Depression Treatment for Urban Low Income Minority Substance Users

大约22%的物质使用者患有重度抑郁症，这与较高的物质滥用治疗辍学率，物质使用复发率和艾滋病毒风险行为有关。此外，在华盛顿特区等市中心地区，药物使用率和抑郁症对少数民族以及贫困人口的影响不成比例。尽管存在这种联系，但很少有针对抑郁症的干预措施被开发出来，以满足抑郁症药物使用者的具体需求。在这方面，一种可能特别合适的方法是行为激活（BA），其目的是增加个体对愉快事件的参与，从而增加与积极强化的接触并降低厌恶事件的频率。BA已被证明是有效的抑郁症的治疗，这种简单和直接的方法可能是特别适合于一个内城低收入物质滥用样本的具体需求。此外，BA在几个关键的实践和理论方面称赞标准药物滥用治疗，因为它更容易被这些环境中的工作人员采用，更省时（例如，更少和更短的疗程，小组形式），更容易被因教育水平低和长期吸毒而遭受认知限制的患者理解，并且可以将清醒的方面纳入其治疗组成部分。在最初的第1阶段开发项目中，开发了一个BA版本，即物质使用的生命增强治疗（LETS ACT），并专门为患有抑郁症状的市中心低收入少数物质使用者量身定制。发表在《临床精神病学杂志》上的Daughters等人（2008）证明，与TAU对照组相比，LETS ACT导致自我报告的抑郁症状显著减少，活动的享受和奖励价值显著增加。虽然初步的研究结果证明是有希望的，但许多问题仍然没有答案，这项工作的几个扩展是必要的，包括评估治疗后物质使用和艾滋病毒风险行为，接触匹配的控制，以及更大的样本量，以允许对这些结果背后的机制进行更复杂的分析。因此，本提案的目的是跟进我们之前的第1阶段治疗开发工作和小规模随机对照试验（RCT），在华盛顿市中心目前接受住宅药物滥用治疗的243名低收入抑郁药物使用者样本中，采用完全有效的第2阶段RCT比较LETS ACT与非指导性治疗（NDT）。

Approximately 22% of substance users suffer from major depression, which is associated with higher rates of substance abuse treatment dropout, relapse to substance use, and HIV risk behavior. Further, in inner-city areas such as DC, rates of substance use and depression disproportionately affect ethnic minorities, as well as those living in poverty. Despite this link, few interventions targeting depression have been developed to meet the specific needs of depressed substance users. One approach that may be especially appropriate in this regard is behavioral activation (BA), which aims to increase individuals¿ engagement in pleasant events, thereby increasing contact with positive reinforcement and decreasing the frequency of aversive events. BA has been shown to be efficacious in the treatment of depression, and this uncomplicated and straightforward approach may be especially appropriate for the specific needs of an inner city low income substance abusing sample. Further, BA compliments standard substance abuse treatment in several key practical and theoretical ways as it is more easily adopted by staff in these settings, more time efficient (e.g., fewer and shorter sessions, group format), more easily understood by patients who suffer from cognitive limitations due to low education level and chronic drug use, and can incorporate aspects of sobriety into its treatment components. In an initial Stage 1 development project, a version of BA, the Life Enhancement Treatment for Substance Use (LETS ACT), was developed and specifically tailored for inner-city low income minority substance users with elevated depressive symptoms. Published in the Journal of Clinical Psychiatry, Daughters et al. (2008) demonstrated that LETS ACT led to a significantly greater reduction in self-reported depressive symptoms and a significant increase in enjoyment and reward value of activities as compared to the TAU control group. While preliminary findings prove promising, many questions remain unanswered and several extensions of this work are necessary, including an assessment of post treatment substance use and HIV risk behavior, a contact-matched control, and a larger sample size to allow for more complex analyses of the mechanisms underlying these outcomes. Thus, the objective of the present proposal is to follow-up on our previous Stage 1 treatment development efforts and small scale randomized control trial (RCT) with a fully-powered Stage 2 RCT comparing LETS ACT to nondirective therapy (NDT) among a sample of 243 low income depressed substance users currently receiving residential substance abuse treatment in inner-city Washington, DC.