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治疗结果更差。抑郁症确实存在有效的治疗方法，可以改善结果；但国家数据表明，在接受AOD治疗的共生疾病患者中，只有不到7%的人得到了适当的治疗。团体认知行为疗法(CBT)是治疗抑郁症的一种有效且廉价的疗法。我们建议调查由AOD咨询师领导的抑郁症小组CBT在治疗抑郁症方面是否有效和成本效益高。如果是这样的话，它可能会大大增加获得适当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：目的1.评估由AOD咨询师提供的团体CBT治疗抑郁症在公共部门居民AOD治疗环境中改善抑郁症状和AOD结果的有效性；目的2.评估由训练有素的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.记录干预在四个地点的实施情况，并确定AOD咨询师是否向模型提供逼真的团体CBT干预，以及治疗保真度是否是患者结果的显著预测因素。 我们将招募和跟踪480名在洛杉矶县四个居民点的单一公共部门AOD治疗机构接受治疗的Beck抑郁症Inventory-ll Score&gt；15和AUDIT-C Score&gt；3的客户。受试者将接受两种情况之一：(1)普通护理住院AOD治疗(UC)；(2)普通护理AOD住院治疗加上由训练有素的AOD辅导员(CBT)讲授的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)后续访谈(CBT治疗结束后3个月)。数据将使用意向治疗模型进行分析。我们将收集与UC和CBT相关的服务级别成本和健康影响的数据，并计算与UC相比，每单位抑郁症和AOD改善的增量成本。实施分析将涉及两组相关活动：(1)一系列关键的信息提供者访谈，以提供了解干预实施情况的背景；(2)评估治疗保真度及其与客户结果的关系。

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.