Examining the Effect of Behavioral Activation on Substance Use Outcomes

描述(申请人提供)：严重抑郁障碍(MDD)在药物使用者中非常普遍，具有重大的临床和公共卫生影响，包括不良的药物使用治疗结果。药物使用率和抑郁率已被证明对市中心地区的少数民族产生了不成比例的影响；但不幸的是，针对抑郁症的干预措施很少，以满足居住在市中心的抑郁症和少数族裔吸毒者的具体需求。在这种情况下，一种被认为有用的方法是行为激活(BA)，它通过增加个人对愉快事件的参与来治疗抑郁症，从而增加积极的强化(Jacobson等人，1996；Lejuez等人，2001)。女儿和同事(2008)已经使BA适应了患有抑郁症的市中心非裔美国人物质使用者的特定需求，在这种治疗[物质使用的生活增强疗法(LET‘s ACT)]的初步初步研究中，LET’s ACT与显著减少自我报告的抑郁症状和显著增加活动的享受和奖励价值有关。虽然let‘s ACT的初步结果被证明是有希望的，但先前研究的几个扩展是必要的，包括1)对治疗后物质使用复发的评估，2)使用接触时间匹配的对照治疗，以及3)使用更大的样本量来允许对治疗结果背后的机制进行更复杂的分析。因此，目前的研究将通过比较让ACT和支持性咨询(SC)在华盛顿特区市中心接受住宅药物滥用治疗的196名患有MDD的低收入药物使用者的样本来解决这些限制。抑郁症在物质使用人群中很普遍，并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吸毒者的抑郁症。这项建议旨在进一步开发专门针对城区非法吸毒者的行为激活疗法，用于居民物质使用治疗，并考察其对物质使用治疗、辍学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.