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Marsh TN, Eshakakogan C, Eibl JK, Spence M, Morin KA, Goertzen A, Gauthier GJ, Gauthier-Frolick D, Tahsin F, Sayers CD, Ozawanimke CA, Bissaillion CB, Nootchtai CC, Marsh DC. Implementation and evaluation of a two-eyed seeing approach using traditional healing and seeking safety in an indigenous residential treatment program in Northern Ontario. Int J Circumpolar Health 2022; 81:2125172. [PMID: 36149060 PMCID: PMC9518291 DOI: 10.1080/22423982.2022.2125172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Indigenous clients in need of residential care for substance use disorders (SUD) often present with the diagnosis of substance use disorder (SUD) combined with intergenerational trauma (IGT) or both. SUD is exceedingly prevalent amongst Indigenous peoples due to the health impacts of colonisation, residential school trauma, and IGT on this population’s health. We evaluated the effectiveness of a Two-Eyed Seeing approach in a four-week harm reduction residential treatment programme for clients with a history of SUD and IGT. This treatment approach blended Indigenous Healing practices with Seeking Safety based on Dr. Teresa Marsh’s research work known as Indigenous Healing and Seeking Safety (IHSS). The data presented in this study was drawn from a larger trial. This qualitative study was undertaken in collaboration with the Benbowopka Treatment Centre in Blind River, Northern Ontario, Canada. Patient characteristic data were collected from records for 157 patients who had enrolled in the study from April 2018 to February 2020. Data was collected from the Client Quality Assurance Survey tool. We used the qualitative thematic analysis method to analyse participants’ descriptive feedback about the study. Four themes were identified: (1) Motivation to attend treatment; (2) Understanding Benbowopka’s treatment programme and needs to be met; (3) Satisfaction with all interventions; and (4) Moving forward. We utilised a conceptualised descriptive framework for the four core themes depicted in the medicine wheel. This qualitative study affirmed that cultural elements and the SS Western model were highly valued by all participants. The impact of the harm reduction approach, coupled with traditional healing methods, further enhanced the outcome. This study was registered with clinicaltrials.gov (identifier number NCT0464574).
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Affiliation(s)
- T N Marsh
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | | | - J K Eibl
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.,Sudbury, ON, Canada
| | - M Spence
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - K A Morin
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.,Sudbury, ON, Canada.,Markham, ON, Canada
| | - A Goertzen
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - G J Gauthier
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | | | - F Tahsin
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | | | | | | | | | - D C Marsh
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.,Sudbury, ON, Canada.,Markham, ON, Canada.,Batchewana First Nation, ON, Canada
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Morgan-López AA, Hien DA, Saraiya TC, Saavedra LM, Norman SB, Killeen TK, Simpson TL, Fitzpatrick S, Mills KL, Ruglass LM, Back SE, López-Castro T. Estimating posttraumatic stress disorder severity in the presence of differential item functioning across populations, comorbidities, and interview measures: Introduction to Project Harmony. J Trauma Stress 2022; 35:926-940. [PMID: 35124864 PMCID: PMC9844237 DOI: 10.1002/jts.22800] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 01/19/2023]
Abstract
Multiple factor analytic and item response theory studies have shown that items/symptoms vary in their relative clinical weights in structured interview measures for posttraumatic stress disorder (PTSD). Despite these findings, the use of total scores, which treat symptoms as though they are equally weighted, predominates in practice, with the consequence of undermining the precision of clinical decision-making. We conducted an integrative data analysis (IDA) study to harmonize PTSD structured interview data (i.e., recoding of items to a common symptom metric) from 25 studies (total N = 2,568). We aimed to identify (a) measurement noninvariance/differential item functioning (MNI/DIF) across multiple populations, psychiatric comorbidities, and interview measures simultaneously and (b) differences in inferences regarding underlying PTSD severity between scale scores estimated using moderated nonlinear factor analysis (MNLFA) and a total score analog model (TSA). Several predictors of MNI/DIF impacted effect size differences in underlying severity across scale scoring methods. Notably, we observed MNI/DIF substantial enough to bias inferences on underlying PTSD severity for two groups: African Americans and incarcerated women. The findings highlight two issues raised elsewhere in the PTSD psychometrics literature: (a) bias in characterizing underlying PTSD severity and individual-level treatment outcomes when the psychometric model underlying total scores fails to fit the data and (b) higher latent severity scores, on average, when using DSM-5 (net of MNI/DIF) criteria, by which multiple factors (e.g., Criterion A discordance across DSM editions, changes to the number/type of symptom clusters, changes to the symptoms themselves) may have impacted severity scoring for some patients.
