Chronic Physical Health Problems Moderate Changes in Depression and Substance Use Among Dual Diagnosed Individuals During and After Treatment

Abstract

Background: Physical illnesses frequently co-occur with depression and substance use disorders and may impact their improvement. Physical illness symptoms may overlap with or exacerbate somatic symptoms of depression. Individuals may use substances to cope with symptoms of physical illness. Objectives: We examined whether chronic physical health problems moderated changes in depression and substance use among dual diagnosed individuals during and in the year following treatment. Methods: Participants were recruited from a Veterans Affairs dual diagnosis outpatient program between March 2000 and November 2007 and were randomized to either Integrated Cognitive-Behavioral Therapy or Twelve-Step Facilitation Therapy. A total of 214 veterans with assessment data for the variables of interest were included in analyses. Participants completed quarterly depression, substance use, and health assessments over an 18 month period. We used linear-mixed effects models to analyze patterns of change for depression and substance use. Results: Individuals with severe chronic health problems and higher intake depression showed slower improvements in both nonsomatic and somatic depression symptoms. Individuals with severe chronic health problems and higher midtreatment substance use showed less improvement in substance use. Conclusions: Assessing and addressing physical health issues during depression and substance use disorder treatment may improve outcomes.

Keywords :

• physical health
• depression
• substance use disorder
• treatment

THE AUTHORS

Ruifeng Cui, B.S., is a research assistant at the Veterans Affairs San Diego Healthcare System. He received his B.S. degree in psychology from the University of California, San Diego. His research interests include depression and substance use among adults, cognitive behavioral therapy interventions, and life stress as a moderator of treatment outcomes.

Susan Tate, Ph.D., is a Clinical Psychologist at the Veterans Affairs San Diego Healthcare System and Associate Professor in the Department of Psychiatry at University of California, San Diego. Her research has focused on clinical interventions for adults with substance use disorders and the role of psychiatric and medical comorbidity in addiction treatment outcomes.

Kevin Cummins, M.Sc., is a statistician in the Departments of Family and Preventive Medicine and Psychiatry and the Technology Coordinator for the NCANDA Consortium, which conducts a longitudinal neuroimaging study of heavy episodic drinking in adolescents. He was awarded Master's degrees, in biology and statistics, at San Diego State University.

Jessica R. Skidmore, Ph.D., is a Clinical Psychology postdoctoral fellow at the University of California, San Diego, funded by an NIAAA training grant through San Diego State University (PI: Ed Riley). Her primary interest is clinical research focused on young adult alcohol use and problems, brief interventions, and the role of co-occurring mental health problems. She has also been involved in research related to behavioral economics, motivational interviewing, and substance treatment for veteran samples.

Sandra A. Brown, Ph.D., is Vice Chancellor for Research and a Distinguished Professor of Psychology and Psychiatry at the University of California, San Diego. Dr. Brown is internationally recognized for her developmentally focused alcohol and drug intervention research. Her primary foci include models of clinical course for substance abuse, psychiatric comorbidity, as well as neurocognitive and psychosocial factors influencing transitions out of alcohol and drug problems. Dr. Brown's research yielded pioneering information on adolescent addiction and the relapse process for youth, as well as long term outcomes for clinical samples of youth who have experienced alcohol and drug problems.

ACKNOWLEDGMENTS

This material is based upon work funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research & Development Merit Review Awards to Sandra A. Brown, Ph.D. and Susan R. Tate, Ph.D. and a NIAAA T32 training grant (5T32AA013525-08) to Jessica R. Skidmore., Ph.D. Address correspondence to Dr. Susan R. Tate, Psychology Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive mc 116B, San Diego, CA 92161; E-mail: [email protected].

GLOSSARY

• Chronic health difficulties: Physical medical conditions that are on-going, continuing for more than 2 weeks (e.g. chronic back pain, arthritis, diabetes) that objectively impact life functioning (impair ability to work, decrease participation in pleasurable activities, negatively impact finances, etc.).

• Nonsomatic depression symptoms: Cognitive and affective symptoms of depressive episodes such as pessimism, indecisiveness, sadness, and crying.

• Somatic depression symptoms: Physical symptoms associated with depressive episodes such as fatigue and changes in sleep and appetite.

• Trajectory: Patterns of change in some variable (e.g. depression, substance use) over time for individuals.

Notice of correction:

Corrections were made to some text citations and the acknowledgments section of this article since its original online publication date of October 7, 2014.