Major depression in patients with substance use disorders: Relationship to 12-Step self-help involvement and substance use outcomes.

Many patients treated for substance use disorders (SUDs) who become involved in 12-Step self-help groups have improved treatment outcomes. However, due to high rates of psychiatric comorbidity and major depressive disorder (MDD), among SUD patients in particular, concerns have been raised over whether these benefits extend to dual diagnosis patients.

This study examined the influence of comorbid MDD among patients with SUDs on 12-Step self-help group involvement and its relation to treatment outcome. A total of 2,161 male patients were recruited during inpatient SUD treatment, 110 of whom had a comorbid MDD diagnosis (SUD-MDD) and 2,051 without psychiatric comorbidity (SUD-only).

A quasi-experimental, prospective, intact group design was used with assessments completed during treatment, and 1 and 2 years postdischarge.

SUD-MDD patients were initially less socially involved in and derived progressively less benefit from 12-Step groups over time compared to the SUD-only group.

However, substance use outcomes did not differ by diagnostic cohort.

In contrast, despite using substantially more professional outpatient services, the SUDD-MDD cohort continued to suffer significant levels of depression.

It is concluded that treatment providers should allocate more resources to targeting depressive symptoms in SUD-MDD patients.

Furthermore, SUD-MDD patients may not assimilate as readily into, nor benefit as much from, traditional 12-Step self-help groups as non-comorbid patients.

Newer dual-diagnosis-specific self-help groups may be a better fit for these patients.

Research report; Kelly, J.F.; McKellar, J.D.; Moos, R. Major depression in patients with substance use disorders: Relationship to 12-Step self-help involvement and substance use outcomes. Addiction, 98(4):499-508, 2003.