Examining the Effect of Behavioral Activation on Substance Use Outcomes

描述（由申请人提供）：重度抑郁症（MDD）在物质使用者中非常普遍，具有显著的临床和公共卫生影响，包括不良的物质使用治疗结果。药物使用率和抑郁症已被证明对内城地区的少数民族产生不成比例的影响;但不幸的是，很少有针对抑郁症的干预措施被开发出来，以满足生活在内城的抑郁症，少数药物使用者的具体需求。在这种情况下，一种被认为有用的方法是行为激活（BA），其通过增加个体对愉快事件的参与来治疗抑郁症，从而增加正强化（Jacobson et al.，1996; Lejuez等人，2001年）。Daughters和同事（2008）已经调整了BA以满足市中心的特定需求，患有抑郁症的非裔美国人物质使用者，并且在这种治疗的初步试点研究中[物质使用的生命增强治疗（LET'S ACT）]，LET'S ACT与自我报告的抑郁症状显着减少以及活动的享受和奖励价值显着增加有关。虽然LET'S ACT的初步研究结果证明是有希望的，但有必要对先前的研究进行一些扩展，包括1）评估治疗后物质使用复发2）利用接触时间匹配的对照治疗，以及3）使用更大的样本量，以允许对治疗结果的机制进行更复杂的分析。因此，目前的研究将解决这些局限性，通过比较LETS ACT支持咨询（SC）之间的样本196低收入物质使用者与MDD接受住宅物质滥用治疗在内城华盛顿，DC。抑郁症在药物使用人群中很普遍，与药物使用治疗结果不佳有关，但很少制定干预措施来治疗市中心少数非法药物使用者的抑郁症。这项建议旨在进一步发展一种专门针对居住在市中心的非法药物使用者的抑郁症行为激活治疗，并研究其对药物使用治疗退出和治疗后复发的影响。

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is highly prevalent among substance users, which has significant clinical and public health implications, including poor substance use treatment outcomes. Rates of substance use and depression have been shown to disproportionately affect ethnic minorities in inner-city areas; yet unfortunately, few interventions targeting depression have been developed to meet the specific needs of depressed, minority substance users living in the inner-city. One approach that has been suggested to be useful in this context is behavioral activation (BA), which treats depression by increasing individuals' engagement in pleasant events, and thus increasing positive reinforcement (Jacobson et al., 1996; Lejuez et al., 2001). Daughters and colleagues (2008) have adapted BA to meet the specific needs of inner-city, African American substance users with depression, and in a preliminary pilot study for this treatment [Life Enhancement Treatment for Substance Use (LET'S ACT)], LET'S ACT was associated with a significant reduction in self-reported depressive symptoms and a significant increase in enjoyment and reward value of activities. While preliminary findings for LET'S ACT prove promising, several extensions of the previous study are necessary, including 1) assessment of post-treatment substance use relapse 2) utilization of a contact time-matched control treatment, and 3) the use of a larger sample size to allow for more complex analyses of the mechanisms underlying treatment outcomes. Thus, the current study will address these limitations by comparing LETS ACT to Supportive Counseling (SC) among a sample of 196 low-income substance users with MDD receiving residential substance abuse treatment in inner-city Washington, DC. Depression is prevalent in substance using populations and is associated with poor substance use treatment outcomes, yet few interventions have been developed to treat depression among inner-city, minority illicit drug users. This proposal aims to further develop a behavioral activation treatment for depression specifically for inner-city illicit drug users in residential substance use treatment and examine its effect on substance use treatment dropout and post-treatment relapse.