This Treatment Improvement Protocol (TIP) is designed to assist you—the substance abuse counselor—in working with clients who are experiencing depressive symptoms. These symptoms occur along a continuum of intensity from mild to severe. When they reach a certain level of intensity and frequency, they become consistent with a diagnosis of a mood disorder, such as major depressive disorder, dysthymic disorder, substance-induced mood disorder, or bipolar disorder. It is clear from clinical research and practice that a significant percentage of your clients have depressive symptoms. Some, but not all, will have these depressive symptoms in the context of a mood disorder diagnosis. Even if you will not be diagnosing and treating depressive illnesses—which is in the scope of practice of those mental and behavioral health professionals licensed in your State to diagnose and treat mood disorders, and capable of doing so—you will be providing substance abuse counseling to clients with these diagnoses and to clients with depressive symptoms but whose mood states do not reach a level that would warrant a mood disorder diagnosis (that is, clients whose symptoms do not meet the diagnostic criteria).
The contributors to this TIP have all had experience as substance abuse counselors or treatment researchers. They have used their understanding of the treatment process to make this TIP as relevant as possible to you. Although the focus of this TIP is on clients with substance use disorders who have depressive symptoms, some of the material presented should be useful to you in all your counseling work.
Depressive symptoms are common among clients in substance abuse treatment. The term “depressive symptoms” refers to symptoms experienced by people who, although failing to meet DSM-IV-TR diagnostic criteria for a mood disorder, experience sadness, depressed mood, or “the blues,” and one or more additional possible symptoms listed in Figure 1.1. Findings from a 2001-2002 national survey indicate that substance abuse counselors will encounter significant numbers of individuals with co-occurring substance abuse and depressive symptoms. Among people who have had past year contact with health personnel or social service agencies and who also have had a past year substance use disorder, 40 percent of those with an alcohol use disorder also had an independent mood disorder and 60 percent of those with a drug use disorder had an independent mood disorder (Grant, Stinson, Dawson, Chou, Dufour, Compton, et al., 2004). Also, of all the people interviewed, one third indicated that sometime during their lives they had had 2 weeks or more during which they had felt down most of the time; sad, blue, or depressed; or didn't care about or enjoy the usual things (Compton, Conway, Stinson, & Grant, 2006). In general, women with substance use disorders have higher rates of co-occurring psychiatric disorders than men. Some studies suggest a higher rate of depressive symptoms in women, although other studies find no such differences.
These findings indicate that it is likely you will encounter clients with substance use disorders who have depressive symptoms—as many as half of the clients you see. Initial intake personnel are charged with identifying clients who are experiencing depressive symptoms when they enter treatment. However, depressive symptoms may appear at any time during substance abuse treatment. Look for pertinent notes in the client's chart and follow up on any indications that your client is experiencing symptoms of depression.
Download
Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery
