Table 1.
Characteristics of included studies comparing cognitive-behavioural therapy/motivational interviewing (CBT/MI) plus treatment as usual (TAU) with TAU alone, or brief other psychological treatments
| Author, year, country | Target group | Recruitment source | Inclusion criteria | Conditions | Intensity of treatment | n (% male) | Symptoms of depression outcome measures | Alcohol consumption outcome measures | Post-treatment (pt) and follow-up (fu) assessments | Study attrition (%) | Methodological qualities |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Agyapong 2012, 2013 57,76 Ireland | Adults 18+ who completed in-patient double diagnosis programme | Clinic | 1. DSM-IV MDD 2. DSM-IV AUD 3. MMSE ≥ 24 | 1. ICBT/MI mobile text messages + TAU 2. Placebo mobile text messages + TAU | 1. 2 per day, 3 months 2. 2 per month, 3 months | 1. 26 2. 28 (46%) | BDI-II | 1. No. of days abstinent 2. No. of days to first drink 3. No. of drinks per drinking day 4. No. of patients abstinent | pt: 3 m fu: 6 m | pt: 7.4% fu:11% | 1. Yes 2. Yes 3. Yes 4. Yes |
| Baker 2010 30 Australia | Young adults ≥16 | Media and referrals by health professionals | • BDI-II ≥ 17 • m ≥ 4/f ≥ 2 drinks per day in past month | 1. CBT/MI-D 2. CBT/MI-A 3. iCBT/MI 4. Brief (control) | 1. 9 × 1 hour 2. 9 × 1 hour 3. 9 × 1 hour 4. 1.5 hours | 1. 71 2. 68 3. 75 4. 70 (53%) | BDI-II | 1. Mean drinks p.w. 2. Mean drinking days p.w. 3. Max. no. of drinks per day 4. Mean drinks per day | pt: 4.5 m | pt: 16 | 1. Yes 2. Yes 3. Yes 4. Yes |
| Battersby 2013 77 Australia | Adults 18+, out-patients (Vietnam veterans) | Referrals by health-care settings and media | • AUDIT ≥ 8 • Chronic condition (mental or physical) | 1. CBT/MI + TAU TAU | 6 × 2.5 hour –gr self-care manual | 1. 46 2. 31 (100%) | HADS | 1. AUDIT | pt: 9 m | pt: 6% | 1. Yes 2. Yes 3. Yes 4. Yes |
| Brown 1997 31 USA | Out-patients in substance use hospital programme (age range 27–58 years) | Clinic | • DSM-III-R alcohol dependence • BDI ≥ 10 | 1. CBT-D + TAU 2. Placebo control + TAU | 1. 8 × 45 m 2. 8 × 45 m | 1. 19 2. 16 (71%) | BDI MHAM-D POMS | 1. % of days abstinent 2. Drinks per drinking day 3. % totally abstinent 4. % drinking heavily | pt: 3 m fu: 6 m | pt: 3 fu: 8.6 | 1. No 2. n.i. 3. No 4. No |
| Brown 2006 24 USA | Out-patient veterans in double diagnosis programme (age range 31–68) | Clinic | • DSM-IV alcohol, cannabis and/or stimulant dependence • DSM-IV MDD | 1. iCBT/MI (gr) + TAU 2. TSF (gr) + TAU | 1. 36 × 1 hour 2. 36 × 1 hour | 1. 48 2. 42 (92%) | HAM-D-21 | 1. % of days abstinent | pt: 6 m fu: 9, 12 m | pt: 26.7 | 1. Yes 2. No 3. No 4. No |
| Brown 2011 78 USA | Out-patients aged 18–65 years in substance use programme | Clinic | • DSM-IV alcohol dependence • BDI ≥ 15 | 1. CBT-D + TAU 2. Placebo control + TAU | 1. 8 × 45 m 2. 8 × 45 m | 1. 83 2. 83 (67%) | BDI HAM-D | 1. % of days abstinent 2. Drinks per drinking day | pt: 1.5 m fu: 3, 6, 12 m | pt: 14 fu 3: 7 fu 6: 5 fu 12: 7 | 1. Yes 2. Yes 3. Yes 4. Yes |
| Hides 2011 58 Australia | Out-patients aged 16–25 in substance use service | Clinic | • K10 ≥ 17 • Weekly AOD use above recommended level in past month | 1. ICBT/MI + TAU 2. TAU | 1. 12 sessions | 1. 60 2. 28 (63%) | CES-D HAM-D-17 K 10 | 1. Days of use per month 2. Mean drinks p.m. 3. Mean drinks per drinking day | pt: 3 m fu: 6 m | pt: 24 fu: 24 | 1. No 2. No 3. Yes 4. No |
| Hunter 2012 59 USA | Out-patients aged 18+ in substance use programme | Clinic | • BDI >13 • One or more substance use disorders (AUDIT-C or DAST) | 1. ICBT/MI (gr) + TAU 2. TAU | 1. 18 × 2 hours | 1. 47 2. 26 (52%) | BDI-II | 1. Drinks per drinking day | pt: 3 m fu: 6 m | pt: 12.3 fu: 5.5 | 1. Yes 2. Yes 3. Yes 4. Yes |