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Affiliation(s)
| | - Denise A. Hien
- Center for Alcohol Studies, Rutgers University–Piscataway, Piscataway, New Jersey, USA
| | - Tanya C. Saraiya
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Sonya B. Norman
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California–San Diego, San Diego, California, USA
| | - Therese K. Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Tracy L. Simpson
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | | | | | - Lesia M. Ruglass
- Department of Psychology, City College of New York, New York, New York, USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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Hien D, Kropp F, Wells EA, Campbell A, Hatch-Maillette M, Hodgkins C, Killeen T, Lopez-Castro T, Morgan-Lopez A, Ruglass LM, Saavedra L, Nunes EV. The "Women and Trauma" study and its national impact on advancing trauma specific approaches in community substance use treatment and research. J Subst Abuse Treat 2021; 112S:12-17. [PMID: 32220405 DOI: 10.1016/j.jsat.2020.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/02/2020] [Accepted: 02/08/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The "Women and Trauma" Study (WTS) conducted in the National Drug Abuse Treatment Clinical Trials Network (CTN-0015) resulted in research publications, presentations, and a train-the-trainer workshop to support dissemination efforts for skills-based trauma treatment in substance use community treatment. Twelve years after its completion, this paper aims to examine whether and how the WTS contributed to knowledge in the field of trauma and addictions and inspired community treatment programs (CTPs) to train staff to identify and provide trauma-related services. METHOD We present findings from two different analyses that explored longer term study impacts on treatment and dissemination: (1) a post-study site survey covering 4 domains from 4/7 programs that participated in delivering the WTS to evaluate their perceptions of study impact on their treatment community; and (2) an analysis of citations of its publications to determine impact on the scientific community. RESULTS Surveys from responding sites indicated that participation in the study significantly increased their agencies'' awareness of the need to take a focused approach to treating trauma issues in this population. Specifically, these sites increased their commitment to using skills-based trauma treatment with the study's target population of female patients with SUD and trauma histories, as well as expanding it to other groups affected by trauma. Citation analysis revealed that according to the Web of Science, as of August 2019, the number of citations of 24 CTN-0015 articles, ranged from 1 to 135 (Mean = 20, SD = 33; Median = 6). Four of the most influential are discussed. CONCLUSIONS This manuscript provides original information about the contributions of the WTS study, demonstrating how the study contributed to serving women with trauma in community substance use treatment.
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Affiliation(s)
- Denise Hien
- Center of Alcohol & Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick, Piscataway, NJ, United States of America.
| | - Frankie Kropp
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States of America
| | - Elizabeth A Wells
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - Aimee Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, United States of America
| | - Mary Hatch-Maillette
- University of Washington Alcohol & Drug Abuse Institute, Department of Psychiatry & Behavioral Sciences, Seattle, WA, United States of America
| | | | - Therese Killeen
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Teresa Lopez-Castro
- Psychology Department, The City College of New York, New York, NY, United States of America
| | - Antonio Morgan-Lopez
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, United States of America
| | - Lesia M Ruglass
- Center of Alcohol & Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick, Piscataway, NJ, United States of America
| | - Lissette Saavedra
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, United States of America
| | - Edward V Nunes
- Department of Psychiatry, Columbia University Irving Medical Center and Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, United States of America
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Saavedra LM, Morgan-López AA, Hien DA, Killeen TK, Back SE, Ruglass LM, Fitzpatrick S, Lopez-Castro T. Putting the Patient Back in Clinical Significance: Moderated Nonlinear Factor Analysis for Estimating Clinically Significant Change in Treatment for Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:454-466. [PMID: 33175470 DOI: 10.1002/jts.22624] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022]
Abstract
The present study introduced a modernized approach to Jacobson and Truax's (1991) methods of estimating treatment effects on individual-level (a) movement from the clinical to the normative range and (b) reliable change on posttraumatic stress disorder (PTSD) severity. Participants were 450 trauma-exposed women (M age = 39.2 years, SD = 8.9, range: 18-65 years) who presented to seven geographically diverse community mental health and substance use treatment centers. Data from 53 of these women, none of whom met the criteria for full or subthreshold PTSD, were used to establish the normative range. Using moderated nonlinear factor analysis (MNLFA) scale scoring, which weights symptoms by their clinical relevance, a significantly larger proportion of participants moved into the normative range for PTSD severity scores and/or exhibited reliable changes after treatment compared to the same individuals' movement when using symptom counts. Further, approximately 24% of the participants showed discrepant judgments on reliable change indices (RCI) between MNLFA scores and symptom counts, likely due to the false assumption that the standard error of measurement is equal for all levels of underlying PTSD severity when estimating RCIs with symptom counts. An MNLFA approach to estimating underlying PTSD severity can provide clinically meaningful information about individual-level change without the de facto assumption that PTSD symptoms have equivalent weight. Study implications are discussed with regard to a joint emphasis on (a) measurement models that highlight differential symptom weighting and (b) treatment-arm differences in individual-level outcomes rather than the current overemphasis of treatment-arm differences on group-averaged trajectories.
