Depression Treatment for Urban Low Income Minority Substance Users

大约22%的吸毒者患有严重抑郁症，这与较高的药物滥用治疗辍学率、再次使用药物和艾滋病毒危险行为有关。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生活在贫困中的人的影响不成比例。尽管有这种联系，但针对抑郁症的干预措施很少被开发出来，以满足抑郁症药物使用者的特定需求。一种在这方面可能特别合适的方法是行为激活(BA)，它旨在增加个人对愉快事件的参与度，从而增加与积极强化的接触，并减少厌恶事件的频率。BA已被证明在治疗抑郁症方面是有效的，这种简单和直接的方法可能特别适合市中心低收入药物滥用样本的特定需求。此外，BA在几个关键的实践和理论方面赞扬了标准的药物滥用治疗，因为它更容易被这些环境中的工作人员采用，更省时(例如，会议更少和更短，小组形式)，更容易被因低教育水平和长期药物使用而受到认知限制的患者理解，并且可以将戒酒的方面纳入其治疗部分。在最初的第一阶段开发项目中，开发了BA的一个版本，即物质使用的生活增强疗法(LETS ACT)，并专门为患有抑郁症状的市中心低收入少数族裔药物使用者量身定做。发表在《临床精神病学杂志》上，女儿等人。(2008)表明，与TAU对照组相比，让ACT导致自我报告的抑郁症状的显著减少，以及活动的快乐和奖励价值的显著增加。虽然初步结果证明是有希望的，但许多问题仍然没有得到回答，这项工作有必要进行几次扩展，包括对治疗后药物使用和艾滋病毒风险行为的评估，接触配对对照，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，本提案的目标是跟进我们之前的第一阶段治疗开发工作和小规模随机对照试验(RCT)，该试验采用完全功率的第二阶段随机对照试验，对243名目前在华盛顿特区市中心接受住宅药物滥用治疗的低收入抑郁症药物使用者进行LET ACT和非直接治疗(NDT)的比较。

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.