| Kay-Lambkin 2009 56 Australia | Adults ≥17 | Referrals alcohol/other health-care settings; TV and print media | • BDI-II ≥ 17 • DSM-IV life-time MDD • Current problematic AOD use above recommended level | 1. ICBT/MI + BI 2. ICBT/MI-c + BI 3. BI | 1. 10 × 1 hour 2. 10 × 1 hour 3. 1 session | 1. 21 2. 22 3. 24 (46%) | BDI-II | 1. Mean no. of alcohol use occasions | pt: 3 m fu: 6, 12 m | pt: 15.5 fu 6: 18.6 fu 12: 15.5 | 1. Yes 2. Yes 3. Yes 4. Yes |
| Kay-Lambkin 2011 79 Australia | Adults ≥16 | Referrals alcohol/other health-care settings; TV and print media | • BDI-II ≥ 17 • Alcohol or cannabis use at harmful levels last month | 1. ICBT/MI (face-to-face)a 2. ICBT/MI-ca 3. PCT | 1. 10 × 1 hour 2. 10 × 1 hour 3. 10 × 1 hour | 1. 185a 2. 89 (57%) | BDI-II | 1. Mean drinks per day 2. % abstinent 3. % with ≥50% reduction 4. % drinking above harmful threshold | pt: 3 m | pt: 40.5 | 1. Yes 2. n.i. 3. Yes 4. Yes |
| Lydecker 2010 60 USA | Out-patient veterans in double diagnosis programme | Clinic | • DSM-IV alcohol, cannabis/stimulant dependence • DSM-IV life-time MDD • Recent substance use HDRS >20 | 1. ICBT/MI (gr) + pharma. 2. TSF (gr) + pharma. | 1. 36 × 1 hour 2. 36 × 1 hour | 1. 107 2. 99 (92%) | HAM-D-21 | 1. % of days substance-use–abstinent | pt: 6 m fu:15 m | pt:19.4 fu: 34.5 | 1. Yes 2. n.i. 3. No 4. Yes |
| Watkins 2011 61 USA | In-patients aged +18 in substance use programme | Clinic | • PHQ-8 ≥ 5 • PHQ-8 ≥ 5 • BDI-II ≥ 17 | 1. ICBT/MI (gr) + TAU 2. TAU | 1. 16 × 2 hours | 1. 140 2. 159 (52%) | BDI-II | 1. Alcohol use days as % of days available for use | pt: 3 m fu: 6 m | pt:13 fu:14.4 | 1. No 2. No 3. No 4. Yes |
Methodological qualities: 1, adequate sequence generation; 2, allocation to conditions by an independent party; 3, blinding of outcome assessors or use of self-report outcomes only; 4, intention-to-treat analyses.
In the meta-analysis the CBT/MI face-to-face and computerized experimental conditions are combined and compared to the PCT control condition, as this was the way the data were presented and amenable.
Adverts = advertisements; alc = alcohol; alcpo = alcohol population; AOD = alcohol and other drugs; AUDIT = Alcohol Use Disorder Identification Test; BDI = Beck Depression Inventory; BI = brief intervention; BSP = brief supportive psychotherapy; C = control condition; CBT = cognitive-behavioural therapy; CBT-D = cognitive-behavioural treatment for depression; CES-D = Center for Epidemiologic Studies Depression Scale; CO = completers-only analysis; DAST = Drugs Abuse Screening Test; DSM = Diagnostic Statistical Manual of Mental Disorders; depr = depression; f = female; fu = follow-up; GAF = Global Assessment of Functioning; gr = group sessions; HADS = Hamilton Anxiety and Depression Scale; HAM-D = Hamilton Rating Scale for Depression; ICBT = integrated cognitive–behavioural therapy; ICBT/MI-c = integrated cognitive–behavioural therapy-computerized ‘integrated’, focusing on both alcohol and depression; IPT-DD = interpersonal psychotherapy adapted for dysthymic disorder; ITT = intention-to-treat analysis; K10 = Kessler Psychological Distress Scale; m = male; max. = maximum; MCMI = Millon Clinical Multiaxial Inventory; MDD = major depressive disorder; MHAM-D = Modified Hamilton Depression Rating Scale; MI = motivational interviewing; MMPI = Minnesota Multiphasic Personality Inventory; n.i. = no information; no. = number; PHQ = Patient Health Questionnaire; pharma. = pharmacotherapy; PCT = person-centred therapy; POMS = Profile of Mood States; pt = post-treatment; p.w. = per week; SCL-90 = Symptom Checklist; SET = self-examination therapy; s-r = self-reports; TAU = treatment as usual; TSF = 12-Step Facilitation Therapy.