Motivational Therapy for Stimulant Users with Depression

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DESCRIPTION (provided by applicant): The proposed career development award is designed to complement the applicant's basic science background in motivational processes underlying addictive behaviors by supporting a training program in the development and evaluation of motivational interventions for underserved populations with substance use disorders (SUDs). This program will facilitate transition of the applicant to an independent investigator in health services research with specialty in psychosocial interventions for SLID populations with comorbid mental health disorders. The proposed 5 year pilot study examines the incremental efficacy of an aftercare psychosocial treatment program of a motivational intervention combined with cognitive behavioral therapy (CBT), relative to standard care, twelve-step facilitation therapy (TSF) for individuals with stimulant dependence and comorbid major depressive disorder. Although the past decade has seen new cognitive and motivational interventions producing improvement in substance use outcomes, few studies have systematically explored the efficacy of these approaches in combination in patients with substance use disorders and comorbid mental health disorders. The proposed randomized trial will include 80 dually diagnosed individuals with stimulant dependence and a substance-independent diagnosis of Major Depressive Disorder. In patients receiving pharmacotherapy for depression, we will compare 12 weeks of CBT combined with motivational therapy (CBT-MT) to 12 weeks of TSF on 6, 12, 24, and 36 week outcomes for depression, substance use, HIV-risk behaviors, and other healthcare outcomes. The primary hypothesis is that CBT-MT will produce better outcomes than TSF. We will also examine predictors of early attrition and treatment retention and examine neuropsychological predictors of treatment retention and outcome. The results of this study might provide a dual-diagnosis specific, cognitive- motivational alternative to traditional aftercare programs for the treatment of stimulant users with depression.