Substance-Related Disorders Clinical Trial
Official title:
Translating Depression Guidelines Into Substance Abuse Treatment
Comorbid depression has been consistently linked to worse outcomes for patients in substance abuse treatment programs. Practice guidelines recommend pharmacotherapy for comorbid depression if symptoms persist after a 4-week "wash-out" period for detoxification (e.g., Veterans Health Administration; American Psychiatric Association). Medications may be considered earlier if a patient has current symptoms and a history of major depressive disorder (MDD) during periods of sobriety. Current efficacy data suggest that antidepressant medication can improve both depression and substance use outcomes among comorbid patients Guideline-concordant use of antidepressant medication for persons with comorbid substance use and depressive disorders, however, is not routine in many VA substance abuse treatment settings.
Background:
Comorbid depression has been consistently linked to worse outcomes for patients in substance
abuse treatment programs. Practice guidelines recommend pharmacotherapy for comorbid
depression if symptoms persist after a 4-week "wash-out" period for detoxification (e.g.,
Veterans Health Administration; American Psychiatric Association). Medications may be
considered earlier if a patient has current symptoms and a history of major depressive
disorder (MDD) during periods of sobriety. Current efficacy data suggest that antidepressant
medication can improve both depression and substance use outcomes among comorbid patients
Guideline-concordant use of antidepressant medication for persons with comorbid substance
use and depressive disorders, however, is not routine in many VA substance abuse treatment
settings.
Objectives:
This study seeks to develop, implement, and test an organizational intervention in VA
substance abuse treatment settings to establish guideline-concordant treatment of comorbid
depression. The intervention will assist "intervention" programs in their own implementation
of a guidelines-based treatment algorithm to improve the recognition of depression and
initiation of pharmacotherapy.
Methods:
Substance abuse treatment programs in the South Central VISN were matched on program
characteristics and current depression management practices (n = 4), and "intervention"
sites were randomly chosen from each pair. Phase 1 (now completed) of the study analyzed the
barriers and facilitators to translation of depression management in participating
facilities, and used these data to inform the development of the translation intervention,
its implementation tools, and the depression algorithm. The translation intervention adopted
in this plan was based on the PRECEDE model of organizational behavior change and included
provider education, use of local champions, feedback of screening data, and patient
education/activation. The depression management algorithm and intervention was developed
with input from programs staff and an Advisory Panel of depression management and
translation experts. Phase 2 of the study implemented and tested the intervention. The
evaluation in examining program- and provider-level outcomes. Program-level outcomes include
feasibility, extent of adoption of the algorithm, and provider/organizational attitudes and
beliefs about the intervention's design and effectiveness. Patient-level outcomes include
depressive symptoms, substance use outcomes, medication adherence, quality of life, and
services use.
Status:
Phase 1 of the study is complete. Phase 2 is near complete.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label
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