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Affiliation(s)
| | | | - Denise A Hien
- Center of Alcohol Studies, Rutgers University-New Brunswick, New Brunswick, New Jersey, USA
| | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lesia M Ruglass
- Department of Psychology, The City College of New York, New York, New York, USA.,Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, New Jersey, USA
| | | | - Teresa Lopez-Castro
- Department of Psychology, The City College of New York, New York, New York, USA
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Crisanti AS, Murray-Krezan C, Reno J, Killough C. Effectiveness of Peer-Delivered Trauma Treatment in a Rural Community: A Randomized Non-inferiority Trial. Community Ment Health J 2019; 55:1125-1134. [PMID: 31338716 PMCID: PMC6744517 DOI: 10.1007/s10597-019-00443-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/25/2019] [Indexed: 11/26/2022]
Abstract
This randomized controlled non-inferiority trial explored the effectiveness of Seeking Safety (SS) delivered by peer providers compared to its delivery by licensed behavioral health clinicians. The study enrolled 291 adults with PTSD and/or substance use disorders. Data were collected at 3 and 6-months post start of treatment. With respect to long-term outcomes, at 6 months PTSD symptoms decreased by 5.1 points [95% CI (- 9.0, - 1.1)] and by 4.9 points [95% CI (- 8.6, - 1.1)] and coping skills increased by 5.5 points [95% CI (0.4, 10.6)] and by 5.6 points [95% CI (0.8, 10.4)], in the peer- and clinician-led groups, respectively. This study demonstrated non-inferiority of peer-delivered SS compared to clinician-delivered SS for reducing PTSD symptoms and similar outcomes for both groups with respect to coping skills. A confirmatory study on the effectiveness of peer-delivered trauma-specific services is warranted, especially given the potential for increasing access to such treatment in underserved rural communities.
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Affiliation(s)
- Annette S Crisanti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, MSC 09 5030, Albuquerque, NM, 87131, USA.
| | | | - Jessica Reno
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, MSC 09 5030, Albuquerque, NM, 87131, USA
| | - Cynthia Killough
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, MSC 09 5030, Albuquerque, NM, 87131, USA
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Yaghubi M, Zargar F. Effectiveness of Mindfulness-based Relapse Prevention on Quality of Life and Craving in Methadone-treated Patients: A Randomized Clinical Trial. ADDICTION & HEALTH 2019; 10:250-259. [PMID: 31263524 PMCID: PMC6593172 DOI: 10.22122/ahj.v10i4.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Quality of life (QOL) is always considered as a final consequence of clinical trials, interventions, and health care. The results of studies indicate that addiction leads to lower QOL. However, studies have been conducted on the effectiveness of mindfulness-based interventions on improving QOL. The aim of this study was to investigate the efficacy of mindfulness-based relapse prevention (MBRP) on QOL and craving in methadone-treated patients. Methods This study was conducted in Qom, Iran, in 2017. A sample of 70 methadone-treated patients were randomly selected and assigned to two groups (intervention and control). Participants in both groups completed the 36-item Short Form (SF-36) QOL Questionnaire and Craving Beliefs Questionnaire (CBQ) at the beginning of the study (pre-test), 8 weeks after the study (post-test), and two months after the study (follow up). In this study, the experimental group received 8 training sessions on mindfulness prevention, while the control group did not receive general information about addiction and did not receive any psychological intervention. Finally, data of 63 patients were analyzed with the SPSS software, chi-square test, t-test, and repeated-measures ANOVA. Findings The results of repeated-measures ANOVA showed that there was no significant difference between intervention and control groups in the pre-test, but MBRP in the intervention group significantly increased the scores of QOL and decreased the scores of craving, significantly (P < 0.001). Conclusion The findings of present study indicate that MBRP training can increase the psychological and physical health in dependent methadone-treated patients and decrease craving. These findings suggest that mindfulness training can be used as an effective intervention for improving QOL and reducing craving.
