The effect of a behavioral activation treatment for substance use on post-treatment abstinence: a randomized controlled trial

Aims to compare outcomes for a behavioral activation group treatment for substance use (LETS ACT), versus a time and group size matched control condition delivered in a residential treatment setting. Design single-site two-arm parallel-group randomized clinical trial with follow-up assessment at 3, 6 and 12 months post-treatment. Setting residential substance use treatment facility in the USA. Participants participants were 263 adults [mean age 42.7 [11.8]; 29.3% female; 94.7% African American; 72.6% court mandated] whose insurance dictated 30-day (65.4%) or 90-day (34.6%) treatment duration. Intervention and comparator LETS ACT (n=142) is a treatment originally developed for depression and modified for substance use. It teaches participants to increase positively reinforcing value-driven activities in order to counter depression and relapse. The control group (SC; n=121) received time and group-size matched supportive counseling. Treatment was delivered in five or eight one-hour sessions depending on patient length of stay. Measurements percent abstinent at follow-up, percent of substance use days among those reporting use, depressive symptoms (BDI), and adverse consequences of drug use (SIP-AD). Findings LETS ACT had significantly higher abstinence rates at 3 months (odds ratio=2.2, 95% confidence interval=1.3-3.7), 6 months (odds ratio=2.6, 95% confidence interval=1.3-5.0), and 12 months (odds ratio=2.9, 95% confidence interval=1.3-6.1) post-treatment compared with SC. LETS ACT participants reported significantly fewer adverse consequences from substance use at 12 months post-treatment (B=4.50, SE=2.17, 95% confidence interval=0.22-8.78). Treatment condition had no effect on percent substance use days among those who resumed use or on change in depressive symptoms; the latter decreased over time only in those who remained abstinent after residential treatment irrespective of condition (B=0.43, SE=0.11, 95% confidence interval=0.22-0.65). Conclusions a behavioral activation group treatment for substance use (LETS ACT) appears to increase the likelihood of abstinence and reduce adverse consequences from substance use up to 12 months post-treatment.