Objective

To investigate prevalence and predictors of early depression response (EDR) in adolescents with substance use and depression receiving cognitive-behavioral therapy (CBT) for substance use and to test the efficacy of supplemental CBT targeting depression (CBT-D) for non-EDR adolescents in an adaptive treatment approach.

Method

At 2 sites, 95 youths (ages 14–21, mean [SD] = 17.4 [1.8]) with alcohol or cannabis use and depressive symptoms received up to 12 sessions of CBT for substance use over 14 weeks. Assessments were at baseline and weeks 4, 9, and 14. The Children’s Depression Rating Scale–Revised was the primary depression measure, with a reduction of 50% or more on this scale at week 4 defining EDR. The primary substance use outcomes of alcohol use, heavy alcohol use, and cannabis use frequency were assessed via interview report on the Alcohol Consumption Questionnaire and the Drug Checklist. Urinalysis provided a secondary measure of cannabis use. Non-EDR adolescents were randomly assigned to supplemental CBT-D or enhanced treatment as usual (ETAU).

Results

Thirty-five adolescents (37%; 95% CI, 27%–47%) demonstrated EDR. Fewer days of cannabis use (odds ratio 0.977; 95% CI, 0.961–0.992) and absence of conduct disorder (odds ratio 0.149; 95% CI, 0.031–0.716) predicted EDR. Frequency of drinking (F_1,82 = 11.09, η² = 0.119, p = .001), heavy drinking (F_1,82 = 19.91, η² = 0.195, p < .0001), and cannabis use (F_1,220 = 35.01, η² = 0.137, p < .001) decreased over time for EDR, CBT-D, and ETAU adolescents, with EDR adolescents evidencing earlier lower cannabis use (F_2,220 = 4.16, η² = 0.036, p = .0169). Negative (clean) urine screens increased over time (F_1,219 = 5.10, η² = 0.023, p = .0249). Comparison of CBT-D and ETAU indicated that depression significantly decreased over time in both groups (F_1,48 = 64.20, η² = 0.572, p < .001), with no advantage for CBT-D.

Conclusion

Approximately one-third of adolescents with substance use and depression attain EDR during substance use treatment. Less frequent cannabis use facilitates depression response. The relatively small sample may have precluded identification of additional EDR predictors.

Clinical trial registration information

Treatment for Teens With Alcohol Abuse and Depression; https://clinicaltrials.gov/; NCT02227589.

中文翻译：

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针对有物质使用和抑郁症的青少年的适应性治疗：早期抑郁症反应和短期结果

客观的

调查接受物质使用认知行为疗法 (CBT) 的物质使用和抑郁症青少年早期抑郁反应 (EDR) 的患病率和预测因素，并测试针对非 EDR 青少年的补充性 CBT 靶向抑郁症 (CBT-D) 的疗效在适应性治疗方法中。

方法

在 2 个地点，95 名酒精或大麻使用和抑郁症状的青少年（14-21 岁，平均 [SD] = 17.4 [1.8]）在 14 周内接受了多达 12 次物质使用的 CBT。在基线和第 4、9 和 14 周进行评估。儿童抑郁量表修订版是主要的抑郁量度，在定义 EDR 的第 4 周时该量表减少 50% 或更多。酒精使用、重度酒精使用和大麻使用频率的主要物质使用结果通过酒精消费问卷和药物清单的访谈报告进行评估。尿液分析提供了大麻使用的辅助措施。非 EDR 青少年被随机分配到补充 CBT-D 或常规强化治疗 (ETAU)。

结果

35 名青少年（37%；95% CI，27%–47%）表现出 EDR。更少的大麻使用天数（比值比 0.977；95% CI，0.961–0.992）和无品行障碍（比值比 0.149；95% CI，0.031–0.716）可预测 EDR。饮酒频率（F _1,82  = 11.09，η ²  = 0.119，p  = .001），大量饮酒（F _1,82  = 19.91，η ²  = 0.195，p  < .0001）和吸食大麻（F _1,220  = EDR、CBT-D 和 ETAU 青少年的35.01，η ²  = 0.137，p  < .001）随着时间的推移而减少，EDR 青少年证明大麻使用率较低（F _2,220  = 4.16，η²  = 0.036，p  = .0169）。随着时间的推移，阴性（干净的）尿液筛查增加（F _1,219  = 5.10，η ²  = 0.023，p  = .0249）。CBT-D 和 ETAU 的比较表明，随着时间的推移，两组的抑郁症显着降低（F _1,48  = 64.20，η ²  = 0.572，p  <.001），CBT-D 没有优势。

结论

大约三分之一患有物质使用和抑郁症的青少年在物质使用治疗期间获得了 EDR。较少使用大麻会促进抑郁反应。相对较小的样本可能无法识别额外的 EDR 预测因子。

临床试验注册信息

对酗酒和抑郁症青少年的治疗；https://clinicaltrials.gov/；NCT02227589。