• Katherine E Watkins, Sarah B Hunter, Kimberly A Hepner, Susan M Paddock, Erin de la Cruz, Annie J Zhou, and Jim Gilmore.
• MSHS, RAND Corporation, Santa Monica, CA 90401-2138, USA. kwatkins@rand.org
• Arch. Gen. Psychiatry. 2011 Jun 1; 68 (6): 577-84.

ContextAlthough depression frequently co-occurs with substance abuse, few individuals entering substance abuse treatment have access to effective depression treatment.ObjectiveThe Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study is a community-based effectiveness trial that compared residential substance abuse treatment with residential treatment plus group cognitive behavioral therapy for depression delivered by substance abuse treatment counselors. We hypothesized that intervention clients would have improved depression and substance use outcomes compared with those of clients receiving usual care.DesignA nonrandomized controlled trial using a quasi-experimental intent-to-treat design in which 4 sites were assigned to alternate between the intervention and usual care conditions every 4 months for 2½ years.SettingFour treatment programs in Los Angeles County.ParticipantsWe screened 1262 clients for persistent depressive symptoms (Beck Depression Inventory-II score >17). We assigned 299 clients to receive either usual care (n = 159) or usual care plus the intervention (n = 140). Follow-up rates at 3 and 6 months after the baseline interview were 88.1% and 86.2%, respectively, for usual care and 85.7% and 85.0%, respectively, for the intervention group.InterventionSixteen 2-hour group sessions of cognitive behavioral therapy for depression.Main Outcome MeasuresChange in depression symptoms, mental health functioning, and days of alcohol and problem substance use.ResultsIntervention clients reported significantly fewer depressive symptoms (P < .001 at 3 and 6 months) and had improved mental health functioning (P < .001 at 3 months and P < .01 at 6 months). At 6 months, intervention clients reported fewer drinking days (P < .05) and fewer days of problem substance use (P < .05) on days available.ConclusionsProviding group cognitive behavioral therapy for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes. These results provide support for a new model of integrated care.Trial Registrationclinicaltrials.gov Identifier: NCT01191788.

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