Co-occurring major depression is prevalent among alcohol-dependent women and is a risk factor for poor treatment outcomes. This uncontrolled pilot study tested the feasibility, acceptability, and initial effects of interpersonal psychotherapy (IPT) for women with co-occurring alcohol dependence and major depression (AD-MD) in an outpatient community addiction treatment program.
Methods
Fourteen female patients with concurrent diagnoses of alcohol dependence and major depression participated. Assessments were conducted at baseline, midtreatment (8 and 16 weeks), posttreatment (24 weeks), and follow-up (32 weeks).
Results
Participants attended a mode of 8 out of 8 possible sessions of IPT in addition to their routine addiction care, and reported high treatment satisfaction on the Client Satisfaction Questionnaire-8. Women's drinking behavior, depressive symptoms, and interpersonal functioning improved significantly over the treatment period and were sustained at follow-up.
Conclusions
These preliminary findings suggest that IPT is a feasible, highly acceptable adjunctive behavioral intervention for AD-MD women.
US Department of Health and Human Services. 2000. Tenth Special Report to the U.S. Congress on Alcohol and Health, Rockville, MD, Author
2.
ConwayK P, ComptonW, StinsonF S and GrantB F. 2006. Lifetime co-morbidity of DSM-IV mood and anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry., 67: 247–257.
3.
HasinD S, StinsonF S, OgburnE and GrantB F. 2007. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States. Arch Gen Psychiatry., 64: 830–842.
4.
RegierD A, FarmerM ERaeD S. 1990. Co-morbidity of mental disorders with alcohol and drug abuse: results from the epidemiological catchment area (ECA) study. JAMA., 264: 2511–2518.
5.
KesslerR C, CrumR M, WarnerL A, NelsonC B, SchulenbergJ and AnthonyJ C. 1997. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the national co-morbidity survey. Arch Gen Psychiatry., 54: 313–321.
6.
CorneliusJ R, JarrettP JThaseM E. 1995. Gender effects on the clinical presentation of alcoholics at a psychiatric hospital. Compr Psychiatry., 36: 435–440.
7.
CurranG C and BoothB M. 1999. Longitudinal changes in predictor profiles of abstinence from alcohol use among male veterans. Alcohol Clin Exp Res, 23: 141–143.
8.
HesselbrockM N, MeyerR E and KeenerJ J. 1985. Psychopathology in hospitalized alcoholics. Arch Gen Psychiatry., 42: 1050–1055.
9.
SchuckitM A. 1986. Genetic and clinical implications of alcoholism and affective disorder. Am J Psychiatry., 150: 695–704.
10.
WeissmanM M, MeyersJ K and HardingP S. 1980. Prevalence and psychiatric heterogeneity of alcoholism in a United States urban community. J Stud Alcohol Drug., 41: 672–681.
11.
BrownR A, EvansD M, MillerI W, BurgessE S and MuellerT I. 1997. Cognitive-behavioral treatment for depression in alcoholism. J Consult Clin Psychol., 65: 715–726.
12.
WatkinsK E, HunterS BHepnerK A. 2011. An effectiveness trial of group Cognitive Behavioral Therapy for patients with persistent depressive symptoms in substance abuse treatment. Arch Gen Psychiatry., 68: 577–584.
13.
ConnerK R, PinquartM and GambleS A. 2009. Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Subst Abuse Treat., 37: 127–137.
14.
CurranG M, KirchnerJ E, WorleyM, RookeyC and BoothB M. 2002. Depressive symptomatology and early attrition from intensive outpatient substance use treatment. J Behav Health Serv Res., 29: 138–143.
15.
CurranG M, FlynnH A, KirchnerJ and BoothB M. 2000. Depression after alcohol treatment as a risk factor for relapse among male veterans. J Subst Abuse Treat., 19: 259–265.
16.
GlennS W and ParsonsO A. 1991. Prediction of resumption of drinking in posttreatment alcoholics. Int J Addict., 26: 237–254.
17.
GreenfieldS F, WeissR DMuenzL R. 1998. The effect of depression on return to drinking: a prospective study. Arch Gen Psychiatry., 55: 259–265.
18.
HodginsD C, el-GuebalyN, ArmstrongS and DufourM. 1999. Implications of depression on outcome from alcohol dependence: a three-year prospective follow-up. Alcohol Clin Exp Res., 23: 151–157.
19.
SvanumS and McAdooW G. 1989. Predicting rapid relapse following treatment for chemical dependence: a matched-subjects design. J Consult Clin Psychol., 57: 222–226.
20.
