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Lifetime Diagnosis of Major Depression as a Multivariate Predictor of Treatment Outcome for Inpatients with Substance Use Disorders from Abstinence-Based Programs

  • Published:
Annals of Clinical Psychiatry

Abstract

A multisite, longitudinal study of patients undergoing inpatient alcohol and drug dependence treatment was conducted in private inpatient facilities, consisting of 4339 subjects from 38 independent programs enrolled in a national addiction treatment outcomes registry. Structured interviews were conducted upon admission, including documentation of current alcohol/drug disorder (DSM-III-R) and lifetime diagnosis of major depressive syndrome; structured interviews were conducted prospectively at 6- and 12-month follow-up periods. The prevalence rate of lifetime diagnosis of major depression in the sample was 39%. Comorbidity varied according to gender and substance of choice. Lifetime depressive symptoms did not correlate with differential length-of-stay, treatment completion, or follow-up consent and, at best, were very weakly associated with follow-up contact. Patients diagnosed with lifetime depression showed the same frequency of participation in posttreatment continuing care: they also showed statistically significant reductions in job absenteeism, inpatient hospitalizations, and arrest rates pre- vs. posttreatment comparable to those of patients without lifetime depression diagnosis. Lifetime major depressive syndrome was not a predictor of outcome in response to abstinence-based treatment. Involvement in posttreatment continuing care accounted for far greater outcome variance. Posttreatment vs. pretreatment factors may be more decisive in influencing risk for relapse.

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REFERENCES

  1. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK: Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264(19):2511–2518

    Google Scholar 

  2. Helzer JE, Pryzbeck TR: The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. J Stud Alcohol 1988; 49:219–224

    Google Scholar 

  3. Miller NS, Mahler JC, Belkin BM, Gold MS: Psychiatric diagnosis in alcohol and drug dependence. Ann Clin Psychiatry 1991; 3(1):79–89

    Google Scholar 

  4. Schuckit MA: Alcoholism and other psychiatric disorders. Hosp Commun Psychiatry 1983; 34:1022–1027

    Google Scholar 

  5. Weissman MM, Sholomskas D, Poltenger M, Prusoff BA, Locke BZ: Assessing depressive symptoms in five psychiatric populations: A validation study. Am J Epidemiol 1977; 106:203–214

    Google Scholar 

  6. Brady K, Casto RB, Lydiard RB, Malcolm R, Arana G: Substance abuse in an inpatient sample. Am J Drug Alcohol Abuse 1991; 17:389–398

    Google Scholar 

  7. Dackis CA, Gold MS, Pottash ALC, Sweeney DR: Evaluating depression in alcoholics. Psychiatry Res 1986; 17:105–109

    Google Scholar 

  8. Dorus W, Kennedy J, Gibbons RD, Ravi S: Symptoms and diagnosis for depression in alcoholics. Alcohol Clin Exp Res 1987; 11:150–154

    Google Scholar 

  9. Blankfield A: Psychiatric symptoms in alcohol dependence: Diagnostic and treatment implications. J Subst Abuse Treat 1986; 3:275–278

    Google Scholar 

  10. McClelland AT, Luborsky L, Woody GE: Predicting response to alcohol and drug abuse treatments: Role of psychiatric severity. Arch Gen Psychiatry 1983; 40:620–625

    Google Scholar 

  11. Mueller TI, Lavori PW, Keller MB, Swartz A, Warshaw M, Hasin D, Coryell W, Endicott J, Rice J, Akiskal H: Prognostic effect of the variable course of alcoholism on the 10-year course of depression. Am J Psychiatry 1994; 151:701–706

    Google Scholar 

  12. Schuckit MA: Clinical implications of primary diagnostic groups among alcoholics. Arch Gen Psychiatry 1985; 42:1043–1049

