Objective: To compare computer-delivered and therapist-delivered treatments for people with depression and comorbid addictive disorders.
Design: Randomised controlled clinical trial.
Setting and participants: Our study was conducted between January 2005 and August 2007 at seven study clinics in rural and urban New South Wales. Participants were 274 people who had a Beck Depression Inventory II (BDI-II) score ≥ 17 and were using alcohol and/or cannabis at harmful levels in the month before baseline. They were self-referred or referred from other sources such as outpatient drug treatment clinics, general practices and non-government support agencies.
Interventions: Participants were randomly allocated to receive (1) integrated cognitive behaviour therapy and motivational interviewing (CBT/MI) delivered by a therapist; (2) integrated CBT/MI delivered by computer, with brief therapist assistance at the end of each session (clinician-assisted computerised [CAC] treatment), or (3) person-centred therapy (PCT), consisting of supportive counselling given by a therapist (the control group). All three treatments were delivered according to a manual developed specifically for the study.
Main outcome measures: Changes in depression, alcohol use and cannabis use at 3 months after baseline; significant predictors of change in the primary outcome variables.
Results: Compared with computer- or therapist-delivered CBT/MI, PCT was associated with significantly less reduction in depression and alcohol consumption at 3 months. CAC therapy was associated with improvement at least equivalent to that achieved by therapist-delivered treatment, with superior results as far as reducing alcohol consumption. Change in depression was significantly predicted by change in alcohol use (in the same direction) and an ability to determine primacy, irrespective of whether this was for drug use or depression. Change in alcohol use was significantly predicted by changes in cannabis use and depression, and change in cannabis use by change in alcohol use. In the regression model, treatment allocation did not independently predict change, but was associated with significant reduction in depression and alcohol use at 3 months.
Conclusions: Over a 3-month period, CBT/MI was associated with a better treatment response than supportive counselling. CAC therapy was associated with greater reduction in alcohol use than therapist-delivered treatment.
Trial registration number: ACTRN12610000274077.
- 1. World Health Organization. The global burden of disease: 2004 update. Geneva: WHO, 2008.
- 2. Helmus TC, Downey KK, Wang LM, et al. The relationship between self-reported cocaine withdrawal symptoms and history of depression. Addict Behav 2001; 26: 461-467.
- 3. Kay-Lambkin FJ, Baker A, Lewin T. The “co-morbidity roundabout”: a framework to guide assessment and intervention strategies and engineer change among people with co-morbid problems. Drug Alcohol Rev 2004; 23: 407-424.
- 4. Australian Bureau of Statistics. National Survey of Mental Health and Wellbeing: summary of results, 2007. Canberra: ABS, 2008. (ABS Cat. No. 4326.0.)
- 5. Brown CH, Ten-Have TR, Jo B, et al. Adaptive designs for randomized trials in public health. Annu Rev Public Health 2009; 30: 1-25.
- 6. Kavanagh DJ, Mueser K, Baker A. Management of co-morbidity. In: Teesson M, editor. Co-morbid mental disorders and substance use disorders: epidemiology, prevention and treatment. Canberra: Commonwealth of Australia, 2003: 78-107.
- 7. Kaltenthaler E, Parry G, Beverley C, Ferriter M. Computerised cognitive-behavioural therapy for depression: systematic review. Br J Psychiatry 2008; 193: 181-184.
- 8. Bewick BM, Trusler K, Barkham M, et al. The effectiveness of web-based interventions designed to decrease alcohol consumption — a systematic review. Prev Med 2008; 47: 17-26.
- 9. Cuijpers P, van Straten A, Andersson G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J Behav Med 2008; 31: 169-177.
- 10. Kay-Lambkin FJ, Baker A, Lewin T, Carr VJ. Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy. Addiction 2009; 104: 378-388.
- 11. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, Tex: Psychological Corporation, 1996.
- 12. National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC, 2009. http://www.nhmrc.gov.au/publications/synopses/ds10syn.htm (accessed Jun 2011).
- 13. Darke S, Heather N, Hall W, et al. Estimating drug consumption in opioid users: reliability and validity of a “recent use” episodes method. Br J Addict 1991; 86: 1311-1316.
- 14. Castle DJ, Jablensky A, McGrath JJ, et al. The diagnostic interview for psychoses (DIP): development, reliability and applications. Psychol Med 2006; 36: 69-80.
- 15. Dawe S, Loxton N, Hides L, et al. Review of diagnostic and screening instruments for alcohol and other drug use and other psychiatric disorders. 2nd ed. Canberra: Commonwealth of Australia, 2002.
- 16. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV-TR axis I disorders, research version, patient edition. New York: Biometrics Research, New York State Psychiatric Institute, 2001.
- 17. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text revision. Washington, DC: APA, 2000.
- 18. Australian Institute of Health and Welfare. Rural, regional and remote health: a guide to remoteness classifications. Canberra: AIHW, 2004. (AIHW Cat. No. PHE 53.)
- 19. Baker AL, Kavanagh DJ, Kay-Lambkin FJ, et al. Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems: short-term outcome. Addiction 2010; 105: 87-99.
- 20. Kalman D, Kim S, DiGirolamo G, et al. Addressing tobacco use disorder in smokers in early remission from alcohol dependence: the case for integrating smoking cessation services in substance use disorder treatment programs. Clin Psychol Rev 2010; 30: 12-24.
- 21. Hasin DS, Tsai W-Y, Endicott J, et al. Five-year course of major depression: effects of comorbid alcoholism. J Affect Disord 1996; 41: 63-70.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.