Efficacy of Integrative Counselling Versus Cognitive Behavioural Therapy in Treating Comorbid Depression and Substance Use Among Undergraduates in Southern Nigeria

Comorbid depression and substance use among Nigerian undergraduates represents a clinically complex presentation that may respond differentially to integrative versus single-modality counselling approaches. This study compared the efficacy of integrative counselling (combining person-centred, cognitive behavioural, and motivational enhancement components) with standard cognitive behavioural therapy (CBT) in treating comorbid depression and substance use among undergraduates in Southern Nigeria. A randomised controlled trial design was used, with 120 undergraduates from four universities in Anambra, Rivers, Edo, and Ogun States meeting comorbidity criteria randomly allocated to integrative counselling and CBT conditions. Both conditions involved sixteen structured sessions delivered over eight weeks by trained counselling psychologists. The Patient Health Questionnaire-9 (PHQ-9), the Alcohol Use Disorders Identification Test (AUDIT), and the Drug Use Disorders Identification Test (DUDIT) were administered at pre-treatment, post-treatment, and three-month follow-up. Latent growth curve modelling and mixed ANCOVA were applied. Findings demonstrated that both conditions significantly reduced depression and substance use, with integrative counselling producing superior outcomes at post-treatment and equivalent outcomes at follow-up. Therapist alliance, identified as higher in the integrative condition, partially mediated differential outcomes. The study provides original randomised evidence for comorbidity treatment in the Nigerian university context and contributes to the debate on integrative versus manualized counselling approaches. Keywords: integrative counselling, cognitive behavioural therapy, comorbidity, depression, substance use.