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Mediational relations between 12‐ S tep attendance, depression and substance use in patients with comorbid substance dependence and major depression
Author(s) -
Worley Matthew J.,
Tate Susan R.,
Brown Sandra A.
Publication year - 2012
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/j.1360-0443.2012.03943.x
Subject(s) - depression (economics) , psychiatry , attendance , major depressive disorder , dual diagnosis , population , substance dependence , substance abuse , medicine , randomized controlled trial , clinical psychology , comorbidity , psychology , mental health , stimulant , cognition , economics , macroeconomics , economic growth , environmental health
Aims Among patients with substance dependence and comorbid major depressive disorder ( MDD ) receiving treatment in a controlled trial, we examined if group differences in depression were mediated by 12‐Step involvement, and if the effects of 12‐Step involvement on future alcohol and drug use were mediated by reductions in depression. Design Controlled trial of Twelve‐Step facilitation ( TSF ) and integrated cognitive–behavioral therapy ( ICBT ), delivered in out‐patient groups for 6 months with adjunct pharmacotherapy. Setting Out‐patient dual diagnosis clinic in Veteran's Affairs Healthcare Center. Participants Veterans ( n = 209) diagnosed with alcohol, stimulant or marijuana dependence and substance‐independent MDD . Measurements Twelve‐Step attendance and affiliation, depression severity, percentage of days drinking and percentage of days using drugs assessed at baseline and months 3, 6 and 9. Findings In multi‐level analyses greater 12‐Step meeting attendance predicted lower depression and mediated the superior depression outcomes of the TSF group, explaining 24.3% of the group difference in depression. Independent of treatment group, lower depression severity predicted lower future alcohol use and mediated the effects of 12‐Step meetings, explaining 15.7% of their effects on future drinking. Controlled, lagged models indicated these effects were not confounded by current substance use, suggesting that depression had unique associations with 12‐Step meeting attendance and future drinking. Conclusions For patients with substance dependence and major depressive disorder, attendance at 12‐Step meetings is associated with mental health benefits that extend beyond substance use, and reduced depression could be a key mechanism whereby 12‐Step meetings reduce future drinking in this population.