; Paul C. Silver, PhD
Cognitive therapy (CT) may reduce depressive relapse and recurrence when patients learn and use the associated skills. Reported relapse and recurrence rates after CT discontinuation vary widely. The factors that determine when CT is preventive remain unidentified. We developed continuation-phase CT (C-CT) to teach responders skills to prevent relapse. This is the first randomized trial comparing CT with and without a continuation phase in responders to CT who were vulnerable, given their history of recurrent unipolar depression.
Methods Patients aged 18 to 65 years (n = 156) with recurrent DSM-IV major depressive disorder (MDD) entered 20 sessions of acute-phase CT (A-CT). Unmedicated responders (ie, no MDD and 17-item Hamilton Rating Scale for Depression score 9; n = 84) were randomized to either 8 months (10 sessions) of C-CT or control (evaluation without CT). Follow-up lasted an additional 16 months. A clinician blind to assignment evaluated relapse and recurrence (ie, DSM-IV MDD).
Results Over an 8-month period, C-CT significantly reduced relapse estimates more than control (10% vs 31%). Over 24 months, including the CT-free follow-up, age of onset and quality of remission during the late phase of A-CT each interacted with condition assignment to influence durability of effects. In patients with early-onset MDD, C-CT significantly reduced relapse and recurrence estimates (16% vs 67% in control). When patients had unstable remission during late A-CT, C-CT significantly reduced relapse and recurrence estimates to 37% (vs 62% in control).
Conclusions Findings suggest that 8 months of C-CT significantly reduces relapse and recurrence in the highest-risk patients with recurrent MDD. Risk factors influenced the necessity for C-CT.
Arch Gen Psychiatry. 2001;58:381-388
GORSKI BOOKS: www.relapse.org