    Google Scholar 

  13. Woodruff RA, Guze SB, Clayton PJ, Carr D: Alcoholism and depression. Arch Gen Psychiatry 1973; 28:97–100

    Google Scholar 

  14. Powell BJ, Penick EC, Nickel EJ, Liskow BI, Riesenmy KD, Campion SL, Brown EF: One year outcomes of male alcoholics subtyped by co-existing psychiatric syndromes. Alcohol Clin Exp Res 1992; 16:131–138

    Google Scholar 

  15. O'Sullivan K, Rynne C, O'Sullivan S: A follow-up study on alcoholics with and without co-existing affective disorder. Br J Psychiatry 1988; 152:813–819

    Google Scholar 

  16. Hasin DS, Endicott J, Keller MB: RDC alcoholism in patients with major affective syndromes: Two-year course. Am J Psychiatry 1989; 146:318–323

    Google Scholar 

  17. Hasin DS, Endicott J, Keller MB: Alcohol problems in psychiatric patients: 5-year course. Compr Psychiatry 1991; 32(4):303–316

    Google Scholar 

  18. Rounsaville BJ, Dolnsky ZS, Babor TF, Meyer RE: Psychopathology as a predictor of treatment outcome in alcoholics. Arch Gen Psychiatry 1987; 44:505–513

    Google Scholar 

  19. Tamerin JS, Mendelson JH: The psychodynamics of chronic inebriation. Observations of alcoholics during the process of drinking in an experimental group setting. Am J Psychiatry 1969; 125:886–899

    Google Scholar 

  20. Longabaugh R: Longitudinal outcome studies. In: Rose R, Barrett J, eds. Alcoholism: Origins and Outcome. New York: Raven Press; 1988:267–280

    Google Scholar 

  21. Goodwin DW: Alcoholism: who gets better and who does not. In: Rose R, Barrett J, eds. Alcoholism: Origins and Outcome. New York: Raven Press; 1988:281–292

    Google Scholar 

  22. Miller NS, Hoffmann NG: Addictions treatment outcomes. In: Miller NS ed. Treatment of the Addictions: Applications of Outcome Research for Clinical Management. New York: Haworth Press, 1995:41–55.

    Google Scholar 

  23. Keso L, Salaspuro M: Inpatient treatment of employed alcoholics: A randomized clinical trial on Hazelden-type and traditional treatment. Alcohol Clin Exp Res 1990; 14(4):584–589

    Google Scholar 

  24. Walsh DC, Hingson RW, Merrigan DM, Levenson SM, Cupples A, Heeren T, Coffman GA, Becker CA, Barker TA, Hamilton SK, McGuire TG, Kelly CA: A randomized trial of treatment options for alcohol-abusing workers. N Engl J Med 1991; 325(11):775–782

    Google Scholar 

  25. Hoffmann NG, Miller NS: Treatment outcomes for abstinence based programs. Psychiatr Ann 1992; 22(8):402–408

    Google Scholar 

  26. Harrison PA, Hoffmann NG, Streed SG: Drug and alcohol addiction treatment outcome. In: Miller NS, ed. Comprehensive Handbook of Drug and Alcohol Addiction. New York: Marcel Dekker; 1991:1163–1200

    Google Scholar 

  27. Chappel JN: Long-term recovery from alcoholism. Psychiatr Clin North Am 1993; 16(1):430–435

    Google Scholar 

  28. Roman PM: Inpatient alcohol and drug treatment: A national study of treatment centers. Executive Report. NIAAA. Athens: Institute for Behavioral Research, University of Georgia; 1989:1–22.

    Google Scholar 

  29. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. rev. APA: Washington, DC., 1987

    Google Scholar 

  30. Hoffmann NG, Ninonuevo FG: Concurrent validation of substance abusers' self-reports against collateral information: Percent agreement vs. Kappa vs. Yule's Y. Alcohol Clin Exp Res 1994; 18:231–238

    Google Scholar 

  31. Babor TF, Stephens RS, Marlatt GA: Verbal report methods in clinical research on alcoholism: Response bias and its minimization. J Stud Alcohol 1987; 48:410–424

