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Co-Occurring Chronic Depression and Alcohol Dependence: A Novel Treatment Approach

Penberthy, Jennifer K. PhD*; Gioia, Christopher J. PhD*; Konig, Andrea PhD*; Martin, Aaron M. PhD; Cockrell, Stephanie A. MSW*; Meshberg-Cohen, Sarah PhD‡§

Addictive Disorders & Their Treatment: June 2014 - Volume 13 - Issue 2 - p 54–67
doi: 10.1097/ADT.0b013e31827de84e
Original Articles

Objectives: Research suggests a lack of successful treatment options targeted specifically for chronically depressed alcohol-dependent individuals. This may be due, in part, to the complex characteristics these individuals possess that make their treatment more challenging. There are currently several empirically supported behavioral treatments for depression and alcoholism as individual disorders; however, few interventions have shown consistent results for treating these disorders concurrently. Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has demonstrated effectiveness in treating chronic depression, but has not yet been studied in persons with co-occurring alcohol dependence and chronic depression. We examine the feasibility of utilizing CBASP in 2 individuals who have co-occurring chronic depression and alcohol dependence, and explore its impact upon depression and alcohol intake.

Methods: We conducted 2 case studies and implemented 20 weeks of manualized CBASP adapted for use in alcohol-dependent individuals.

Results: Both participants tolerated the therapy well and completed the study. CBASP was effective in reducing symptoms of chronic depression and significantly reducing alcohol intake to healthy drinking levels.

Conclusions: CBASP seems to be ideally suited for this population, which has extensive avoidance learning, high rates of early trauma, repeated interpersonal failures, and uses alcohol to cope. We propose that treatment for this population must be tailored to the underlying interpersonal issues and skill deficits described above in order to be effective, and that CBASP can be the therapy for the chronically depressed, alcohol-dependent individual.

*Department of Psychiatry and Neurobehavioral Sciences, Center for Addiction Research and Education, University of Virginia School of Medicine, Charlottesville

Department of Psychology, Virginia Commonwealth University, Richmond, VA

Department of Veteran Affairs, VA Connecticut Healthcare System, Psychology Service

§Department of Psychiatry, Yale University School Medicine, New Haven, CT

The authors declare no conflict of interest.

Reprints: Jennifer K. Penberthy, PhD, Department of Psychiatry and Neurobehavioral Sciences, Center for Addiction Research and Education, University of Virginia School of Medicine, P.O. Box 800623, Charlottesville, VA 22908-0623 (e-mail:

© 2014 by Lippincott Williams & Wilkins