GROUP CBT FOR DEPRESSION IN CLIENTS WITH AOD DISORDERS

描述（由申请人提供）： 患有酒精和其他药物（AOD）障碍的人经常患有抑郁症，导致生活质量下降和AOD治疗效果较差。抑郁症的有效治疗确实存在，并可以改善结果;但国家数据表明，只有不到7%的患有合并症的人在AOD治疗中接受了适当的治疗。团体认知行为疗法（CBT）是治疗抑郁症的一种有效且廉价的方法。我们建议调查是否组CBT抑郁症，与AOD辅导员领导的团体，是有效的和成本效益的治疗抑郁症。如果是这样，它可以大大增加获得适当的精神卫生保健的机会。 我们提出了一项为期5年的准实验研究，具体目标如下：目标1。评估在公共部门住宅AOD治疗环境中接受治疗的客户中，由AOD咨询师提供的抑郁症团体CBT在改善抑郁症状和AOD结局方面的有效性;目的2。评估由经过培训的AOD咨询师进行的团体CBT与常规护理AOD治疗相比的成本效益;目的3。记录在四个站点中的每个站点实施干预的情况，并确定AOD辅导员是否以模型的保真度提供团体CBT干预，以及治疗保真度是否是客户结果的重要预测因素。 我们将招募并跟踪480名贝克抑郁量表-II评分> 15和AUDIT-C评分>3的客户，他们正在洛杉矶县四个居民点的一个公共部门AOD治疗机构接受治疗。受试者将接受以下两种情况之一：（1）常规护理住院AOD治疗（UC）;（2）常规护理AOD住院治疗加上由经过培训的AOD顾问（CBT）提供的16个疗程的团体CBT。受试者将完成：（1）基线访谈;（2）治疗后访谈（在CBT治疗结束时）和（3）随访访谈（CBT治疗结束后3个月）。将使用意向治疗模型分析数据。我们将收集与UC和CBT相关的服务水平成本和健康影响的数据，并将计算与UC相比，抑郁和AOD改善的每单位增量成本。实施分析将涉及两组相关的活动：（1）一系列关键的知情人访谈，以提供一个背景下，了解干预措施的实施和（2）治疗的保真度和它的关系，客户的结果进行评估。

DESCRIPTION (provided by applicant): Individuals with alcohol and other drug (AOD) disorders frequently suffer from depression, leading to reduced quality of life and poorer AOD treatment outcomes. Efficacious treatments for depression do exist and could improve outcomes; but national data suggest that fewer than 7% of people with co-occurring disorders who are in AOD treatment have received appropriate treatment. Group cognitive behavioral therapy (CBT) is an effective and inexpensive treatment for depression. We propose to investigate whether group CBT for depression, with AOD counselors leading the groups, is effective and cost effective in treating depression. If so, it could substantially increase access to appropriate mental health care. We propose a 5-year quasi-experimental study with the following specific aims: Aim 1. To evaluate the effectiveness of group CBT for depression provided by AOD counselors in improving depressive symptoms and AOD outcomes, among clients being treated in public sector residential AOD treatment settings; Aim 2. To evaluate the cost-effectiveness of group CBT conducted by trained AOD counselors compared to usual care AOD treatment; Aim 3. To document the implementation of the intervention at each of the four sites, and to determine whether the AOD counselors are delivering the group CBT intervention with fidelity to the model, and whether treatment fidelity is a significant predictor of client outcomes. We will enroll and follow 480 clients with Beck Depression Inventory-ll scores > 15 and AUDIT-C scores >3 who are being treated in a single public sector AOD treatment organization at four residential sites in LA County. Subjects will receive one of two conditions: (1) usual care residential AOD treatment (UC); (2) usual care AOD residential treatment plus a 16-session course of group CBT delivered by trained AOD counselors (CBT). Subjects will complete: (1) a baseline interview; (2) a post-treatment interview (at the conclusion of the CBT treatment) and (3) a follow-up interview (3 months after CBT treatment ends). Data will be analyzed using an intent-to-treat model. We will collect data on the service-level costs and health effects associated with UC and CBT, and will calculate the incremental cost per unit of depression and AOD improvement, compared to UC.. The implementation analysis will involve two related sets of activities: (1) a series of key informant interviews to provide a context in which to understand intervention implementation and (2) an assessment of treatment fidelity and it's relationship to client outcomes.