Alcoholism and
depression are the right and left hands of a heartbreaking condition that often
includes both. Nearly half of people in treatment for alcohol addiction exhibit co-occurring
depression. And of people treated for major depressive disorder, nearly
40 percent will
struggle with alcoholism at some point in their lives. Not only do these two
challenges tend to happen together, there’s strong evidence they may actually create each other. Depression makes
addiction; addiction makes depression. If you treat one without treating the
other, the challenge that remains can cause relapse of the other – alcoholism
can flare depression, or after addiction treatment, depression can lead to
alcohol relapse.
A study in the journal Addiction
looks at what we know about treating these two disorders together. Specifically,
the article asks how the promising techniques of Cognitive Behavioral Therapy
(CBT) and Motivation Interviewing (MI) stack up against ‘treatment as usual
based’ on 12-Step models. Rather than playing whack-a-mole in which hitting one
head makes the other pop up, can CBT and MI hit these two heads of alcoholism
and depression at once so that neither reoccurs?
Let’s get
right to the results. At the end of treatment, the 1,721 people included in the
CBT/MI study were slightly less depressed and consumed slightly less alcohol
than controls in the treatment-as-usual group.
Of course
that’s good, but the interesting effect showed up a year later. Twelve months
after treatment, the benefits of adding these psychotherapeutic techniques were
even stronger – the effects of CBT/MI lasted whereas the benefit of treatment
as usual tended to evaporate by the 1-year mark.
Also
interesting is the fact that the benefit of CBT/MI on depression showed up
first, followed by influence on alcoholism. The authors write that, “the alcohol outcome may result from
good CBT/MI depression response” meaning that it could be the treatment’s
benefit in lowering depression that allowed people to stay free of addiction.
In other words, removing depression may help formerly depressed and addicted
people stay sober. But this remains theoretical and requires further study.
The
authors write that this longer-lasting effect might be due to “the cognitive
and relapse skills that patients learn during treatment and can still apply
afterwards.”
You’ve
heard the quote “Give a man a fish and you feed him for a day; teach him to
fish and you feed him for a lifetime.” In the context of treating alcoholism
and depression, it seems as if adding the psychotherapeutic techniques of
Cognitive Behavioral Therapy and Motivational Interviewing is the equivalent of
teaching people to fish. In addition to stopping the symptoms while in
treatment, these techniques instill in people the skills they need to stay free
of alcohol and depression into the future.
**
Richard
Taite is founder and CEO of Cliffside Malibu, offering evidence-based,
individualized addiction treatment based on the Stages of Change model. He is
also co-author with Constance Scharff of the book Ending
Addiction for Good.
Image credit: Josep Salvia i Bote via Flickr cc license
