young adults with both problems
When adolescents with substance use problems and depression are treated
for substance use, about a third also have early improvements in depression


Date:
March 29, 2022
Source:
Elsevier
Summary:
A new study reports that, among youth with substance use and
depression, a significant proportion show early improvements in
depression during their treatment for substance use. Youth who
are using cannabis less frequently prior to treatment and those
without conduct disorder are more likely to experience early
depression improvement.



FULL STORY ==========================================================================
A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that, among youth
with substance use and depression, a significant proportion show
early improvements in depression during their treatment for substance
use. Youth who are using cannabis less frequently prior to treatment
and those without conduct disorder are more likely to experience early depression improvement.


==========================================================================
"The combination of alcohol or cannabis use and depression is a
significant problem in adolescents and young adults. In addition to
the negative outcomes associated with substance use, like automobile
accidents and academic problems, those with both conditions tend to
have longer episodes of depression, more substance-related problems,
and, most importantly, an increased risk for suicidal behavior," said
lead author John Curry, PhD, Professor Emeritus in the Department of
Psychiatry & Behavioral Sciences at Duke University, Durham, NC.

"Yet there is no standard approach to treating them, and they are often
treated in two separate systems of care." Earlier studies have shown
that some of these young people will show significant improvement in
depression during treatment for substance use alone, suggesting that if
that improvement is sustained, they may not need additional depression treatment. Based on this evidence, the researchers tested an adaptive
approach in which everyone received substance use treatment. Yet, if
they were still depressed after a month, they would receive additional depression treatment either with the same therapist or in the community.

"This approach allowed us to examine two different approaches to
depression treatment for youth with substance use," said Dr. Curry. "We
also wanted to discover what proportion of the youth would have an early depression response during substance use treatment and what factors
predicted it." Across two sites, a sample of 95 youths between the ages
of 14 and 21 with alcohol or cannabis use and depressive symptoms received
up to 12 sessions of cognitive behavior therapy (CBT) for substance use
over 14 weeks. Before treatment, they completed measures of psychiatric diagnoses, alcohol or cannabis use, and severity of depression. Early depression response was defined as a 50% reduction in symptoms by week
4 of treatment. Those without early depression response were randomized
to add either CBT for depression with the same therapist or depression treatment in the community.

Thirty-five participants (37%) demonstrated early depression response.

Predictors of early depression response were lower frequency of
cannabis use at baseline and lack of a conduct disorder diagnosis. No
other variables - - including demographic characteristics, severity of depression, or other psychiatric diagnoses -- were predictors. Frequency
of drinking, heavy drinking, and cannabis use declined over the full
course of treatment for all participants. Among those without early
depression response, depression improved significantly with either
additional CBT or community treatment, with no difference between
treatments.

"This treatment study emphasizes the importance of recognizing
the heterogeneity of youth with substance use and co-occurring
disorders such as depression, including the different trajectories
of their responses to treatment," said lead author Yifrah Kaminer,
MD, MBA, Professor Emeritus of Psychiatry at the University of
Connecticut, Storrs, CT. "An important finding is that the level of
cannabis use affects the trajectory of change in depression during
treatment. Additional examination of potential biological markers or
other predictors of treatment response is of paramount importance for developing cost-effective interventions." Additional analyses will
examine the course of depression and substance use after treatment,
and whether the young people whose depression responded to substance
use treatment continue to remain less depressed. Given the relatively
small sample, it will be important to replicate the study's findings in
other samples. Future research is needed to investigate the factors that underlie the relationship between substance use and depression over time.


========================================================================== Story Source: Materials provided by Elsevier. Note: Content may be edited
for style and length.


========================================================================== Journal Reference:
1. John F. Curry, Yifrah Kaminer, David B. Goldston, Grace Chan,
Karen C.

Wells, Rebecca H. Burke, Adrienne Banny Inscoe, Allison E. Meyer,
Shayna M. Cheek. Adaptive Treatment for Youth With Substance
Use and Depression: Early Depression Response and Short-term
Outcomes. Journal of the American Academy of Child & Adolescent
Psychiatry, 2022; 61 (4): 508 DOI: 10.1016/j.jaac.2021.07.807 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/03/220329114730.htm

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