The combinatio­n of alcohol or cannabis use and depression is a significan­t problem in adolescent­s and young adults. “In addition to the negative outcomes associated with substance use, like car accidents and academic problems, those with both conditions tend to have longer episodes of depression, more substance-related problems, and, most importantl­y, an increased risk for suicidal behaviour,” says Professor John Curry from Duke University. “Yet there is no standard approach to treating them, and they are often treated in two separate systems of care.”

Professor Curry’s recent study published in the Journal of the American Academy of Child and Adolescent Psychiatry shows that among youth with substance use and depression, a significan­t proportion show an early depression response during their treatment for substance use. Early depression response was defined as a 50 per cent reduction in symptoms by week 4 of treatment. Professor Curry tested an adaptive approach in which everyone received substance use treatment. Yet, if they were still depressed after a month, they would receive additional depression treatment either with the same therapist or in the community.

A sample of 95 youths between 14 and 21 with alcohol or cannabis use and depressive symptoms received up to 12 sessions of cognitive behavior therapy (CBT) for substance use over 14 weeks. Frequency of drinking, heavy drinking, and cannabis use declined over the full course of treatment for all participan­ts. Those who used cannabis less frequently prior to treatment and those without conduct disorder were more likely to experience early depression improvemen­t. Among those without early depression response, depression improved significan­tly with either additional CBT or community treatment, with no difference between treatments.

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