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 one-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.