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Affiliation(s)
- Mehdi Yaghubi
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Zargar
- Associate Professor, Department of Psychiatry, School of Medicine AND Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Is Integrated CBT Effective in Reducing PTSD Symptoms and Substance Use in Iraq and Afghanistan Veterans? Results from a Randomized Clinical Trial. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9931-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Korotana LM, Dobson KS, Pusch D, Josephson T. A review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences. Clin Psychol Rev 2016; 46:59-90. [DOI: 10.1016/j.cpr.2016.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 02/18/2016] [Accepted: 04/17/2016] [Indexed: 12/18/2022]
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Fernández-Montalvo J, López-Goñi JJ, Arteaga A. Psychological, physical, and sexual abuse in addicted patients who undergo treatment. JOURNAL OF INTERPERSONAL VIOLENCE 2015; 30:1279-1298. [PMID: 24992952 DOI: 10.1177/0886260514539843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study explored the prevalence of a history as victims of abuse among patients who sought outpatient treatment for drug addiction. A sample of 252 addicted patients was assessed. Information was collected on the patients' lifetime history of abuse (psychological, physical, and/or sexual abuse), sociodemographic factors, consumption factors, psychopathological factors, and personality variables. Drug-addicted patients who present a lifelong history of abuse were compared with patients who were not abused. Of the total sample, 46% of the patients (n = 115) who were addicted to drugs had been victims of abuse. There was a statistically significant difference between the victimization rates of men (37.8%) and women (79.6%). Moreover, for some variables, significant differences were observed between patients who had been abused and those who had not. Compared with patients who had not been abused, the addicted patients with a history of victimization scored significantly higher on several European Addiction Severity Index, Millon Clinical Multiaxial Inventory-II, and maladjustment variables but not on the Symptom Checklist-90-Revised. The current results indicate that patients who present a lifelong history of abuse exhibit both a more severe addiction than patients who were not abused and several comorbidities. The implications of these results for further research and clinical practice are discussed.
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The Comorbidity of PTSD and MDD: Implications for Clinical Practice and Future Research. BEHAVIOUR CHANGE 2015. [DOI: 10.1017/bec.2014.26] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The high prevalence of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) comorbidity is well established, with comorbidity rates often between 30 and 50%. However, despite the high prevalence of this comorbidity, very few researchers have explored specific treatments for individuals who present with comorbid PTSD and MDD. Further, there has not been explicit examination of the mechanisms through which MDD influences trauma-focused therapy. As individuals with comorbid PTSD and MDD often present with a more chronic course of impairment and in some instances, a more delayed response to treatment, the need for such research is imperative. It will be proposed that there is merit in targeting depression within the treatment of comorbid PTSD and MDD. Accordingly, in this article we review explanations for the high PTSD and MDD comorbid relationship and highlight variables likely to explain such comorbidity. Theoretical accounts for how depression impedes optimal recovery from PTSD and the associated empirical findings are illustrated. We consequently argue that there is a need to develop and test treatments that target both PTSD and MDD symptoms. Directions for future research are highlighted.
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Wolff N, Huening J, Shi J, Frueh BC, Hoover DR, McHugo G. Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men. J Anxiety Disord 2015; 30:66-80. [PMID: 25617774 PMCID: PMC4620997 DOI: 10.1016/j.janxdis.2014.10.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 11/17/2022]
Abstract
A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n=230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n=142) or by preference (n=88) to receive SS or M-TREM, with a waitlist group of (n=93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co-morbid PTSD and addiction problems.
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Affiliation(s)
- Nancy Wolff
- Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, 176 Ryders Lane, New Brunswick, NJ 08901, United States.
| | - Jessica Huening
- Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, 176 Ryders Lane, New Brunswick, NJ 08901, United States
| | - Jing Shi
- Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, 176 Ryders Lane, New Brunswick, NJ 08901, United States
| | - B Christopher Frueh
- Department of Psychology, University of Hawaii, 200 W. Kawili St., Hilo, HI 96720, United States; The Menninger Clinic, Houston, TX 12303, United States
| | - Donald R Hoover
- Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, 176 Ryders Lane, New Brunswick, NJ 08901, United States
| | - Gregory McHugo
- Dartmouth Psychiatric Research Center, The Geisel School of Medicine at Dartmouth, United States
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Cognitive processing therapy for veterans with comorbid PTSD and alcohol use disorders. Addict Behav 2014; 39:420-7. [PMID: 24035644 DOI: 10.1016/j.addbeh.2013.08.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/25/2013] [Accepted: 08/14/2013] [Indexed: 11/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUD) frequently present comorbidity in veteran populations. Traditionally those with alcohol dependence have been excluded from PTSD treatment outcome studies, thus we do not know how those with alcohol dependence may tolerate or respond to PTSD-specific interventions; no studies to date have examined the extent to which cognitive PTSD interventions are tolerated or effective for those with comorbid PTSD/AUD. The present study examines the extent to which CPT is tolerated by and effective in treating PTSD symptoms for veterans with PTSD and AUD, as compared to veterans with PTSD only in an outpatient treatment setting. Data were obtained through chart review of 536 veterans diagnosed with PTSD who had received at least 1 session of CPT at a Midwestern US Veterans Affairs hospital. Nearly half (n=264, 49.3%) of the veterans in the study exhibited a current or past AUD diagnosis. Participants were grouped into the following diagnostic groups: current AUD (past 12 months), past AUD (prior to 12 months), and no AUD. Participants completed an average of 9 sessions of CPT with no significant difference between AUD diagnostic groups on the number of CPT sessions completed. Individuals with past AUD had higher initial symptoms of self-reported PTSD symptoms than those with no AUD. All groups reported significant reductions in PTSD symptoms and depression over time. Overall, the results suggest that CPT appears well tolerated among veterans with comorbid AUD and is associated with significant reductions in symptoms of PTSD and depression in an outpatient treatment setting.
