Dr Leanne Hides
Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne
beyondblue Victorian Centre of Excellence
Project completion year
This study tested the effectiveness of a new model of care – Brief Cognitive Behavioural Skill (BCBS) intervention – for young people with co-occurring depression/anxiety and substance misuse. Participants were 97 young people aged 15 to 25, each with a moderate level of psychological distress and concurrent risky alcohol/drug use.
The BCBS intervention involved motivational interviews, coping skills training (cognitive, behavioural) and relapse prevention. Sixty-nine participants received BCBS intervention for 12 weeks, while the other 28 received standard care for substance use. Random allocation of participants to groups was not possible due to procedural issues – allocation was dependent on the availability of case managers. As a result, there was an uneven number between the two groups.
The study used a range of measures including clinical (Kessler 10), substance use (Alcohol Use Disorders Identification Test) and functioning (Social and Occupational Functioning Scale), with data collected at baseline, 12 and 24 weeks.
Both groups had a reduction in the severity of symptoms and anxiety and depression from baseline to 12 and 24 weeks. However, there were no significant differences between the two groups.
Cannabis and other drug use decreased from baseline to 12 and 24 weeks in both groups. Alcohol use decreased in the BCBS group and increased in the standard care group at weeks 12 and 24. There were no significant treatment group differences in the amount of alcohol used per drinking day, the frequency of other drug use (other than alcohol or cannabis) or the severity of drug or alcohol use.
This study showed no differences in outcomes between young people receiving the BCBS intervention and those receiving standard care. However, it is difficult to make firm conclusions as randomised participant allocation could not be used and the BCBS group had significantly more severe mental health symptoms at baseline.
The results are consistent with previous studies which also found few treatment group effects even though there were improvements for mental health and substance use outcomes. The coping skills component of the treatment is an important factor and is most likely responsible for the enduring effects of Cognitive Behaviour Therapy (CBT).
Implications for policy, practice and further research
This project demonstrated the feasibility of:
- implementing mental health screening in youth alcohol and other drug (AOD) services
- embedding co-morbidity clinicians in youth AOD services
- providing integrated CBT for co-occurring depression/anxiety and substance misuse in youth AOD services
- conducting a clinical trial of the effectiveness of a BCBS intervention compared to standard care in a real world clinical setting.
More thorough investigation of the efficacy of BCBS is, however, required before any changes to policy and practice can be implemented.