Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery A Treatment Improvement Protocol TIP 48 Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery Treatment Improvement Protocol (TIP) Series 48 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road Rockville, MD 20857 Acknowledgments Recommended Citation This publication was prepared under contract number Center for Substance Abuse Treatment. Managing 270-04-7049 by the Knowledge Application Program Depressive Symptoms in Substance Abuse Clients (KAP), a Joint Venture of The CDM Group, Inc., and During Early Recovery. Treatment Improvement JBS International, Inc., for the Substance Abuse and Protocol (TIP) Series, No. 48. HHS Publication No. Mental Health Services Administration (SAMHSA), (SMA) 13-4353. Rockville, MD: Substance Abuse and U.S. Department of Health and Human Services Mental Health Services Administration, 2008. (HHS). Christina Currier served as the Contracting Officer’s Representative. Originating Office Disclaimer Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for The views, opinions, and content of this publication Substance Abuse Treatment, Substance Abuse and are those of the author and do not necessarily reflect Mental Health Services Administration, 1 Choke the views, opinions, or policies of SAMHSA or HHS. Cherry Road, Rockville, MD 20857. HHS Publication No. (SMA) 13-4353 Public Domain Notice First Printed 2008 Revised 2009, 2012, 2013, and 2014 All material appearing in this report is in the public domain and may be reproduced or copied without per- mission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specif- ic, written authorization of the Office of Communications, SAMHSA, HHS. Electronic Access and Copies of Publication This publication may be ordered from or downloaded from SAMHSA’s Publications Ordering Web page at http://store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). ii Contents Consensus Panel . v Expert Advisory Board. vi What Is a TIP? . vii Foreword . ix How This TIP Is Organized . xi Part 1 . 1 Chapter 1 . 3 Introduction . 3 Framework . 4 Preparing Yourself To Work With Clients With Depressive Symptoms . 15 Screening and Assessment . 21 Treatment Planning. 22 Treatment . 24 Continuing Care and Treatment Termination . 29 Chapter 2 . 31 Introduction . 31 Vignette 1—Behavioral Interventions . 39 Vignette 2—Cognitive Interventions . 56 Vignette 3—Interventions With Core Beliefs . 67 Vignette 4—Interventions With Feelings. 82 Part 2 . 99 Chapter 1 . 101 Introduction . 101 Why SAMHSA Created an Implementation Guide as Part of This TIP . 101 Consensus Panel Recommendations for Administrators . 102 Why Address Depressive Symptoms?. 102 Thinking About Organizational Change . 103 The Role of the Administrator in Introducing and Supporting New Clinical Practices . 106 Managing Depressive Symptoms iii Chapter 2 . 109 Introduction . 109 Assessment and Planning Before Implementation . 109 Addressing Policies and Procedures . 114 Addressing Relevant Regulations . 119 Addressing Staff Competence . 119 Addressing Community Relationships . 127 Addressing Financial Considerations . 128 Addressing Continuity and Fidelity . 128 Summary . 129 Appendix A—Bibliography . 131 Appendix B—Center for Epidemiologic Studies Depression Scale (CES-D) . 135 Appendix C—Fidelity Checklists . 137 Appendix D—DSM-IV-TR Mood Disorders . 143 Appendix E—Advisory Meeting Panel . 147 Appendix F—Field Reviewers . 149 Appendix G—Acknowledgments. 151 Index . 153 iv Contents Consensus Panel Note: The information given indicates each participant's affiliation during the time the panel was convened and may no longer reflect the individual's current affiliation. Chair, Part 1 and Part 2 Part 2 Consensus Panel Members Consensus Panels Jennifer Frey, Ph.D. Rose M. Urban, M.S.W., J.D., LCSW, LCAS KAP Expert Content Director KAP Project Co-Director The CDM Group, Inc. The CDM Group, Inc. Bethesda, Maryland Bethesda, Maryland Nancy VanDeMark, Ph.D. Part 1 Consensus Panel Members Director, Research and Program Evaluation Arapahoe House, Inc. Bruce Carruth, Ph.D. Thornton, Colorado KAP Expert Content Director The CDM Group, Inc. Bethesda, Maryland Jennifer Frey, Ph.D. KAP Expert Content Director The CDM Group, Inc. Bethesda, Maryland Michael Klitzner, Ph.D. KAP Expert Content Director The CDM Group, Inc. Bethesda, Maryland Sheldon R. Weinberg, Ph.D. Senior Research/Applied Psychologist The CDM Group, Inc. Bethesda, Maryland v Managing Depressive Symptoms Expert Advisory Board Note: The information given indicates each participant's affiliation during the time the board was convened and may no longer reflect the individual's current affiliation. Richard N. Rosenthal, M.D., Chair William Mock, Ph.D., LISW, LICDC, SAP Professor of Clinical Psychiatry Director Columbia University College of Physicians and The Center for Interpersonal Development Surgeons Lakewood, Ohio Chairman, Department of Psychiatry St. Luke’s Roosevelt Hospital Center Paul Nagy, LPC, CCAS, CCS New York, New York Program Director, Duke Addictions Program and Clinical Associate, Duke University Department of Patricia A. Burke, M.S.W., LCSW, BCD, C- Psychiatry and Behavioral Sciences CATODSW Durham, North Carolina Private Practice West Baldwin, Maine Bette Ann Weinstein, Ph.D., LCSW Private Practice Dennis C. Daley, LCSW, BCD Delray Beach, Florida Associate Professor of Psychiatry Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center Pittsburgh, Pennsylvania vi What Is a TIP? Treatment Improvement Protocols (TIPs) are developed by the Center for Substance Abuse Treatment (CSAT),.