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Objective: The current study examined the distinction between primary and secondary depression among substance use patients to test whether the primary depressed subgroup presents to treatment with a unique profile of clinical and vulnerability characteristics. Method: The heterogeneous sample comprised 286 individuals (76% male) with alcohol and/or drug abuse or dependence (according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised) across four treatment outcome studies conducted at the alcohol research center at the Rutgers University Center of Alcohol Studies. Participants were classified as having comorbid lifetime history of primary depression (21%), secondary depression (24%), or no depression (55%). Results: Participants in the primary depression and secondary depression groups were comparable in severity of substance use, and both of these groups had more severe substance use problems than the no-depression group. The primary depression group presented with more severe depression histories, higher levels of current depressive symptoms, and higher rates of additional Axis I comorbidity at treatment entry. In terms of vulnerability indices, the primary depression subgroup had a uniquely high family history risk for major depressive disorder; underlying personality vulnerability to depression was also evident in the primary depression group, with higher neuroticism and lower extraversion relative to secondary depression patients. Conclusions: The findings suggest that careful assessment of lifetime depression symptoms vis-a-vis substance use history and severity yields important information identifying the primary depression subtype of substance use patients as a group with a unique and more severely affected clinical presentation of depression and other Axis I psychopathology relative to secondary depression patients. Effectiveness of substance use interventions may be augmented with depression treatment for primary depression patients, given their more severe clinical presentation and vulnerability characteristics. (J. Stud. Alcohol Drugs, 72, 151-157, 2011), DEPRESSIVE DISORDERS ARE HIGHLY comorbid with drug and alcohol use disorders (i.e., substance use disorders [SUDs]; Grant, 1995; Grant and Hartford, 1995; Grant et al., 1996; Substance Abuse and Mental [...]

A growing body of literature suggests that computerized cognitive-behavioral therapies (CCBT) are effective in community settings in terms of symptom reduction, favorable client satisfaction, attrition comparable to standard cognitive-behavioral therapy, reduced clinician time, high cost-effectiveness, and ease of integration into community clinics. Clinicians report lack of knowledge about computerized programs as the main reason that they have not used CCBT in their practice. To mitigate this disconnect between empirical evidence and dissemination, this article first reviews empirical studies focusing on the efficacy of CCBT for specific psychological disorders, followed by a review of research on the effectiveness of CCBT in community settings. Next, issues related to dissemination and barriers to CCBT adoption by clinicians are discussed. Finally, the implications of CCBT for research and practice and the possible role of CCBT in a stepped care model of treatment is discussed in terms of cost-effectiveness, standards of care, and implications for public policy. Keywords: cognitive-behavioral therapies, computerized applications, treatment effectiveness evaluation, stepped care

This study explored optimization of item-attribute matrices with the linear logistic test model (Fischer, 1973), with optimal models explaining more variance in item difficulty due to identified item attributes. Data were 8th-grade mathematics test item responses of two TIMSS 2007 booklets. The study investigated three categories of attributes (content, cognitive process, and comprehensive cognitive process) at two grain levels (larger, smaller) and also compared results with random attribute matrices. The proposed attributes accounted for most of the variance in item difficulty for two assessment booklets (81% and 65%). The variance explained by the content attributes was very small (13% to 31%), less than variance explained by the comprehensive cognitive process attributes which explained much more variance than the content and cognitive process attributes. The variances explained by the grain level were similar to each other. However, the attributes did not predict the item difficulties of two assessment booklets equally.