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Najavits LM, Hien D. Helping vulnerable populations: a comprehensive review of the treatment outcome literature on substance use disorder and PTSD. J Clin Psychol 2013; 69:433-79. [PMID: 23592045 DOI: 10.1002/jclp.21980] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We review treatment studies for comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD). Results show positive outcomes on multiple domains. Most models had more effect on PTSD than SUD, suggesting SUD is harder to treat. Seeking Safety (SS) is the most studied model. It shows positive outcomes, and is the only treatment outperforming a control on both PTSD and SUD. Partial-dose SS had more mixed results than the full dose. This first-generation of PTSD/SUD research addresses complex samples excluded from "gold standard" PTSD-alone literature. Treatments for PTSD/SUD are generally longer than PTSD-alone treatments and present-focused, emphasizing stabilization and coping. The few models with past-focused (exposure-based) components also incorporated present-focused approaches for these vulnerable clients. We discuss public health perspectives to advance the field.
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Affiliation(s)
- Lisa M Najavits
- VA Boston Healthcare System, 150 South Huntington Ave., 116-B, Boston, MA 02130, USA.
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Morgan-Lopez AA, Saavedra LM, Hien DA, Campbell AN, Wu E, Ruglass L. Synergy between seeking safety and twelve-step affiliation on substance use outcomes for women. J Subst Abuse Treat 2013; 45:179-89. [PMID: 23558158 PMCID: PMC4153737 DOI: 10.1016/j.jsat.2013.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 01/16/2013] [Accepted: 01/28/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Recovery Management paradigm provides a conceptual framework for the examination of joint impact of a focal treatment and post-treatment service utilization on substance abuse treatment outcomes. We test this framework by examining the interactive effects of a treatment for comorbid PTSD and substance use, Seeking Safety, and post-treatment Twelve-Step Affiliation (TSA) on alcohol and cocaine use. METHOD Data from 353 women in a six-site, randomized controlled effectiveness trial within the NIDA Clinical Trials Network were analyzed under latent class pattern mixture modeling. LCPMM was used to model variation in Seeking Safety by TSA interaction effects on alcohol and cocaine use. RESULTS Significant reductions in alcohol use among women in Seeking Safety (compared to health education) were observed; women in the Seeking Safety condition who followed up with TSA had the greatest reductions over time in alcohol use. Reductions in cocaine use over time were also observed but did not differ between treatment conditions nor were there interactions with post-treatment TSA. CONCLUSIONS Findings advance understanding of the complexities for treatment and continuing recovery processes for women with PTSD and SUDs, and further support the chronic disease model of addiction.
