Examining the Effect of Behavioral Activation on Substance Use Outcomes

描述（由申请人提供）：重度抑郁症（MDD）在药物使用者中非常普遍，具有重要的临床和公共卫生影响，包括不良的药物使用治疗结果。药物使用率和抑郁症对市中心地区少数民族的影响不成比例；然而，不幸的是，很少有针对抑郁症的干预措施被开发出来，以满足生活在市中心的抑郁的少数群体药物使用者的具体需求。在这种情况下，一种有用的方法是行为激活（BA），它通过增加个体对愉快事件的参与来治疗抑郁症，从而增加正强化（Jacobson等人，1996；Lejuez等人，2001）。女儿和同事（2008）已经对BA进行了调整，以满足市中心患有抑郁症的非裔美国药物使用者的具体需求，并且在对这种治疗的初步试点研究中[物质使用的生活增强治疗（LET’s ACT）]， LET’s ACT与自我报告的抑郁症状的显著减少以及活动的享受和奖励价值的显著增加有关。虽然LET'S ACT的初步研究结果证明是有希望的，但有必要对先前的研究进行一些扩展，包括1)评估治疗后药物使用复发；2)使用接触时间匹配的对照治疗；3)使用更大的样本量，以便对治疗结果的潜在机制进行更复杂的分析。因此，目前的研究将通过比较let ACT和支持性咨询（SC）来解决这些局限性，在华盛顿特区市中心接受药物滥用治疗的196名低收入重度抑郁症药物使用者的样本中。抑郁症在药物使用人群中很普遍，并且与药物使用治疗效果不佳有关，但很少有干预措施用于治疗市中心少数群体非法吸毒者的抑郁症。本研究旨在进一步发展一种行为激活治疗抑郁症的方法，特别是针对城市内非法吸毒者的住宅药物使用治疗，并研究其对药物使用治疗退出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.