GambleS A, ConnerK R, TalbotN L, YuQ, TuX M and ConnorsG J. 2010. Effects of pretreatment and posttreatment depressive symptoms on alcohol consumption following treatment in project MATCH. J Stud Alcohol Drugs., 71: 71–77.
21.
KodlM M, FuS S, WillenbringM L, GravelyA, NelsonD B and JosephA M. 2008. The impact of depressive symptoms on alcohol and cigarette consumption following treatment for alcohol and nicotine dependence. Alcohol Clin Exp Res., 32: 92–99.
22.
SchutteK K, HearstJ and MoosR H. 1997. Gender differences in the relations between depressive symptoms and drinking behavior among problem drinkers: a three-wave study. J Consult Clin Psychol., 65: 392–404.
23.
GreenfieldS F, BrooksA JGordonS M. 2007. Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug Alcohol Depend., 86: 1–21.
24.
LutzM E. 1991. Sobering decisions: are there gender differences?. Alcohol Treat Q., 8: 51–64.
25.
HussongA. 2007. Predictors of drinking immediacy following daily sadness: an application of survival analysis to experience sampling data. Addict Behav., 32: 1054–1065.
26.
Lau-BarracoC, SkewesM C and StasiewiczP R. 2009. Gender differences in high-risk situations for drinking: are they mediated by depressive symptoms?. Addict Behav., 34: 68–74.
27.
JesterJ M, JacobsonS W, SokolR J, TuttleB S and JacobsonJ L. 2000. The influence of maternal drinking and drug use on the quality of the home environment of school-aged children. Alcohol Clin Exp Res., 24: 1187–1197.
28.
AllanC A and CookeD J. 1985. Stressful life events and alcohol misuse in women: a critical review. J Stud Alcohol Drugs., 46: 147–152.
29.
WalitzerK S and DearingR L. 2006. Gender differences in alcohol and substance use relapse. Clin Psychol Rev., 26: 128–148.
30.
HolahanC J, MoosR H, HolahanC K, CronkiteR C and RandallP K. 2004. Unipolar depression, life context vulnerabilities, and drinking to cope. J Consult Clin Psychol., 72: 269–275.
31.
ConnorsG J, MaistoS A and ZwiakW H. 1998. Male and female alcoholics’ attributions regarding the onset and termination of relapses and the maintenance of abstinence. J Subst Abuse., 10: 27–42.
32.
KlermanG L, WeissmanM M, RounsavilleB J and ChevronE. 1984. Interpersonal Psychotherapy of Depression, Northvale, NJ: Jason Aronson.
33.
StuartS and RobertsonM. 2003. Interpersonal Psychotherapy: A Clinician's Guide, London: Arnold.
34.
ElkinI, SheaM TWatkinsJ T. 1989. National Institute of Mental Health treatment of depression collaborative research program: general effectiveness of treatments. Arch Gen Psychiatry., 46: 971–982.
35.
FrankE, KupferD J, WagnerE F, McEachranA B and CornesC. 1991. Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression: contributing factors. Arch Gen Psychiatry., 48: 1053–1059.
36.
FrankE and SpanierC. 1995. Interpersonal psychotherapy for depression: overview, clinical efficacy, and future directions. Clin Psychol Sci Pract., 2: 349–369.
37.
GroteN, SwartzH, GeibelS, ZuckoffA, HouckP R and FrankE. 2009. A randomized controlled trial of culturally relevant, brief Interpersonal Psychotherapy for perinatal depression. Psychiatr Serv., 60: 313–321.
38.
JohnsonJ E and ZlotnickC. 2008. A pilot study of group psychotherapy for depression in substance-abusing female prisoners. J Subst Abuse Treat., 34: 371–377.
39.
PoleshuckE L, TalbotN EZlotnickC. 2010. Interpersonal psychotherapy for women with co-morbid depression and chronic pain. J Nerv Ment Dis., 198: 597–600.
40.
TalbotN L, ChaudronL HWardE A. 2011. Randomized effectiveness trial of Interpersonal psychotherapy for depressed women with sexual abuse histories. Psychiatr Serv., 62: 374–380.
41.
WeissmanM M, MarkowitzJ C and KlermanG L. 2000. Comprehensive Guide to Interpersonal Psychotherapy, New York: Basic Books.
42.
HodginsD C, el-GuebalyN and ArmstrongS. 1995. Prospective and retrospective reports of mood states before relapse to substance use. J Consult Clin Psychol., 63: 400–407.
43.
WadeT D and KendlerK S. 2000. The relationship between social support and major depression: cross-sectional, longitudinal, and genetic perspectives. J Nerv Ment Dis., 188: 251–258.
44.
MohrC D, AvernaS, KennyD A and Del BocaF K. 2001. Getting by (or getting high) with a little help from my friends”: an examination of adult alcoholics’ friendships. J Stud Alcohol Drugs., 62: 637–645.
