Group Therapy for Women Prisoners With Comorbid Substance Use and Depression

Incarcerated women are a vulnerable and rapidly expanding population with high lifetime rates of both substance use disorder (SUD; abuse or dependence on alcohol, illegal drugs, or prescription drugs; 70%) and depressive disorder (DD; major depressive disorder and dysthymic disorder; 20-27%). DDs tend to worsen the course of SUDs for incarcerated women by increasing their risk for suicide attempts, contributing to the persistence of substance abuse, and reducing the likelihood of a successful transition to an independent, sober life in the community. Recent evidence indicates that DDs are common in persons with SUDs, often do not remit with SUD treatment, and should be treated. Despite growing recognition that co-occurring disorders, such as DDs, among substance abusing incarcerated women present an important public health concern, integrated treatments for SUD-DD have not been well-developed for or systematically tested in this population. Group Interpersonal Psychotherapy (IPT-G) has been shown to be efficacious in treating DD in other populations and may be especially pertinent to the needs of incarcerated women with SUD-DD because interpersonal difficulties not only affect severity of depression, but are also strong predictors of drinking to cope, SUD relapse, and prison recidivism in women.

This study tests the hypotheses that as adjuncts to prison SUD treatment, IPT-G, relative to psychoeducation on co-occurring disorders, will produce at least moderate effect sizes for:

• Reduction in the risk and severity of substance use relapse after release from prison
• Recovery from depressive disorder and reduction in depressive symptoms
• Improvement in social support and interpersonal functioning
• Reduction in the severity of legal problems during the 3 month follow-up period

Inclusion criteria

• Participants are recruited from prison substance use treatment programs.
• Current primary (non-substance-induced, as defined by the SCID) depressive disorder (major depressive or dysthymic disorder) after at least 4 weeks of prison SUD treatment and abstinence.
• A minimum Hamilton Depression score of 18 or higher, indicating moderate to severe depression.
• Depressive disorder at any time while not incarcerated.
• Substance use disorder one month prior to incarceration.
• Between 10 and 18 weeks away from release from prison.

Exclusion criteria

• Lifetime criteria for bipolar disorder
• Lifetime criteria for a psychotic disorder
• Actively suicidal