Researchers at UC Santa Barbara have been awarded a four-year, $1.3 million grant from the National Institute for Drug Abuse to begin testing a pair of promising new treatments for sufferers of depression who abuse cocaine or methamphetamine.
The new methods, one based on patient life review and reflection exercises and the other on individualized care using a variety of therapeutic techniques, will be compared to a more established and successful treatment for chemical abuse and depression, cognitive therapy.
"This is a very exciting development. We've discussed these approaches and worked on some of the theory for years. The idea is to bridge theoretical models and devise treatments tailored to individuals, and to test them against standard treatments," said Larry E. Beutler, principal investigator of the study and a professor of psychology and education at UCSB.
Developed by Beutler and Cornell University's J.N. Clarkan, prescriptive therapy involves combining techniques from a variety of established treatments according to the needs of each patient. Cognitive narrative therapy, developed by Oscar Concalves at the University of Ninho in Portugal along with UCSB researchers Lynnette Glassman and Robert Romanelli, encourages self-reflectionthrough newly developed techniques for helping people put their lives in perspective.
Cognitive therapy, by contrast, seeks to change people's beliefs and assumptions about themselves, drug use, and relationships in order to help them make changes in their behavior. The approach is uniformly applied irrespective of individual circumstances or inclinations.
"In narrative therapy patients receive therapy geared toward a certain kind of individual. In other words, they receive treatment based on the therapeutic profile group they best fit. Each profile group has signature characteristics requiring different treatment approaches," said Beutler.
"Prescriptive therapy is different in that patients are assessed and then receive a mix of cognitive therapy and life review therapy depending on their particular situation. So each patient is treated according to their problem and their individual characteristics."
To weigh the relative strengths of prescriptive and cognitive narrative therapies against those of standard cognitive therapy, Beutler and study director T.M. Harwood have assembled 12 area psychologists and family counselors and are recruiting about 60 test subjects who suffer from depression and substance abuse problems. Therapists and patients will be randomly divided among the three treatment approaches and participate in upwards of 20 counseling sessions.
"A systematic statistical comparison between the treatments is just not possible with such a small sample. But we're still looking at outcomes during and after treatment: Are they staying off drugs, how is their depression, are they functioning well? If they need additional treatment we will help them find it," Beutler said.
"Our main purpose is to determine if we can train therapists to do these therapies. We know we can train people to do cognitive therapy, but we don't know about the other two, particularly prescriptive therapy. Psychotherapists and drug therapists aren't typically trained to bridge across theoretical viewpoints."
The NIDA grant will cover the first of what is hoped will be four phases of related research. Study results will also likely yield a series of research articles and be incorporated into a guidebook on depression that Beutler is co-authoring.
Noting that approximately two-thirds of the patients who enter therapy for drug abuse and depression return to some drug use regardless of the treatment they received, Beutler says the ultimate goal is to develop a range of options that together will prove effective in the treatment of the vast majority of people.
"In the world that we want science to play a part of, we will be able to---and this is obviously idealistic and unrealistic---find ways of helping everyone. I don't expect to see it in my lifetime, but that's the idea," he said.