Research on psychological therapies provides support for the use of integrated psychological treatments for co-occurring depression and AOD use disorders [228, 665, 1086, 1087]. However, the small number of studies, methodological limitations (e.g., lack of randomisation to treatment conditions), variation in study results, and small sample sizes used in these studies highlight the need for larger trials to be conducted in this area [665, 1088].
The majority of studies to date have examined the use of integrated treatments that adopt a CBT approach [122, 665, 1089]. Reviews of the literature have shown that integrated CBT approaches yield superior results for depression and AOD use when compared to no treatment or treatment as usual comparison groups [1088, 1090], but there is insufficient evidence demonstrating that any one psychological therapy is more effective than another for these co-occurring conditions [1091].
In a 2019 Cochrane review, Hides and colleagues [1091] identified there was limited evidence to suggest that integrated CBT (ICBT) results in higher rates of abstinence at 6- to 12-months follow-up compared to 12-step facilitation therapy. Both approaches appeared to be similarly effective in terms of depressive symptoms at follow-up, however, reductions appeared more quickly with 12-step facilitation therapy than ICBT and Hides and colleagues [1091] caution that these findings are based on low-quality evidence. As a way of enhancing CBT, it has been suggested that CBT be combined with other evidence-based psychological strategies, such as contingency management (see Chapter B6). The addition of contingency management to CBT-based approaches has been shown to lead to superior outcomes in terms of AOD abstinence and depressive symptoms relative to CBT-based approaches alone [1092, 1093].
Another approach showing promise in the treatment of co-occurring AOD use and depression is behavioural activation (described in Chapter B6). There is empirical evidence illustrating that behavioural activation is as effective in treating depression as cognitive and behavioural techniques (with or without antidepressants) and more effective than antidepressant medication alone [693, 694, 1094]. The efficacy of behavioural activation in treating co-occurring AOD use and depression has been examined in several RCTs across a variety of AOD treatment settings (community-based clinics, residential treatment, specialist addiction clinics). A systematic review of these trials concluded that, although the research to date is promising, further research is needed [690].
Lastly, although still in the early stages, there is preliminary support for the use of mindfulness-based approaches in the treatment of co-occurring depression and AOD use. These approaches include mindfulness-based relapse prevention [1095, 1096] and mindfulness-based cognitive therapy [1097], which have been associated with greater reductions in depressive symptoms and AOD craving relative to treatment as usual for AOD.