Abstract
Many clients in publicly funded substance abuse treatment programs suffer from depression yet lack access to effective mental health treatment. This study sought to examine whether addiction counselors could be effectively trained to deliver group CBT for depression and to ascertain client perceptions of the treatment. Five counselors were trained in the therapy and treated 113 clients with depression symptoms. Counselors demonstrated high fidelity to the therapy and client perceptions of the therapy were positive. Our results suggest that training addiction counselors to deliver group CBT for depression is a promising integrated treatment approach for co-occurring depression and substance disorders.
Similar content being viewed by others
References
Barber, J. P., Liese, B., & Abrams, M. J. (2003). Development of the Cognitive Therapy Adherence and Competence Scale. Psychotherapy Research, 13(2), 205–221.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
Beidas, R. S., & Kendall, P. C. (2010). Training clinicians in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science & Practice, 17, 1–30.
Bright, J. I., Baker, K. D., & Neimeyer, R. A. (1999). Professional and paraprofessional group treatments for depression: A comparison of cognitive-behavioral and mutual support interventions. Journal of Consulting and Clinical Psychology, 67(4), 491–501.
Browne, W. J., Goldstein, H., & Rasbash, J. (2001). Multiple membership multiple classification (MMMC) models. Statistical Modeling, 1(2), 103–124.
Busseri, M. A., & Tyler, J. D. (2003). Interchangeability of the Working Alliance Inventory and Working Alliance Inventory, Short Form. Psychological Assessment, 15(2), 193–197.
Byrt, T., Bishop, J., & Carlin, J. (1993). Bias, prevalence and kappa. Journal of Clinical Epidemiology, 46, 423–429.
Carey, K. (2000). A multilevel modeling approach to analysis of patient costs under managed care. Health Economics, 9, 435–446.
Clark, H. W., Power, A. K., Le Fauve, C. E., & Lopez, E. I. (2008). Policy and practice implications of epidemiological surveys on co-occurring mental and substance use disorders. Journal of Substance Abuse Treatment, 34(1), 3–13.
Dawson, D. A., Grant, B. F., Stinson, F. S., & Zhou, Y. (2005). Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the U.S. general population. Alcoholism, Clinical and Experimental Research, 29(5), 844–854.
Dennis, M. L., White, M. K., Titus, J. C., & Unsicker, J. I. (2006). Short Blessed Scale Exam. Global appraisal of individual needs: Trainer’s training manual and resources (July 2006 version). Bloomington, IL: Chestnut Health Systems.
Druss, B. G., & Rosenheck, R. A. (1999). Patterns of health care costs associated with depression and substance abuse in a national sample. Psychiatric Services, 50, 214–218.
Friedmann, P. D., Alexander, J. A., & D’Aunno, T. A. (1999a). Organizational correlates of access to primary care and mental health services in drug abuse treatment units. Journal of Substance Abuse Treatment, 16(1), 71–80.
Friedmann, P. D., Alexander, J. A., Jin, L., & D’Aunno, T. A. (1999b). On-site primary care and mental health services in outpatient drug abuse treatment units. Journal of Behavioral Health Services and Research, 26(1), 80–94.
Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Compton, W., et al. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61(8), 807–816.
Grella, C. E., & Hser, Y. I. (1997). A county survey of mental health services in drug treatment programs. Psychiatric Services, 48(7), 950–952.
Grella, C. E., & Stein, J. A. (2006). Impact of program services on treatment outcomes of patients with comorbid mental and substance use disorders. Psychiatric Services, 57(7), 1007–1015.
Harris, K. M., & Edlund, M. J. (2005). Use of mental health care and substance abuse treatment among adults with co-occurring disorders. Psychiatric Services, 56(8), 954–959.
Hepner, K. A., Miranda, J. M., Woo, S. M., Watkins, K. E., Lagomasino, I. T., Wiseman, S. H., & Muñoz, R. F. (2011a). Building recovery by improving goals, habits, and thoughts (BRIGHT): A group cognitive behavioral therapy for depression in clients with co-occurring alcohol and drug use problems—group leaders manual. Santa Monica, CA: RAND Corporation, TR-977/1-NIAAA. http://www.rand.org/pubs/technical_reports/TR977z1.html.
Hepner, K. A., Stern, S., Paddock, S. M., Hunter, S. B., Osilla, K. C., & Watkins, K. E. (2011b). A fidelity coding guide for a group cognitive behavioral therapy for depression. Santa Monica, CA: RAND Corporation, TR-980-NIDA/NIAAA. http://www.rand.org/pubs/technical_reports/TR980.html.
Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36(2), 223–233.
Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61(4), 561–573.
Jaycox, L. H., Langley, A. K., Stein, B. D., Wong, M., Sharma, P., Scott, M., et al. (2009). Support for students exposed to trauma: A pilot study. School Mental Health, 1(2), 49–60.
Kramer, C. Y. (1956). Extension of multiple range tests to group means with unequal numbers of replications. Biometrics, 12, 309–310.
Landis, J., & Koch, G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174.
McGovern, M. P., Xie, H., Segal, S. R., Siembab, L., & Drake, R. E. (2006). Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers. Journal of Substance Abuse Treatment, 31(3), 267–275.
