Can people with substance misuse and depression benefit from brief psychological therapies?

INTERVENTION: Comparing behavioural activation with a minimal treatment intervention (1 session self‐help and bibliotherapy) Behavioural Activation (BA) is a structured psychological intervention for depression based on principles of operant conditioning, functional analysis of behaviour and problem solving (Martell et al., 2001; Hopko et al., 2003). Essentially, it consists of: 1. Self‐monitoring to identify depressive and maladaptive behaviours 2. Scheduling activities aiming to reinforce adaptive behaviour patterns 3. Reducing the frequency avoidant behaviours, rumination and maladaptive coping strategies. The intervention delivered in this pilot feasibility trial will follow a published BA protocol developed by Kanter et al. (2009) structured BA treatment manual developed by our collaborators for a previous RCT (Ekers et al., 2011), which integrates and summarises the main theoretical principles, techniques and intervention strategies presented in the above cited versions of BA. Most importantly, the Kanter protocol outlines key problems that impede effective treatment and presents alternative therapeutic strategies to address such barriers to activation follows the conventional BA theory and treatment model by Martell et al. (2001). The BA intervention will be based on a 12 session treatment manual. BA will be delivered by qualified mental health practitioners based in the Primary Care Mental Health Service. Mental health practitioners will maintain contact with the participants' key workers and General Practitioners who are based in the community drugs treatment services and manage patients' care and treatment plans. Therefore, the intervention is considered collaborative care between mental health and community drugs services. The therapists delivering the BA intervention have already had training in this type of therapy as part of their professional qualification; in addition the research team will organise a full‐day training event to orientate therapists to this CONDITION: Mild to moderate substance misuse and depression ; Mental and Behavioural Disorders ; Depressive episode, unspecified PRIMARY OUTCOME: Patient Health Questionnaire (PHQ‐9); Measured at baseline, then 6 weeks post therapy and 12 weeks post therapy. SECONDARY OUTCOME: 1. Generalised Anxiety Disorder (GAD‐7); 2. Treatment Outcomes Profile (TOP) ; 3. Substance misuse section of PRISM; ; Measured at baseline, then 6 weeks post therapy and 12 weeks post therapy. INCLUSION CRITERIA: 1. Are currently engaging with a community drugs treatment, detox, maintenance or addiction recovery focused service in Leeds. Engagement is defined by: 1.1. Being currently registered with a formal addiction focused service or programme 1.2. Having had planned contact with the service within the last month 2. Meet criteria for a current depressive disorder as defined by a score of 12 or more on the PHQ‐9 questionniare. Comorbid anxiety disorders are not exclusion criteria, as long as depression is the primary disorder 3. Meet criteria for mild‐to‐moderate severity of drug dependence, as defined by a score between 0 ? 10 on the Severity of Dependence Questionnaire 4. Have used alcohol, drugs, or methadone maintenance medication within the last month