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Kok T, de Haan HA, van der Meer M, Najavits LM, DeJong CAJ. Efficacy of "seeking safety" in a Dutch population of traumatized substance-use disorder outpatients: study protocol of a randomized controlled trial. BMC Psychiatry 2013; 13:162. [PMID: 23735118 PMCID: PMC3679962 DOI: 10.1186/1471-244x-13-162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 05/22/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Traumatic experiences and, more specifically, posttraumatic stress disorder (PTSD) are highly prevalent among substance use disorder (SUD) patients. This comorbidity is associated with worse treatment outcomes in substance use treatment programs and more crisis interventions. International guidelines advise an integrated approach to the treatment of trauma related problems and SUD. Seeking Safety is an integrated treatment program that was developed in the United States. The aim of the current study is to test the efficacy of this program in the Netherlands in an outpatient SUD population. METHODS/DESIGN A randomized controlled trial (RCT) will be used to test the efficacy of Seeking Safety compared to Cognitive Behavioral Therapy (CBT) in a population of SUD outpatients. Each treatment will consist of 12 group sessions. The primary outcome measure will be substance use severity. Secondary outcome measures are PTSD and trauma symptoms, coping skills, functioning, and cognitions. Questionnaires will be administered at the start of treatment, at the end of treatment (three months after the start of treatment) and at follow-up (six months after the start of treatment). DISCUSSION This study protocol presents a RCT in which the efficacy of an integrated treatment for comorbid PTSD and SUD, Seeking Safety, is evaluated in a SUD outpatient population compared to CBT. It is expected that the intervention group will show significantly more improvement in substance use severity compared to the control group at end-of-treatment and at follow-up. Furthermore, a lower drop-out rate is expected for the intervention group. If the intervention proves to be effective, it can be implemented. A cost-effectiveness analysis will be conducted to evaluate the two treatments. TRIAL REGISTRATION The protocol for this study is registered with the Netherlands Trial Register with number NTR3084 and approved by the local medical ethical committee (METC\11270.haa).
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Affiliation(s)
- Tim Kok
- Tactus Addiction Treatment, P.O. box 154, 7400 AD, Deventer, The Netherlands.
| | - Hein A de Haan
- Tactus Addiction Treatment, P.O. box 154, Deventer, 7400 AD, The Netherlands,Nijmegen Institute for Scientist Practitioners in Addiction, P.O. box 6909, Nijmegen, 6503 GK, The Netherlands
| | | | - Lisa M Najavits
- Boston University School of Medicine, 28 Westbourne Road, Newton Centre, MA, USA
| | - Cor AJ DeJong
- Nijmegen Institute for Scientist Practitioners in Addiction, P.O. box 6909, Nijmegen, 6503 GK, The Netherlands,Radboud University Nijmegen, P.O. box 9102, Nijmegen, 6500 HC, The Netherlands
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McCauley JL, Killeen T, Gros DF, Brady KT, Back SE. Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment. ACTA ACUST UNITED AC 2012; 19. [PMID: 24179316 DOI: 10.1111/cpsp.12006] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are prevalent and frequently co-occur. Comorbid PTSD/SUD is associated with a more complex and costly clinical course when compared with either disorder alone, including increased chronic physical health problems, poorer social functioning, higher rates of suicide attempts, more legal problems, increased risk of violence, worse treatment adherence, and less improvement during treatment. In response, psychosocial treatment options have increased substantially over the past decade and integrated approaches - treatments that address symptoms of both PTSD and SUD concurrently -are fast becoming the preferred model for treatment. This paper reviews the prevalence, etiology and assessment practices as well as advances in the behavioral and pharmacologic treatment of comorbid PTSD and SUDs.
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Ruzek JI, Rosen RC, Marceau L, Larson MJ, Garvert DW, Smith L, Stoddard A. Online self-administered training for post-traumatic stress disorder treatment providers: design and methods for a randomized, prospective intervention study. Implement Sci 2012; 7:43. [PMID: 22583520 PMCID: PMC3405469 DOI: 10.1186/1748-5908-7-43] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 05/14/2012] [Indexed: 11/10/2022] Open
Abstract
This paper presents the rationale and methods for a randomized controlled evaluation of web-based training in motivational interviewing, goal setting, and behavioral task assignment. Web-based training may be a practical and cost-effective way to address the need for large-scale mental health training in evidence-based practice; however, there is a dearth of well-controlled outcome studies of these approaches. For the current trial, 168 mental health providers treating post-traumatic stress disorder (PTSD) were assigned to web-based training plus supervision, web-based training, or training-as-usual (control). A novel standardized patient (SP) assessment was developed and implemented for objective measurement of changes in clinical skills, while on-line self-report measures were used for assessing changes in knowledge, perceived self-efficacy, and practice related to cognitive behavioral therapy (CBT) techniques. Eligible participants were all actively involved in mental health treatment of veterans with PTSD. Study methodology illustrates ways of developing training content, recruiting participants, and assessing knowledge, perceived self-efficacy, and competency-based outcomes, and demonstrates the feasibility of conducting prospective studies of training efficacy or effectiveness in large healthcare systems.
