Digital integrated interventions for comorbid depression and substance use disorder: narrative review and content analysis.

Abstract

Background: Integrated digital interventions for the treatment of comorbid depression and substance use disorder have been developed, and evidence of their effectiveness is mixed.

Objective: To better understand the potential underlying causes of these mixed findings, we described intervention characteristics, examined evidence-based treatment strategies within integrated digital treatments, reported the frequency of specific evidence-based strategies across different treatment modalities, and identified overlap between various treatment strategies and critical gaps in existing literature.

Methods: In June 2024, a literature search was conducted in Google Scholar to identify digital integrated interventions for comorbid MDD and SUD. Articles were included if they described interventions targeting both conditions simultaneously, were grounded in CBT, MI, or MET, and were delivered at least in part via digital modalities. Fourteen studies meeting these criteria were coded using an open coding approach to identify treatment strategies. Statistical analyses summarized the number, frequency, and overlap of these strategies.

Results: Half of studies (50.0%, n=7) included participants with mild to moderate depression symptom severity and hazardous substance use. Only 35.7% (n=5) of the studies required that participants meet the full diagnostic criteria for MDD, as assessed by the SCID or MINI, for inclusion and 21.4% (n=3) required a SUD diagnosis. Web-based (35.3%, n=6), computer-based (21.4%, n=3) and supportive text messaging interventions (21.4%, n=3) were included. Treatment duration averaged 10.3 weeks (SD=6.8). Common treatment strategies included self-monitoring (78.6%, n=11), psychoeducation (71.4%, n=10), and coping skills (64.3%, n=9). Interventions often combined therapeutic strategies, with psychoeducation frequently paired with self-monitoring (64.3%, n=9) and coping skills (50%, n=7).

Conclusions: Among integrated digital interventions for comorbid depression and substance use, there was significant variability in inclusion criteria, digital modalities, methodology, and treatment strategies, significant methodological challenges, and underrepresentation of evidence-based practices. Without standardized methodologies comparison of the clinical outcomes across studies is challenging. These results emphasize the critical need for future research to adopt standardized approaches, thereby facilitating more accurate comparisons and a deeper understanding of intervention efficacy.

Clinicaltrial: