Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literature

Morten Hesse

doi:10.1186/1471-244x-9-6

Abstract

BackgroundThere is an increasing consensus in favour of integrated treatment of substance use disorders and co-morbid conditions, such as depression or anxiety. However, up till now no systematic reviews have been published.MethodsBased on a systematic search of MedLine and PsychInfo, 9 trials of integrated treatment for depression or anxiety plus substance use disorder were identified. Where possible, meta-analyses were carried out, using random effects models.ResultsMeta-analyses were carried out for integrated treatment for depression and substance use disorders on a number of outcomes. No meta-analysis could be carried out for integrated treatment for anxiety and substance use disorders, due to multivariate reporting of outcomes in original articles. Integrated treatment for depression and substance abuse produced significant effects on percent days abstinent at follow-up. Differences in retention and symptoms were non-significant, but favoured the experimental condition. For studies of integrated treatment for co-morbid anxiety disorders and substance use disorders, no meta-analysis could be carried out. Several studies of integrated treatment for anxiety and substance use disorders reported that patients assigned to substance use treatment only fared better.ConclusionPsychotherapeutic treatment for co-morbid depression and substance use disorders is a promising approach, but is not sufficiently empirically supported at this point. Psychotherapeutic treatment for co-morbid anxiety and substance use disorders is not empirically supported. There is a need for more trials to replicate the findings from studies of integrated treatment for depression and substance use disorders, and for the development of new treatment options for co-morbid anxiety and substance use disorders.

Highlights

There is an increasing consensus in favour of integrated treatment of substance use disorders and co-morbid conditions, such as depression or anxiety
There is a need for more trials to replicate the findings from studies of integrated treatment for depression and substance use disorders, and for the development of new treatment options for co-morbid anxiety and substance use disorders
Tiet and Mausbach reviewed the literature on integrated treatment, and found that few studies have assessed the effectiveness of integrated treatments for substance use disorders with co-morbid disorders [5]

Summary

Introduction

There is an increasing consensus in favour of integrated treatment of substance use disorders and co-morbid conditions, such as depression or anxiety. Around 25% of people in the community in the United States with alcohol dependence and around 50% of people with drug dependence have co-morbid depression [2]. Anxiety disorders can be diagnosed in around 25% of alcohol dependent people and 43% of drug dependent people [2]. Co-morbid psychiatric diagnoses accompanying alcohol addiction, such as severe cases of anxiety or depression, may have a negative impact on quality of life, and on functioning and ability to respond to treatment [3,4]. Tiet and Mausbach reviewed the literature on integrated treatment, and found that few studies have assessed the effectiveness of integrated treatments for substance use disorders with co-morbid disorders [5]

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Results

Discussion

Conclusion