Personalized blended care for depression with comorbid alcohol misuse among young people: a multi-centre RCT

Many studies have found that consuming alcohol to cope with distress or to escape problems plays a fundamental role in the development of problematic drinking in young people including students with depressive symptoms or depression. Combined treatment of comorbid alcohol problems and MDD could hence be vitally important from a clinical and a public health viewpoint (Riper et al 2014), especially for adolescents and young adults. However, evidence on the effectiveness, and the availability of combined depression and alcohol interventions tailored at young people is currently insufficient. Therefore, the threefold aim of this project is: 1. To develop - in collaboration with patient experts - online, cognitive behavioural therapy / motivational interviewing (CBT/MI) based alcohol reduction add-on modules tailored for young people (incl. students) in depression therapy; 2. To test the (cost-) effectiveness of treatment as usual + internet-based alcohol reduction add-on modules on alcohol and depression outcomes against treatment as usual (TAU) in a multi-centre randomized clinical trial (RCT); 3. To prepare and execute an implementation plan to foster the wider use of alcohol reduction add-on modules when successful outcomes of the RCT are found. Objective RCT: To reduce depression symptoms and alcohol intake simultaneously in a population of young adults with a depressive disorder and problematic alcohol use. Primary outcome variable: Positive clinical treatment outcome in this trial (treatment response) is defined as: (a) Drinking less than 21 (males) / 14 (females) standard alcohol drinks in the week prior to measurement; (b) 0 days with 4 or more (women), or 5 or more (men) drinks reported in the last 7 days; (c) Center for Epidemiological Studies-Depression (CES-D) score < 16 or reduced by 40% relative to CES-D at baseline. The primary clinical endpoint assessment is 6 months post-randomization. For the cost-effectiveness analyses, all outcomes up until 12 months will be used. Patients (n=156) will enrol in this RCT from two sites in Amsterdam (NL): Arkin and GGZ inGeest. The primary outcome -treatment response- is assessed 3, 6 (primary) and 12 months post-randomization. For the cost-effectiveness analyses, all outcomes up until 12 months will be used. An implementation plan will be developed in collaboration with patient organizations. If successful, the add-on modules will be integrated in clinical practice.