Treating substance use disorder and major depression that co-occur

When a patient has both substance use disorder and major depression, how likely is it that both will be treated successfully, and what populations may not be getting all of the needed treatment?

Both major depression and substance use disorders commonly co-occur in teenagers, but the treatment used for patients where they co-occur is still relatively unknown. Building an understanding of the trends in treating co-occurring depression and substance use disorder is important to understanding how well the effort to reach teenagers who require such services is performing. A report provides some of this much-needed information.1

The investigators conducted a survey study that used publicly available data from the annual cross-sectional surveys of the National Survey on Drug Use and Health from 2011 to 2019. The data were used to assess the co-occurrence of major depressive episodes and substance use disorders in teenagers aged 12 to 17 years along with prevalence of treatment for either condition.

A total of 136,262 teenagers participated in the study. Throughout the survey period, the annual prevalence of co-occurring major depressive episodes and substance use disorders was stable, between 1.4% and 1.7%. Among the teenagers with co-occurring conditions, the prevalence of treatment for major depressive events only significantly increased from 28.5% in 2011 to 42.5% in 2019 (odds ratio [OR], 1.07; 95% CI, 1.02-1.11; P = .005), and treatment prevalence for substance use disorder decreased from 4.8% to 1.5% (OR, 0.92; 95% CI, 0.85-0.99; P = .04). The treatment use for both conditions varied between 4.5% and 11.6% and no significant linear trend over time was noted (OR, 0.95; 95% CI, 0.87-1.03; P = .24). The investigators found extensive disparities in a number of demographic conditions including boys for substance use disorder and co-occurrence, older teenagers with major depressive episodes, Hispanic teenagers with co-occurring conditions (adjusted OR, 0.52; 95% CI, 0.27-0.98; P = .04), and Asian, Native Hawaiian, or Pacific Islander adolescents for both co-occurring conditions (adjusted OR, 0.04; 95% CI, 0.01-0.33; P = .003) as well as major depressive episodes. Moving households 3 or more times over the past years was linked to higher odds of receiving treatment for both conditions (adjusted OR, 2.52; 95% CI, 1.26-5.05; P = .009).

The investigators concluded that from 2011 to 2019 less than 12% of teenagers who have major depression and substance use disorder were given treatment for both conditions. They believe that these findings should lead to improved coordination between service delivery system, expanded service provision, and increased support for teenagers who have unmet needs.

Reference

1. Lu W, Muñoz-Laboy M, Sohler N, Goodwin R. Trends and disparities in treatment for co-occurring major depression and substance use disorders among US adolescents from 2011 to 2019. JAMA Netw Open. 2021;4(10):e2130280. doi:10.1001/jamanetworkopen.2021.30280