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The effect of a behavioral activation treatment for substance use on post‐treatment abstinence: a randomized controlled trial
Author(s) -
Daughters Stacey B.,
Magidson Jessica F.,
Anand Deepika,
SeitzBrown C. J.,
Chen Yun,
Baker Sydney
Publication year - 2018
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.14049
Subject(s) - abstinence , randomized controlled trial , medicine , confidence interval , depression (economics) , beck depression inventory , odds ratio , adverse effect , psychiatry , clinical trial , treatment and control groups , anxiety , economics , macroeconomics
Aims To compare outcomes for a behavioral activation group treatment for substance use [life enhancement treatment for substance use (LETS ACT)] versus a time and group size‐matched control condition delivered in a residential treatment setting. Design Single‐site two‐arm parallel‐group randomized clinical trial with follow‐up assessment at 3, 6 and 12 months post‐treatment. Setting Residential substance use treatment facility in the United States. Participants Participants were 263 adults [mean age 42.7 (11.8); 29.5% female; 95.4% African American; 73.2% court mandated] whose insurance dictated 30‐day (65.9%) or 90‐day (34.1%) treatment duration. Intervention and comparator LETS ACT ( n = 142) is a treatment developed originally for depression and modified for substance use. It teaches participants to increase positively reinforcing value‐driven activities in order to counter depression and relapse. The control group [supportive counseling (SC); n = 121] received time and group size‐matched supportive counseling. Treatment was delivered in five or eight 1‐hour sessions depending on patient length of stay. Measurements Percentage abstinent at follow‐up, percentage of substance use days among those reporting use, depressive symptoms [Beck Depression Inventory (BDI)] and adverse consequences of drug use [Short Inventory of Problems—Alcohol and Drug (SIP‐AD)]. Findings LETS ACT had significantly higher abstinence rates at 3 months [odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.3–3.7], 6 months (OR = 2.6, 95% CI= 1.3–5.0) and 12 months (OR = 2.9, 95% CI = 1.3–6.1) post‐treatment compared with SC. LETS ACT participants reported significantly fewer adverse consequences from substance use at 12 months post‐treatment [B = 4.50, standard error (SE) = 2.17, 95% CI = 0.22–8.78]. Treatment condition had no effect on percentage substance use days among those who resumed use or on change in depressive symptoms; the latter decreased over time only in those who remained abstinent after residential treatment irrespective of condition (B = 0.43, SE = 0.11, 95% confidence interval = 0.22–0.65). Conclusions A behavioral activation group treatment for substance use (LETS ACT) appears to increase the likelihood of abstinence and reduce adverse consequences from substance use up to 12 months post‐treatment.