Life Enhancement Treatment for Substance Use (LETS ACT)

Adults with substance use disorder

Life Enhancement Treatment for Substance Use (LETS ACT) is a behavioral activation treatment that was developed to treat depressive symptoms among low-income individuals with SUD in residential substance use treatment. LETS ACT is modified from the Behavioral Activation Treatment for Depression.

Stacey B. Daughters, PhD

• Email: daughter@unc.edu

Manual Information

There is a manual that describes how to deliver this program.

Child Welfare Outcome: Child/Family Well-Being

What is included in the Relevant Published, Peer-Reviewed Research section? 

• Magidson, J. F., Gorka, S. M., MacPherson, L., Hopko, D. R., Blanco, C., Lejuez, C. W., & Daughters, S. B. (2011).  Examining the effect of the Life Enhancement Treatment for Substance Use (LETS ACT) on residential substance abuse treatment retention. Addictive Behaviors, 36(6), 615–623. https://doi.org/10.1016/j.addbeh.2011.01.016 

  Type of Study: Randomized controlled trial

  Sample:

  Age — Mean=44.78 years

  Participants: 58

  Race/Ethnicity — 90% African American, 5% White, 3% Hispanic, and 2% Other

  Gender — 66% Male

  Status — Participants were adult substance users in residential substance abuse treatment presenting with depressive symptoms.

  Location/Institution: Residential treatment facility in Washington D.C.

  Summary:

  The purpose of the study was to test the efficacy of Life Enhancement Treatment for Substance Use (LETS ACT) compared to a contact-time matched control condition, supportive counseling (SC), examining effects on depressed mood, substance abuse treatment retention, and behavioral activation outcomes. Participants were randomly assigned to either LETS ACT or SC. Measures utilized include the Beck Depression Inventory–II (BDI‑II), Behavioral Activation for Depression Scale (BADS), Circumstances, Motivation, Readiness Scale (CMR), Environmental Reward Observation Scale (EROS), and the Hamilton Depression Rating Scale–7 item version (HAMD‑7). Results indicate that participants in LETS ACT had significantly higher rates of substance abuse treatment retention and significantly greater increases in activation on the BADS compared to those in SC. Both groups had decreased depression severity at posttreatment, although the group by time interaction was not significant. Limitations include the small sample size, high attrition rate, and lack of controlled postintervention follow-up.

  Length of controlled postintervention follow-up: None.

• Daughters, S. B., Magidson, J. F., Anand, D., Seitz-Brown, C. J., Chen, Y., & Baker, S. (2018). The effect of a behavioral activation treatment for substance use on post-treatment abstinence: A randomized controlled trial. Addiction, 113 (3), 535–544. https://doi.org/10.1111/add.14049

  Type of Study: Randomized controlled trial

  Sample:

  Age — Mean=42.7 years

  Participants: 263

  Race/Ethnicity — 95% African American

  Gender — 30% Female

  Status — Participants were patients with substance abuse disorders.

  Location/Institution: Residential substance use treatment center in Northeast Washington, DC.

  Summary:

  The purpose of the study was to compare outcomes for a behavioral activation group treatment for substance use, Life Enhancement Treatment for Substance Use (LETS ACT), versus a time and group size matched control condition delivered in a residential treatment setting. Participants were randomized to either LETS ACT or to a control group that received supportive counseling (SC). All participants also received treatment-as-usual (TAU), consisting of daily group sessions including Alcoholics/ Narcotics Anonymous, 12-step, relapse prevention, spirituality, and drug education. Measures utilized include biochemically verified abstinence (breathalyzer and 5‑panel urine toxicology), the Timeline Follow‑Back Interview (TLFB), Beck Depression Inventory–II (BDI‑II), and the Short Inventory of Problems–Alcohol and Drugs (SIP‑AD). Results indicate that LETS ACT had significantly higher abstinence rates at 3 months, 6 months, and 12 months post-treatment compared with SC. LETS ACT participants reported significantly fewer adverse consequences from substance use at 12 months post-treatment. Treatment condition had no effect on percent of 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. Limitations include reliance on self-report measures and concern for generalizability given study demographics.

  Length of controlled postintervention follow-up: 6 and 12 months.

• Paquette, C. E., Reese, E. D., Yi, J. Y., Maccarone, J. M., Stewart, Z. J., & Daughters, S. B. (2023). Group behavioral activation with and without a smartphone app in intensive outpatient treatment for substance use disorder: A three-arm randomized controlled trial. Drug and Alcohol Dependence, 243, 1–10, Article 109758. https://doi.org/10.1016/j.drugalcdep.2022.109758

  Type of Study: Randomized controlled trial

  Sample:

  Age — Mean=40.29 years

  Participants: 206

  Race/Ethnicity — 54% White/Caucasian, 34% Black/African American, 9% Multiracial/Multiethnic, 2% Native American/American Indian, 2% Other, and 1% Hispanic/Latino

  Gender — 67% Male and 34% Female

  Status — Participants were inpatients with substance abuse disorders (SUD).

  Location/Institution: Intensive outpatient SUD treatment center in Raleigh, North Carolina

  Summary:

  The purpose of the study was to test the effect of Life Enhancement Treatment for Substance Use (LETS ACT) when delivered alongside intensive outpatient SUD treatment-as-usual (TAU), with and without a smartphone app designed to extend access to treatment content outside of clinician-administered sessions. Participants were randomized to LETS ACT +TAU, smartphone-enhanced LETS ACT +TAU (LETS ACT-SE), or TAU with assessments only. All participants received intensive outpatient SUD TAU that consisted of 12 weeks of group therapy for three hours per day, three days per week, weekly individual case management appointments, and up to two optional individual counseling sessions per week. Group sessions did not have a set curriculum, but typically include individual check-ins, psychoeducation, and time to verbally process and share. Measures utilized include the Timeline Follow‑Back Interview (TLFB) and the Short Inventory of Problems–Alcohol and Drugs (SIP‑AD). Results indicate that there is a significant condition x time interaction for substance use days; days of substance use significantly declined from pretreatment until 1 month for TAU, 3 months for LETS ACT-SE, and 6 months for LETS ACT +TAU. Decreases in substance-related problems were maintained across all conditions through 12 months. Limitations include concerns for generalizability given that all participants were inpatients.

   

  Length of controlled postintervention follow-up: 3, 6, and 12 months.

There are currently no references available for Life Enhancement Treatment for Substance Use.