Technology Enhanced Behavioral Activation Treatment for Substance Use

Comorbid substance use disorder (SUD) and depression is highly prevalent and associated with
elevated rates of post treatment relapse to substance use, HIV risk behavior, and associated
poor mental and physical health outcomes. Further, rates of substance use and depression
disproportionately affect minority groups and those living in poverty. Although efficacious,
the often complex, specialized nature of CBT poses problems in its integration into substance
use treatment programs. Budget cuts for mental health and substance use treatment both
nationally and in the state of North Carolina, reduce availability of publically funded
treatment programs and staff to patient ratios. To address this limitation, a behavioral
activation (BA) treatment, the Life Enhancement Treatment for Substance Use (LETS ACT), was
developed to treat depressive symptoms among a predominantly African American sample of low
income illicit drug users currently receiving residential substance use treatment.
Collectively, two Stage I studies and 1 year follow-up data from the investigators Stage II
R01DA026424 indicate that compared to a control condition, LETS ACT is associated with
significantly better outcomes for treatment retention, post treatment abstinence, HIV sexual
risk behavior, depressive symptoms, and environmental reward.

Although these strong outcomes suggest that LETS ACT may be ready for a Stage III
dissemination trial, it is of note that there was a significant indirect effect of LETS ACT
homework compliance on post treatment substance use and HIV sexual risk behavior via the
theoretically proposed BA mechanism of action, environmental reward. In the context of
limited access to care, these findings point to the need to identify cost-effective
delivery-vehicles to increase treatment engagement outside of clinician sessions. Further,
identifying neuroscience based biomarkers (neuromarkers) underlying key theoretical aspects
of BA (i.e., reward sensitivity), and their relation to heterogeneity in BA treatment
response among substance users with depression, are critical for the identification of
accurately targeted interventions.

Inclusion Criteria:

- Between 18 and 55

- Meet criteria for DSM-V substance use disorder

- Elevated depressive symptoms (BDI ≥ 14)

Exclusion Criteria:

- Limited mental competency (MMSE < 23)

- Psychosis

- The use of psychotropic medication for < 3 months

- The inability to give informed, voluntary, written consent to participate