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Affiliation(s)
- Josef I Ruzek
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
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18
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Searcy V, Lipps A. The Effectiveness of Seeking Safety on Reducing PTSD Symptoms in Clients Receiving Substance Dependence Treatment. ALCOHOLISM TREATMENT QUARTERLY 2012. [DOI: 10.1080/07347324.2012.663304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Vicki Searcy
- a School of Social Work, Abilene Christian University , Abilene , Texas , USA
| | - Alan Lipps
- a School of Social Work, Abilene Christian University , Abilene , Texas , USA
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Boden MT, Kimerling R, Jacobs-Lentz J, Bowman D, Weaver C, Carney D, Walser R, Trafton JA. Seeking Safety treatment for male veterans with a substance use disorder and post-traumatic stress disorder symptomatology. Addiction 2012; 107:578-86. [PMID: 21923756 DOI: 10.1111/j.1360-0443.2011.03658.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS To determine whether substituting Seeking Safety (SS), a manualized therapy for comorbid substance use disorders (SUD) and post-traumatic stress disorder (PTSD) for part of treatment-as-usual (TAU) improves substance use outcomes. DESIGN Randomized controlled effectiveness trial. SETTINGS Out-patient Veterans Administration Health Care System SUD clinic. PARTICIPANTS Ninety-eight male military Veterans with a SUD and co-occurring PTSD symptomatology. MEASUREMENTS Drug and alcohol use and PTSD severity, measured on the first day of treatment, and 3 (i.e. the planned end of SS sessions) and 6 months following the baseline assessment. Treatment attendance and patient satisfaction were measured following treatment (3-month follow-up). Active coping was measured at treatment intake and following treatment. FINDINGS SS compared to TAU was associated with better drug use outcomes (P < 0.05), but alcohol use and PTSD severity decreased equally under both treatments (P's < 0.01). SS versus TAU was associated with increased treatment attendance, client satisfaction and active coping (all P's < 0.01). However, neither these factors nor decreases in PTSD severity mediated the effect of treatment on drug use. CONCLUSIONS The manualized treatment approach for substance use disorder, Seeking Safety, is well received and associated with better drug use outcomes than 'treatment as usual' in male veterans with post-traumatic stress disorder. However, the mechanism of its effect is unclear.
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Affiliation(s)
- Matthew Tyler Boden
- Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA.
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20
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van Dam D, Vedel E, Ehring T, Emmelkamp PMG. Psychological treatments for concurrent posttraumatic stress disorder and substance use disorder: a systematic review. Clin Psychol Rev 2012; 32:202-14. [PMID: 22406920 DOI: 10.1016/j.cpr.2012.01.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 12/21/2011] [Accepted: 01/30/2012] [Indexed: 11/16/2022]
Abstract
This article gives an overview of research into psychological treatments for concurrent posttraumatic stress disorder (PTSD) and substance used disorder (SUD), with a special focus on the effectiveness of treatments addressing both disorders compared to treatments addressing one of the disorders alone. In addition, a distinction is made between trauma-focused versus non-trauma-focused therapies for concurrent PTSD and SUD. The databases Embase, Psychinfo, Medline and Web of science were searched for relevant articles. In total, seventeen studies were identified evaluating ten treatments protocols (six trauma-focused and four non-trauma-focused treatment approaches). In general, the studies showed pre-post reductions for PTSD and/or SUD symptoms. Although most treatments for concurrent PTSD and SUD did not prove to be superior to regular SUD treatments, there are some promising preliminary results suggesting that some patients might benefit from trauma-focused interventions. However, the lack of methodologically sound treatment trials makes it difficult to draw firm conclusions. Methodological limitations are discussed, along with recommendations for future research.
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Affiliation(s)
- Debora van Dam
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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21
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Therapist training in empirically supported treatments: a review of evaluation methods for short- and long-term outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 38:254-86. [PMID: 21656256 DOI: 10.1007/s10488-011-0360-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Therapist training efforts have been assessed using several outcomes. A model for evaluating therapist training in empirically supported treatments is presented, adapted from Kirkpatrick's (in: Craig and Bittel (eds.) Training and development handbook, 1967) training evaluation model. The adapted framework includes short-term outcomes, such as reactions to training and changes in attitude, knowledge, or skills, and longer-term outcomes, such as changes in therapist behavior in practice or client outcomes. Evaluation methods for these outcomes are reviewed, with information on their validity, reliability, and feasibility. An agenda for further research to improve therapist training evaluation is presented, with discussion of how evaluation can inform other areas of the field.
