Combined treatment best for alcohol and depression
Landmark research by one of Australia’s leading clinical psychologists is poised to reshape treatment for people suffering the combined effects of substance abuse and depression.
Three major trials led by Professor Amanda Baker have confirmed that people suffering from alcohol or drug abuse problems combined with depression recover better with integrated treatment for both conditions rather than singlefocus treatments.
As chief investigator in what were the world’s largest trials of their kind, Baker noted that all but a handful of previous investigations had screened out subjects with comorbid conditions - that is the co-existence of two or more diseases or health disorders.
"Up to 80 per cent of people in treatment for problems with alcohol or other drugs also report mental health problems," Baker said. "But often health care providers make the assumption that it is too difficult to treat people with mental health disorders in addition to drug or alcohol problems, or they don’t have the knowledge and skills.
"For example, clinicians have frequently told patients to address their drug or alcohol problems first before treating depression or vice-versa. Patients were finding themselves caught in the gaps between service providers.
"In that environment, people are often crying out for treatment and not receiving it. Our research looked at treating both problems at the same time."
The most recent study involved 248 Newcastle and Brisbane residents suffering from depression and alcohol problems. After being assessed, all subjects received a brief intervention that included self-help material. Participants were then assigned to one of three groups, each undertaking a different treatment program.
The researchers found that where integrated treatment was available, it could be the treatment of choice for both men and women. However, there was an intriguing difference in how men and women responded to singlefocus treatments. Men with drinking problems experienced benefits from treatment focused solely on alcohol but women were more likely to reduce their drinking if treatment addressed depression rather than alcohol.
"The practical implication," Baker said, "is that if a man went into a traditional drug and alcohol centre, the counsellors could do a brief intervention for depression and then have a standard alcohol-focused intervention and he would do well. If a woman came in, she would need her depression addressed first because if you just tried to address her alcohol issues, her drinking would remain problematic."
An earlier study by Baker’s team compared computerbased to face-to-face integrated treatments of people suffering depression plus alcohol or cannabis abuse. She said the results, published in the journal Addiction, had important implications for the delivery of intervention services, particularly outside major cities and regional centres.
The study found computer therapy and the face-to-face integrated therapy were equally successful, which means that in rural areas or locations where psychologists are scarce, people can receive effective treatment online.
"My team’s studies are groundbreaking and there is great potential for the delivery of treatment services in Australia and around the world to be radically improved based on what we have found," Baker said.
Baker and several fellow researchers at the University’s Priority Research Centre for Brain and Mental Health Research have had their work in developing world-first treatments recognised, winning the 2009 National Excellence in Research National Drug and Alcohol Award.
The Priority Research Centre for Brain and Mental Health Research draws on expertise across a diversity of scientific and clinical disciplines. In addition to Baker’s work in clinical interventions, the Centre supports research into schizophrenia, stroke, pain and sensory dysfunction, and emerging programs investigating developmental trauma, suicide prevention and personality disorders.
A Professor of Clinical Psychology and a National Health and Medical Research Council Senior Research Fellow, Professor Baker’s research is supported by the Hunter Medical Research Institute (HMRI) and PULSE.