45.
AndrewsB and BrownG W. 1988. Social support, onset of depression and personality: an exploratory analysis. Soc Psychiatry Psychiatr Epidemiol., 23: 99–108.
46.
Nelson-ZlupkoL, DoreM M, KauffmanE and KaltenbachK. 1996. Women in recovery: their perceptions of treatment effectiveness. J Subst Abuse Treat., 13: 51–59.
47.
American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders.4th ed, Washington, DC: American Psychiatric Association.
48.
KroenkeK, SpitzerR L and WilliamsJ B. 2001. The PHQ-9. validity of a brief depression severity measure. J Gen Intern Med., 16: 606–613.
49.
HasinD, TrautmanK, MieleG, SametS, SmithM and EndicottJ. 1996. Psychiatric Research Interview for Substance and Mental Disorders (PRISM): reliability for substance users. Am J Psychiatry., 153: 1195–1201.
50.
LarsenD L, AttkissonC C, HargreavesW A and NguyenT D. 1979. Assessment of client/patient satisfaction: development of a general scale. Eval Program Plan., 2: 197–207.
51.
SobellL C and SobellM B. 1996. Timeline Followback User's Guide: A Calendar Method for Assessing Alcohol and Drug Use, Toronto: Addiction Research Foundation.
52.
BaborT F, LongabaughRZwebenA. 1994. Issues in the definition and measurement of drinking outcomes in alcoholism treatment research. J Stud Alcohol Drugs., 12: S101–S111.
53.
SobellL C and SobellM B. 1978. Validity of self-reports in three populations of alcoholics. J Consult Clin Psychol., 46: 901–907.
54.
SobellL C, MaistoS A, SobellM B and CooperA M. 1980. Reliability of alcohol abusers’ self-reports of drinking behavior. Behav Res Ther., 17: 157–160.
55.
SobellM B, SobellL C and VanderspekR. 1979. Relationship between clinical judgment, self-report, and breath-analysis measures of intoxication in alcoholics. J Consult Clin Psychol., 47: 204–206.
56.
BaborT F, StephensR S and MarlattG A. 1987. Verbal report methods in clinical research on alcoholism: response bias and its minimization. J Stud Alcohol Drugs., 48: 410–424.
57.
BeckA T, SteerR A and BrownG K. 1996. Beck Depression Inventory-II (BDI-II), San Antonio, TX: The Psychological Corporation.
58.
HamiltonM. 1960. A rating scale for depression. J Neurol Neurosurg Psychiatry., 23: 56–61.
59.
KellerM B. 2003. Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond. JAMA., 289: 3152–3160.
60.
MillerW R, ToniganJ S and LongabaughR. 1995. Project MATCH Monograph Series: Vol. 4. The Drinker Inventory of Consequences (DrInC): An Instrument for Assessing Adverse Consequences of Alcohol Abuse, Rockville, MD: National Institute on Drug Abuse. DHHS Publication No. 95–3991
61.
LiangK Y and ZegerS L. 1986. Longitudinal data analysis using generalized linear models. Biometrika., 73: 13–22.
62.
RosenthalR. 1994. “Parametric measures of effect size”. In The Handbook of Research Synthesis, Edited by: CooperH and HedgesL V. 231–244. New York: Sage.
63.
JacobsonN S, FolletteW C and RevenstorfD. 1984. Psychotherapy outcome research: methods for reporting variability and evaluating clinical significance. Behav Ther., 15: 336–352.
64.
McCradyB S, EpsteinE E, CookS, JensenN and HildebrandtT. 2009. A randomized trial of individual and couple behavioral alcohol treatment for women. J Consult Clin Psychol., 77: 243–256.
65.
RounsavilleB J, GlazerW, WilberC H, WeissmanM M and KleberH D. 1983. Short-term Interpersonal Psychotherapy in methadone-maintained opiate addicts. Arch Gen Psychiatry., 40: 629–636.
66.
RounsavilleB J, KostenT R, WeissmanM M and KleberH D. 1986. A 2.5-year follow-up of short-term interpersonal psychotherapy in methadone-maintained opiate addicts. Compr Psychiatry., 27: 201–210.
67.
CarrollK M, RounsavilleB J and GawinF H. 1991. A comparative trial of psychotherapies for ambulatory cocaine abusers: relapse prevention and interpersonal psychotherapy. Am J Drug Alcohol Abuse., 17: 229–247.
68.
KellyT M, DaleyD C and DouaihyA B. 2012. Treatment of substance abusing patients with comorbid psychiatric disorders. Addict Behav., 37: 11–24.
