Outpatient Programs Mental Depression Cocaine Dependence Treatment

Outpatients With Depression and Cocaine Dependence

Outpatient Programs, Mental Depression, Cocaine Dependence, Treatment

Increasing Treatment Adherance Among Outpatients with Depression and Cocaine Dependence: Results of a Pilot Study

This research study by Dennis C. Daley et.al (1998) was conducted to examine the effect of a modified motivational therapy intervention on outpatient treatment adherence and completion for patients with co morbid depressive disorder and cocaine dependence. This study was located using EBSCOhost, data: academic search premier, field: TI -- title, key words; outpatient, cocaine, dependence.

The significance of this study lies in the finding that an outpatient program combining individual and group motivational therapy sessions holds promise for improving treatment adherence and completion among depressed patients with cocaine dependence. Depression is common among cocaine-dependent patients and poor adherence with outpatient treatment among cocaine-dependent patients is well documented. The majority of these patients drop out within 1 month of treatment. Cocaine-dependent patients treated on an inpatient psychiatric unit for depression who drop out of outpatient treatment before completion of month 1 are at significant risk of re-hospitalization. This study was undertaken to look into strategies to improve these patients' motivation to adhere with outpatient treatment. Motivational interventions have been employed for alcohol use disorders; however, there is a lack of practical data on motivational strategies for depressed cocaine-dependent patients.

This study aimed to investigate whether individual and group motivational therapy sessions would improve adherence to and completion of the initial 30 days of outpatient treatment among depressed cocaine-dependent patients. The researchers hypothesized that patients who received motivational therapy would have better treatment adherence and completion rates than patients who did not.

This was a quantitative study was designed to compare two groups of outpatients similar in age, marital status, education and employment status. The two groups did not differ in previous psychiatric hospitalizations. The treatment group had more Caucasians (45%) than the control group (8%). Recurrent major depression was more common among patients in the treatment group (85%) than among patients in the control group (42%).

The treatment group included 11 subjects consecutively admitted to outpatient care following inpatient treatment. This group was given Motivational therapy, which integrates dual disorders recovery counseling with motivational therapy. This is an integrated treatment approach addressing substance use and psychiatric issues and aims to help patients anticipate and cope with external situations or internal problems that contribute to poor adherence. All patients were eligible to attend five individual and four group sessions during month 1. The control group included the previous 12 patients consecutively admitted to outpatient care and received treatment-as-usual. Treatment-as-usual combined pharmacotherapy with supportive therapy, provided psycho-education on dual disorders, and focused on encouraging patients to attend Narcotics Anonymous and Alcoholics Anonymous meetings in the community.

Primary outcome variables were 30-day treatment completion rates and mean number of sessions attended. Secondary outcome measures were 90-day treatment completion rates and psychiatric re-hospitalization rates within 1 year of entering outpatient treatment. The Beck Depression Inventory was administered at outpatient visits during month 1.

The authors reported that results indicated that motivational therapy patients were more likely to complete 30 and 90 days of outpatient treatment, attend more treatment sessions, and be re-hospitalized less often than treatment-as-usual patients. In addition, nine of the 11 motivational therapy patients (82%) reported continuous sobriety, and their mean Beck Depression Inventory score had decreased over 20 points at the end of the first 30 days in outpatient treatment.