    Google Scholar 

  32. Polich JM: The validity of self-reports in alcoholism research. Addict Behav 1982; 7:123–132

    Google Scholar 

  33. Hesselbrock M, Babor TF, Hesselbrock V, Meyer RE, Workman K: “Never believe an alcoholic?” On the validity of self-report measures of alcohol dependence and related constructs. Int J Addict 1983; 18:593–609

    Google Scholar 

  34. Cohen J: Statistical Power Analysis for the Behavioral Sciences, rev. ed. New York: Academic Press; 1977

    Google Scholar 

  35. Hays WL: Statistics Thirded. New York: Holt, Rinehart & Winston; 1981

    Google Scholar 

  36. Hesselbrock MN: Gender comparison of antisocial personality disorder and depression in alcoholism. J Subst Abuse 1991; 3:205–219

    Google Scholar 

  37. Miller NS, Millman RB, Keskinen S: Outcome at six and twelve months postinpatient treatment for cocaine and alcohol dependence. Adv Alcohol Subst Abuse 1990; 9(3/4):101–120

    Google Scholar 

  38. Hoffmann NG, Harrison PA: CATOR Report: Treatment Outcome—Adult Inpatients Two Years Later. St. Paul, MN: Ramsey Clinic; 1988

    Google Scholar 

  39. Vaillant GE: The Natural History of Alcoholism. Boston, MA: Harvard University Press/Cambridge University Press; 1983

    Google Scholar 

  40. Ries RK, Samson H: Substance abuse among inpatient psychiatric patients. Subst Abuse 1987; 8:28–34

    Google Scholar 

  41. Group for the Advancement of Psychiatry, Committee on Alcoholism and the Addictions: Substance abuse disorders: A psychiatric priority. Am J Psychiatry 1991; 148(10):1291–1300

    Google Scholar 

  42. Khantzian ES: The self medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. Am J Psychiatry 1986; 142:1259–1264

    Google Scholar 

  43. Holder H, Longabaugh R, Miller WR, Rubonis AV: The cost effectiveness of treatment for alcoholism: A first approximation. J Stud Alcohol 1991; 6:517–540

    Google Scholar 

  44. Hunt WA, Barnett LW, Branch LB: Relapse rates in addiction programs. J Clin Psychol 1971; 27:455–456

    Google Scholar 

  45. Aneshensel CS, Huba GJ: Depression, alcohol use, and smoking over one year: A four-wave longitudinal causal model. J Abnorm Psychol 1983; 92:134–150

    Google Scholar 

  46. McLellan AT, Woody GE, O'Brien CP: Development of psychiatric illness in drug abusers. N Engl J Med 1979; 301:1310–1314

    Google Scholar 

  47. Miller NS: Pharmacological management of major comorbid psychiatric disorders in drug and alcohol addictions. Psychiatr Ann 25(10):621–627, 1995.

    Google Scholar 

  48. Mayfield DG, Allen D: Alcohol and affect: A psychopharmacological study. Am J Psychiatry 1967; 123:1346–1351

    Google Scholar 

  49. Kosten TR, Kleber HD: Differential diagnosis of psychiatric comorbidity in substance abusers. J Subst Abuse Treat 1988; 5:201–206

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, The University of Illinois at Chicago, Chicago, Illinois

    Norman S. Miller & Boris M. Astrachan

  2. Center for Alcohol and Addiction Studies, Brown University, USA

    Norman G. Hoffmann

  3. New Standards, Inc., St. Paul, Minnesota

    Fred Ninonuevo

Authors
  1. Norman S. Miller
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  2. Norman G. Hoffmann
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  3. Fred Ninonuevo
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  4. Boris M. Astrachan
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Miller, N.S., Hoffmann, N.G., Ninonuevo, F. et al. Lifetime Diagnosis of Major Depression as a Multivariate Predictor of Treatment Outcome for Inpatients with Substance Use Disorders from Abstinence-Based Programs. Ann Clin Psychiatry 9, 127–137 (1997). https://doi.org/10.1023/A:1026269706001

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