Effectiveness of a Brief Behavioral Treatment for Inner-City Illicit Drug Users With Elevated Depressive Symptoms: The Life Enhancement Treatment for Substance Use (LETS Act!)

Stacey B. Daughters, Ph.D.; Ashley R. Braun, B.A.; Marsha N. Sargeant, B.A.; Elizabeth K. Reynolds, B.A.; Derek R. Hopko, Ph.D.; Carlos Blanco, M.D., Ph.D.; and C. W. Lejuez, Ph.D.

Objective: Depression is highly prevalent among illicit drug users, and this co-occurrence is associated with poorer treatment outcomes. However, there has been limited empirical attention toward developing and assessing behavioral interventions for depression among illicit drug users. The objective of the current study was to test the efficacy of integrating a brief behavioral intervention for depression into standard inpatient substance abuse treatment.

Method: Forty-four adult illicit drug users with mild to moderate depressive symptoms (Beck Depression Inventory-II [BDI-II] score >= 10) who were receiving inpatient substance abuse treatment were randomly assigned to either treatment as usual (TAU) alone or TAU plus brief behavioral therapy for depression (i.e., Life Enhancement Treatment for Substance Use [LETS Act!]). Patients were assessed at baseline for DSM-IV psychiatric diagnoses, depressive symptoms (Hamilton Rating Scale for Depression, BDI-II), anxiety symptoms (Beck Anxiety Inventory), and enjoyment and reward value of activities (Environmental Reward Observation Scale). Patients were again assessed at posttreatment and at 2-week follow-up. Treatment satisfaction and attrition rates also were assessed at posttreatment. Data were collected from November 2005 to March 2006.

Results: Patients who received the LETS Act! intervention (N = 22) evidenced significantly greater improvements than the TAU group (N = 22) in severity of depression, anxiety symptoms, and enjoyment and reward value of activities at posttreatment and in depressive symptoms at 2-week follow-up. The LETS Act! group also reported significantly higher treatment satisfaction ratings.

Conclusions: This study supports the efficacy of LETS Act! in treating depressive symptoms and improving the enjoyment and reward value of activities among illicit drug users currently receiving inpatient substance use treatment. Data also indicate the intervention may help prevent treatment attrition. LETS Act! appears to be a feasible and parsimonious intervention to improve the treatment of depression and overall quality of care within inpatient substance abuse treatment settings.

(J Clin Psychiatry 2008;69:122-129; online ahead of print January 3, 2008)

Received Oct. 16, 2006; accepted April 16, 2007. From the Center for Addictions, Personality, and Emotion Research, Department of Psychology, University of Maryland, College Park (Drs. Daughters and Lejuez and Mss. Braun, Sargeant, and Reynolds); Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, N.Y. (Dr. Blanco); and Department of Psychology, University of Tennessee, Knoxville (Dr. Hopko).

This work was supported by an internal grant from the Center for Addictions, Personality, and Emotion Research (CAPER) at the University of Maryland, College Park and National Institutes of Health (NIH) grant numbered DA00482.

We would like to thank Major Douglas Browning, M.S.W.; Larry Williamson, B.A.; Walter Askew, M.S.; A. J. Horowitz, M.S.W.; Pinque Alston, B.A., B.S.; and Michelle Williams at the Salvation Army Harbor Light Center for their help with patient recruitment.

Dr. Blanco has received grant/research support from Somaxon. Drs. Daughters, Hopko, and Lejuez and Mss. Braun, Sargeant, and Reynolds report no other financial affiliations relevant to the subject of this article.

Corresponding author and reprints: Stacey B. Daughters, Ph.D., Center for Addictions, Personality, and Emotion Research, Department of Psychology, University of Maryland, College Park, MD 20742 (e-mail: sdaughters@psyc.umd.edu).