30th May 2023

Doncaster clinical trial highlights potential for more effective substance misuse treatment

Service users at Aspire have seen their recovery and on-going abstinence prospects boosted thanks to a pioneering trial with anti-depression therapy.

People needing help for substance misuse problems are often clinically depressed, which impairs their response to drug and alcohol treatment. Limited research has taken place in the past but the findings of a new two-year study, carried out at Doncaster’s Aspire Drug & Alcohol Services, suggests that ‘behavioural activation therapy’ could be a key missing link to improving the mental health outcomes of those battling substance misuse problems.

Behavioural activation focuses on how our environment shapes our actions and impacts on our mental health. By deliberately practising certain behaviours we can ‘activate’ a positive emotional state. The theory is that engaging in fulfilling activities, such as volunteering or walking, can create a feelgood factor and lead to the addiction being replaced with a healthier alternative.

The study was jointly carried out by staff from Aspire, a partnership between Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) and registered charity The Alcohol & Drug Service; University of Sheffield academics Sophie Pott – who led the investigation – Dr Jaime Delgadillo and Dr Stephen Kellett; along with Professor Stacey Daughters from the University of North Carolina – Chapel Hill.

Dr Kellett said: “To conduct a randomised controlled trial in a busy substance misuse service is a major achievement and shows that key workers can effectively integrate behavioural activation into the help they offer. Drug and alcohol problems are notoriously difficult to overcome, especially when they are complicated by depression.”

The team researched the feasibility and potential clinical benefits of behavioural activation being delivered by drug and alcohol workers to patients having community-based drugs and alcohol treatment. The therapy was compared to ‘treatment as usual’ in the Aspire service and all the participants had both substance misuse and depression symptoms.

Dr Delgadillo, who is also Director of Psychological Therapies Research with the Grounded Research team at RDaSH, added: “This new research makes us optimistic about the potential to help many people with these problems by training drug and alcohol workers to adopt behavioural activation as part of their treatment toolkit.”

Some 59 per cent of those who took part in the trial attended at last one session and there was 95 per cent adherence to the guidelines set out. Behavioural activation was associated with significantly reduced depression in those patients at a follow-up 12 weeks later. Participants also used less illicit substances on top of their prescribed medication. The researchers concluded that this therapy may add clinical benefit to the care provided for patients who have substance misuse and depression problems and that it is an area which needs further research.

Stuart Green, Service Manager with Aspire, said: “The results are very promising, particularly for people who are trying to hold down a job or reduce illicit use on top of their medications. The study has raised exciting prospects for the care provided for this cohort of people across the country, with potential improvements through the talking therapies on offer, as well as returning potential gains on treatment costs and harm reduction.”

The findings were last month (March 2022) published in the highly influential Journal of Substance Abuse Treatment.

Heather Rice, Assistant Director of Research at RDaSH’s Grounded Research, said: “We are delighted that the Aspire team are active in research and we will continue to collaborate with them and our partners in the University, particularly to engage service users who are harder to involve in research.”

Link to research document: (March 23, 2022) in an article titled: Behavioural activation for depression delivered by drug and alcohol treatment workers: A pilot randomized controlled trial. (https://doi.org/10.1016/j.jsat.2022.108769)