Patients with depression plus substance use disorder less likely to receive treatment

Patients with co-occurring depression and substance use disorders don’t usually receive guideline-concordant depression therapy despite available treatments for depression, a study has found.

“Clinical practice guidelines recommend concurrent treatment of co-occurring depression and substance use disorders, [but] the degree to which patients with substance use disorders receive guideline-concordant treatment for depression is unknown,” the investigators said.

To address this, they conducted a retrospective cohort study of 53,034 patients diagnosed with a depressive disorder in fiscal year 2017 in the US Veterans Health Administration. The association of comorbid substance use disorders with guideline-concordant depression treatment, including both medication and psychotherapy, was assessed while adjusting for patient demographic and clinical characteristics.

Across metrics, guideline-concordant depression therapy was lower for patients with co-occurring depression and substance use disorders than those without substance use disorders.

Covariate-adjusted models of antidepressant treatment showed similar findings, such that patients with substance use disorders had 21-percent lower likelihood of guideline-concordant acute treatment (adjusted odds ratio [aOR], 0.79, 95 percent confidence interval [CI], 0.73–0.84) and 26-percent lower probability of continuing treatment (aOR, 0.74, 95 percent CI, 0.69–0.79).

Concerning psychotherapy, patients with co-occurring depression and substance use disorders had 13-percent lower chances of adequate acute-phase treatment (aOR, 0.87, 95 percent CI, 0.82–0.91) and 19-percent lower likelihood of psychotherapy continuation (aOR, 0.81, 95 percent CI, 0.73–0.89).

“Efforts to improve the provision of care to those with co-occurring substance use disorders should focus on clinician-based interventions and use of integrated care models to improve the quality of depression treatment,” the investigators said.