Motivational Interviewing to Reduce Substance Use Among Depression Patients
Motivational Interviewing to Reduce Substance Use Among Depression Patients
The study aims to evaluate the effectiveness of an intervention to reduce alcohol and drug
 use and depression symptoms, improve functional status and promote appropriate health
 services utilization, in a sample of 300 adults seeking treatment for depression who also
 report hazardous drinking or drug use with depression.
This study addresses important questions regarding how to identify and treat patients in
 Psychiatry who present for services with alcohol or drug use that may exacerbate depression.
 The investigators propose a study of Brief Motivational Intervention (BMI) to reduce drug and
 alcohol use among patients with depression, and to enhance engagement with a Kaiser Chemical
 Dependency Recovery Program (CDRP) as needed. Patients with depression who use drugs or
 alcohol even at sub-diagnostic levels are at high risk for escalation of substance problems.
 BMI is an innovative, evidence-based approach that could decrease drug and alcohol use and
 improve outcomes. But it has not been tested among depression patients. This study sample
 will include 300 outpatients in treatment for depression in Kaiser Permanente Northern
 California Hayward/Fremont Psychiatry. Inclusion criteria are based on drug use (any illicit
 drug use and non-prescribed use of prescription drugs) and hazardous drinking (i.e., ≥ 3
 drinks in a day for women and ≥ 4 drinks in a day for men), and moderate to severe depression
 symptoms at intake. Three hundred patients will be randomized to receive one in-person BMI
 session and two telephone BMI sessions within 6 weeks of intake (intervention) or a brochure
 on risks of drug and alcohol use (control). The investigators anticipate that the
 intervention will be effective in reducing frequency of drug use and hazardous drinking at
 3-, 6-, and 12-month telephone follow-up interviews; improving mood and functional outcomes;
 increasing depression treatment retention (number of psychiatry visits, based on Healthcare
 Effectiveness Data and Information Set (HEDIS) standards); and facilitating patient
 initiation of chemical dependency program treatment if needed, and will be cost effective.
 For the improvement of patient care, it will also yield important information on integrating
 alcohol and drug intervention in Psychiatry and how best to help patients access specialty
 CDRP services when needed.
Inclusion Criteria:

 -  Hazardous drinking (i.e., ≥ 3 drinks in a day for women and ≥ 4 drinks in a day for
 men)

 -  Drug use (including any illicit drug use and non-prescribed use of prescription drugs
 in the prior 30 days)

 -  Moderate or greater symptoms of depression based on a score of ≥ 5 on the Patient
 Health Questionnaire (PHQ-9)

 Exclusion Criteria:

 -  Current mania or psychosis