The Impact of Depressive Symptoms on Alcohol and Cigarette Consumption Following Treatment for Alcohol and Nicotine Dependence

This study found moderate and severe depression to be a predictor of drinking relapse, but not tobacco. Odd.

Here’s the abstract and some reactions:

Abstract

Background: Although depression is common among alcohol and tobacco dependent patients, its impact on treatment outcomes is not well established. The purpose of this study was to examine the impact of depressive symptoms on abstinence from tobacco and alcohol after treatment for alcohol dependence and nicotine dependence.

Methods: The Timing of Alcohol and Smoking Cessation Study (TASC) randomized adults receiving intensive alcohol dependence treatment, who were also smokers, to concurrent or delayed smoking cessation treatment. The sample consisted of 462 adults who completed depression and substance use (alcohol and smoking) assessments at treatment entry and 6, 12, and 18 months posttreatment. Longitudinal regression models were used to examine the relationships between depression and subsequent abstinence from alcohol and tobacco after baseline characteristics, including alcohol and smoking histories, were considered.

Results: Depressive symptoms were prospectively related to nonabstinence from alcohol. Depressive symptoms at the previous assessment increased the odds of drinking at the subsequent time point by a factor of 1.67 (95% CI 1.14, 2.43), p

Conclusions: Depression is an important negative predictor of the ability to maintain abstinence from alcohol within the context of intensive alcoholism and smoking treatment. It may be important to include depression-specific interventions for alcohol and tobacco dependent individuals to facilitate successful drinking treatment outcomes.

It does a good job reviewing the mixed literature on the subject:

Several studies have suggested that patients with current or a past history of depression have less positive outcomes from alcohol treatment (Curran and Booth, 1999; Driessen et al., 2001; Hasin et al., 2002; Hodgins et al., 1999; Rounsaville et al., 1987). Others have found no relationship between depression and alcohol treatment outcomes (Burns et al., 2005; Davidson and Blackburn, 1998;Hunter et al., 2000; Miller et al., 1997; Sellman and Joyce, 1996).

Here’s some more detail from the full text:

…the majority of participants who began the study with mild or no depressive symptoms, had no clinically significant depression at the follow-up assessments. However, most participants who entered the study with moderate or severe depression continued to report significant depressive symptomatology throughout the study.

…it is important to note that some of the variation in the existing literature may be related to differences in the way depression has been measured. For example, when we used just baseline depression scores (vs. the longitudinal, lagged model used in the present analyses) and examined their relationships to subsequent alcohol use, depression did not predict alcohol use beyond the 6-month assessment (data not presented).

It also found immediate smoking treatment to be a predictor of drinking:

Consistent with prior analyses (Joseph et al., 2004b), there was a significant effect of smoking treatment timing; those who had concurrent smoking treatment were more likely to drink over time [OR = 1.63, 95%CI (1.08, 2.47), p While it’s presented as consistent with the literature, my impression is that this is very inconsistent with most research on the subject.

It says nothing about the treatment received and also found unemployment at baseline to be a predictor of drinking. To me this suggests the limitations of looking at drinking and mood in a vacuum.

The article seems pretty invested in self-medication for endogenous depression as an explanation for the relationship between alcohol and depression:

Our results suggest that depression is related to difficulty achieving 6 months of alcohol abstinence following treatment for alcohol and nicotine dependence. These findings are consistent with the findings from some, but not all, previous studies. For example, at least 1 study found no evidence that alcohol consumption reliably preceded a depressive episode or that depressive episodes reliably preceded the onset of alcohol relapse (Hodgins et al., 1999). However, several other studies have illustrated links between the remission of depression and alcohol or substance use (Hasin et al., 1996, 2002; Mueller et al., 1994; Sullivan et al., 2005). This fits with the model that negative mood states are precursors of relapse (Marlatt and Gordon, 1985) and the idea that negative reinforcement (drinking to reduce negative mood) may help to maintain drinking behavior. In fact, there is evidence that alcohol dependent subjects are more likely to report that alcohol relieved depressive symptoms than other psychiatric patients (Leibenluft et al., 1993).

Here’s the predictable headline.