Treatment of comorbid depression and alcohol use disorders in an inpatient setting: comparison of acceptance and commitment therapy versus treatment as usual

Abstract

Depression and alcohol use disorders are the most frequently identified problems with in out patient and inpatient mental health and substance abuse treatment facilities. As a result, the identification of an effective approach for the treatment of these comorbid conditions has become essential. The goal of this study was to compare a treatment, acceptance and commitment therapy (ACT), which sought to weaken experiential avoidance as a potentially common pathogenic process that may help support comorbid disorders to a treatment as usual(TAU) approach. Individuals committed to the Mississippi State Hospital with diagnoses of comorbid depressive and alcohol use disorders were randomly assigned to receive either TAU (n = 12) or ACT (n = 12). They were administered a battery of measures at pretreatment, during treatment ,and prior to discharge, which assessed level of depression and alcohol use and alcohol-related issues as outcome variables, as well as level of experiential avoidance and therapeutic alliance between counselor and participants as process measures. Results indicated that ACT participants required a smaller dose of treatment until they metc riteria for discharge and were significantly less depressed than their counterparts who received TAU. An analysis of the process measures suggested that both a reduction in experiential avoidance as well as enhancement of therapeutic alliance contributed to the differential treatment effect associated with ACT. Implications of the findings for the treatment of comorbid depression and alcohol use disorders, in particular, are discussed as well as those for dealing with co-occurring presenting problems more broadly. Weaknesses and limitations of the current study are discussed with the goal of strengthening future related research.