Treating Comorbid Major Depressive Disorder and Substance Use Disorder

Substance use disorders (SUDs) and major depressive disorder (MDD) have a bidirectional relationship, where symptoms of one disorder tend to exacerbate the other. Various etiologies may account for this dynamic; because of the complexity of their interrelationship, the co-occurrence of these two disorders necessitates therapeutic approaches to address their transdiagnostic processes simultaneously. This chapter describes the empirical basis and applied practices of motivational interviewing, cognitive behavioral therapy, behavioral activation therapy, and mindfulness-based relapse prevention to address co-occurring SUDs and MDD. Considerations for optimizing treatment outcomes are discussed, such as combining psychotherapy modalities, incorporating screening instruments for SUDs and MDD in settings where they are frequently under-detected, and integrating technology in treatment programs.