McLellan, A. T., Carise, D., & Kleber, H. D. (2003). Can the national addiction treatment infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment, 25(2), 117–121.
Miller, W. R., Sorensen, J. L., Selzer, J. A., & Brigham, G. S. (2006). Disseminating evidence-based practices in substance abuse treatment: A review with suggestions. Journal of Substance Abuse Treatment, 31(1), 25–39.
Miranda, J., Chung, J. Y., Green, B. L., Krupnick, J., Siddique, J., Revicki, D. A., et al. (2003). Treating depression in predominantly low-income young minority women: A randomized controlled trial. Journal of the American Medical Association, 290(1), 57–65.
Montgomery, E. C., Kunik, M. E., Wilson, N., Stanley, M. A., & Weiss, B. (2010). Can paraprofessionals deliver cognitive-behavioral therapy to treat anxiety and depressive symptoms? Bulletin of the Menninger Clinic, 74(1), 45–62.
Morgenstern, J., Morgan, T. J., McCrady, B. S., Keller, D. S., & Carroll, K. M. (2001). Manual-guided cognitive-behavioral therapy training: A promising method for disseminating empirically supported substance abuse treatments to the practice community. Psychology of Addictive Behaviors, 15(2), 83–88.
Muñoz, R., Ippen, C., Rao, S., Le, H., & Dwyer, E. (2000). Manual for group cognitive-behavioral therapy of major depression: A reality management approach. San Francisco, CA: Cognitive Behavioral Depression Clinic, San Francisco General Hospital, University of California.
Muñoz, R. F., & Mendelson, T. (2005). Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals. Journal of Consulting and Clinical Psychology, 73(5), 790–799.
Oei, T. P., & Dingle, G. (2008). The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders. Journal of Affective Disorders, 107(1–3), 5–21.
Perepletchikova, F., & Kazdin, A. E. (2005). Treatment Integrity and therapeutic change: Issues and research recommendations. Clinical Psychology: Science and Practice, 12(4), 365–383.
Rakovshik, S., & McManus, G. (2010). Establishing evidence-based training in cognitive behavioral therapy: A review of current empirical findings and theoretical guidance. Clinical Psychology Review, 30, 496–516.
Roche, A. M., Todd, C. L., & O’Connor, J. (2007). Clinical supervision in the alcohol and other drugs field: An imperative or an option? Drug and Alcohol Review, 26(3), 241–249.
Rounsaville, B. J., Carroll, K. M., & Onken, L. S. (2001). A stage model of behavioral therapies research: Getting started and moving on from Stage 1. Clinical Psychology Science and Practice, 8(2), 133–142.
Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F., & Carroll, K. M. (2005). We don’t train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73, 106–115.
Sloan, K., Kivlahan, D., & Saxon, A. (2000). Detecting bipolar disorder among treatment-seeking substance abusers. The American Journal of Drug and Alcohol Abuse, 26(1), 13–23.
Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association, 282(18), 1737–1744.
Thompson, L. W., Gallagher, D., Nies, G., & Epstein, D. (1983). Evaluation of the effectiveness of professionals and nonprofessionals as instructors of “coping with depression” classes for elders. Gerontologist, 23(4), 390–396.
Walters, E., Kessler, R., Nelson, C., & Mroczek, D. (1998). Composite International Diagnostic Interview (CIDI) 2.1. Geneva: World Health Organization (WHO).
Ware, J., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.
Watkins, K. E., Burnam, A., Kung, F.-Y., & Paddock, S. (2001). A national survey of care for persons with co-occurring mental and substance use disorders. Psychiatric Services, 52(8), 1062–1068.
Watkins, K. E., Hunter, S. B., Hepner, K. A., Paddock, S., De La Cruz, E., Zhou, A., et al. (in press). An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment. Archives of General Psychiatry.
Wells, K. B., Sherbourne, C., Schoenbaum, M., Duan, N., Meredith, L., Unutzer, J., et al. (2000). Impact of disseminating quality improvement programs for depression in managed primary care: A randomized controlled trial. Journal of the American Medical Association, 283(2), 212–220.
Wells, K., Sturm, R., & Burnam, M. A. (2001). Healthcare for communities (HCC) psychoticism screener. Healthcare for communities HCC1 questionnaire. http://www.hsrcenter.ucla.edu/research/hcc.shtml.
Acknowledgments
We would like to acknowledge the contributions of Stephanie Woo, Ph.D. (Pepperdine University) and Ricardo Muñoz, Ph.D. (University of California San Francisco, San Francisco General Hospital, San Francisco State University). We would also like to acknowledge Shirley Summers (Behavioral Health Services) and outpatient counselors Conswaila Jackson, Elizabeth Macias, Sabrina Navarette, James B. Thompson, and Pamela Webber-Sandres. This work was supported by a grant from NIAAA (1R01AA014699).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hepner, K.A., Hunter, S.B., Paddock, S.M. et al. Training Addiction Counselors to Implement CBT for Depression. Adm Policy Ment Health 38, 313–323 (2011). https://doi.org/10.1007/s10488-011-0359-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-011-0359-7