Current Depression Is a Marker for Crack Cocaine Use
July 15, 2011 — Depression is not a marker for more long-term vulnerability to using crack cocaine, according to a study published in the July 2011 issue ofAddiction. But a major depressive episode can be a marker for crack use in the subsequent months.
The findings come from a study that involved urine drug screens from and diagnostic interviews with 261 women who went to drug court, a criminal justice intervention designed to relieve pressure on jails and prisons by giving nonviolent offenders court-supervised treatment for substance use.
Of the women in the study, 16% were depressed when they entered the study and 40% had experienced a major depression in their lifetime. Among those depressed when they entered the study, 46% used crack in the subsequent 4 months. In contrast, only 25% of the women who weren’t depressed when they began the study used crack in the subsequent 4 months.
“For me, the most surprising finding was that women with a recent major depressive episode didn’t seem to have any higher risk for crack use than women who had never been depressed,” said lead investigator Jennifer Johnson, PhD, assistant professor in the Warren Alpert Medical School of Brown University in Providence, Rhode Island.
The findings add more nuance to a continuing debate about the relation between substance use and depression, according to Dr. Johnson, who is also affiliated with Brown’s Center for Alcohol and Addiction Studies and the Center for Prisoner Health and Human Rights, a collaboration of Brown University and The Miriam Hospital.
It’s known that crack use leads to depression, which leads to crack use, which leads to a vicious circle, she said. Some of the debate surrounds whether biology or third variables like poverty and trauma predispose people both to depression and to crack use, Dr. Johnson told Medscape Medical News. “Given all that debate, it was a little bit surprising that, at least in this data in the short term, depression predicted crack use in the future, but not at the same time, and that depression didn’t seem to be a marker for more long-term vulnerability to crack use,” she said.
John F. Kelly, PhD, who is associate professor of psychiatry at Harvard Medical School and associate director of the Massachusetts General Hospital–Harvard Center for Addiction Medicine, in Boston, said the study’s main strengths are separating the influence of a current depressive episode vs recent vs lifetime on future return to crack cocaine use.
The study raises questions about why a current major depressive episode should relate only to beginning use, not how much someone uses, Dr. Kelly said. “It may be that the presence of a current [major depressive episode] may negatively affect self-regulation and decision making, increasing the risk of initial use, but it is hard to know whether its nonrelationship with frequency of use is attenuated by drug-court involvement.” Consequently, he said, “it’s unclear how these findings might generalize to women (or men) outside of drug-court settings or with other primary substance disorders (e.g., opiate or alcohol dependence).”
Although not a major focus of the study, the fact that 72% of the women in the sample were abstinent at the 4-month follow-up attests to the therapeutic strengths of the drug courts in aiding abstinence and facilitating early recovery among vulnerable substance-dependent women, he added.
Drug courts vary by state, but generally they were developed to give nonviolent offenders court-supervised substance-use treatment. These nonviolent offenders must get treatment and undergo urine drug screens. If they fail in drug court, many will go to prison, Dr. Johnson said.
The study could have implications for public policy, Dr. Johnson said. “It strongly suggests that screening for depression and treatment for depression should be available to women in drug court,” she said. “If you want them to succeed in drug court, it makes sense to pay attention to their mental health.”
It’s also cheaper to treat than incarcerate, she added; the cost of incarcerating a woman is somewhere between $30,000 and $50,000 a year. The study, she said, shows one place where, for relatively little money, you might be able to make a big difference in terms of addiction outcomes and future incarceration.
The study was supported by grants from the National Institute of Drug Abuse and the National Institute of Nursing Research. Dr. Johnson has disclosed no relevant financial relationships. Dr. Kelly reports being supported by funding from the National Institute of Alcohol Abuse and Alcoholism and the Hazelden Foundation.
Addiction. 2011;106:1279-1286. Abstract
Medscape Medical News © 2011 WebMD, LLC
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