Integrated Psychological Treatment for Substance Use and Co-Morbid Anxiety or Depression Vs. Treatment for Substance Use Alone. A Systematic Review of the Published Literature
Hesse M
BMC Psychiatry. 2009;9:6
Summary
Although expert opinion currently supports integrated treatment of substance use disorders and comorbid conditions, such as depression or anxiety, no systematic reviews have been previously published. A systematic search of MedLine and PsychInfo identified 9 trials of integrated treatment for depression or anxiety plus substance use disorder, and meta-analyses were performed using random effects models when feasible.
Integrated treatment for depression and substance abuse was associated with significant benefits on percent days abstinent at follow-up. Although differences in retention and symptoms were not significant, trends favored the integrated treatment intervention. Multivariate reporting of outcomes precluded meta-analysis for trials of integrated treatment for anxiety and substance use disorders.
However, several studies of integrated treatment for anxiety and substance use disorders indicated better outcomes in patients receiving substance use treatment only. One possible exception was a single, very small trial in which integrated treatment for comorbid obsessive-compulsive disorder and substance use disorder appeared to have more favorable outcomes than substance use treatment only.
Viewpoint
Despite the apparent promise of integrated psychotherapy for comorbid depression and substance use disorders, there is insufficient empiric evidence to date, and psychotherapeutic treatment for comorbid anxiety and substance use disorders is not supported by available evidence. Limitations of the meta-analysis include small sample sizes in the included studies; methodological and other variations between studies; high attrition rate in 1 study; and insufficient number of studies to conduct more formal analyses of publication bias. Additional research is needed to confirm the findings from studies of integrated treatment for depression and substance use disorders, and to develop new treatment options for comorbid anxiety and substance use disorders.
Abstract