Treatment for depression among individuals with substance use disorder: The Activate Study

The intervention is Behavioural Activation Treatment for Depression (BATD-R), modified for use in out-patient and in-patient drug and alcohol treatment settings (Activate). BATD-R involves 10 individual 60 minute therapy sessions with a psychologist, delivered once a week for 10 weeks. Sessions include an examination of five key life areas and the client's values within each of these, as well as daily activity scheduling and problem solving. Activate has modified BATD-R to incorporate: psychoeducation about the role of substance use in depression; the use of motivational interviewing techniques for helping the client identify treatment goals related to their substance use; a brief relaxation technique and strategies for coping with craving; and self-soothing exercises. Treatment fidelity: Project staff will receive extensive training at the commencement of the project, including research procedures and role plays of assessment administration and treatment sessions. We will ensure treatment fidelity throughout the project by delivering the therapy in a consistent fashion, closely adhering to the treatment manual. The manual will be taken into each session by the therapist to ensure all proposed areas are covered. The therapist will also complete a session checklist, with any deviations from the therapy manual recorded in the clinical notes kept for each session. Weekly clinical supervision will be held with the CIs, where session checklists will be monitored. In addition, all treatment sessions will be recorded using MP3 recorders. Sessions will be uploaded onto computer for blind rating by an independent assessor. Ten percent of each therapist’s sessions will be randomly selected and rated for treatment fidelity (i.e., compliance with the treatment manual), and inter-rater reliability. Therapist will be controlled for in analyses of treatment outcome.