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Web-Based Intervention for Returning Veterans with Symptoms of Posttraumatic Stress Disorder and Risky Alcohol Use. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2011; 41:237-246. [PMID: 25378713 DOI: 10.1007/s10879-011-9173-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A substantial number of military personnel who have served in Iraq (Operation Iraqi Freedom; OIF) and Afghanistan (Operating Enduring Freedom; OEF) develop symptoms of posttraumatic stress disorder (PTSD) in response to their military experiences and many of these same individuals will drink in a risky or problematic manner following deployment. If left untreated, PTSD symptoms and alcohol problems can become chronic and have a significant, negative impact on the lives of veterans, their families and communities. Further, OIF and OEF service members are often reluctant to seek treatment for mental health symptoms or alcohol problems secondary to stigma. In order to reach this population it is essential that new strategies and venues for delivering evidence-based care are explored. Web-based interventions are uniquely suited to this cohort of veterans in that they have the potential to reach a significant number of veterans who commonly use the Web and who might not otherwise receive care. This article will review the prevalence of PTSD and alcohol problems among OIF and OEF veterans, common barriers they experience with accessing care in traditional mental health settings, and what is known about the effectiveness of Web-based approaches for PTSD and alcohol problems. It also describes the components of a new Web-based intervention, developed by the authors, that uses motivational enhancement and cognitive-behavioral strategies to intervene with returning veterans who report PTSD symptoms and problem drinking. Recommendations for future directions in working with returning veterans with PTSD and alcohol problems will be offered.
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Abstract
Cognitive behavioral therapy (CBT) for substance use disorders has shown efficacy as a monotherapy and as part of combination treatment strategies. This article provides a review of the evidence supporting the use of CBT, clinical elements of its application, novel treatment strategies for improving treatment response, and dissemination efforts. Although CBT for substance abuse is characterized by heterogeneous treatment elements such as operant learning strategies, cognitive and motivational elements, and skills-building interventions, across protocols several core elements emerge that focus on overcoming the powerfully reinforcing effects of psychoactive substances. These elements, and support for their efficacy, are discussed.
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Affiliation(s)
- R Kathryn McHugh
- Department of Psychology, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215, USA.
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24
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Abstract
PTSD and substance use disorder (SUD) are highly prevalent among veterans returning from Iraq and Afghanistan (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF). Seeking Safety (SS) is a cognitive-behavioral psychotherapy for co-occurring PTSD/SUD. This pilot study with fourteen male OEF/OIF veterans suggests that SS may help to reduce alcohol use, PTSD, and depression in some participants at clinically significant levels, even when providing less than half of the full model. We emphasize several SS features as especially helpful: the case management component to help engage clients in further mental health and SUD care, offering PTSD as an entry point, and emphasis on community resources. Issues particular to veterans include reintegration to civilian life and supporting their connection with other veterans.
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Disseminating evidence-based treatments for PTSD in organizational settings: A high priority focus area. Behav Res Ther 2009; 47:980-9. [DOI: 10.1016/j.brat.2009.07.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hien DA, Wells EA, Jiang H, Suarez-Morales L, Campbell ANC, Cohen LR, Miele GM, Killeen T, Brigham GS, Zhang Y, Hansen C, Hodgkins C, Hatch-Maillette M, Brown C, Kulaga A, Kristman-Valente A, Chu M, Sage R, Robinson JA, Liu D, Nunes EV. Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. J Consult Clin Psychol 2009; 77:607-19. [PMID: 19634955 PMCID: PMC2795638 DOI: 10.1037/a0016227] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors compared the effectiveness of the Seeking Safety group, cognitive-behavioral treatment for substance use disorder and posttraumatic stress disorder (PTSD), to an active comparison health education group (Women's Health Education [WHE]) within the National Institute on Drug Abuse's Clinical Trials Network. The authors randomized 353 women to receive 12 sessions of Seeking Safety (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment 1 week and 3, 6, and 12 months posttreatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS), the PTSD Symptom Scale-Self Report (PSS-SR), and a substance use inventory (self-reported abstinence and percentage of days of use over 7 days). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively) but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline. Study results do not favor Seeking Safety over WHE as an adjunct to substance use disorder treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions.
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Affiliation(s)
- Denise A Hien
- Department of Psychology, City University of New York, City College of New York, New York, NY 10030, USA.
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Cucciare MA, Weingardt KR, Villafranca S. Using blended learning to implement evidence-based psychotherapies. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1468-2850.2008.00141.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Covington SS, Burke C, Keaton S, Norcott C. Evaluation of a Trauma-Informed and Gender-Responsive Intervention for Women in Drug Treatment. J Psychoactive Drugs 2008; Suppl 5:387-98. [DOI: 10.1080/02791072.2008.10400666] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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29
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Brown VB, Najavits LM, Cadiz S, Finkelstein N, Heckman JP, Rechberger E. Implementing an evidence-based practice: Seeking Safety Group. J Psychoactive Drugs 2008; 39:231-40. [PMID: 18159776 DOI: 10.1080/02791072.2007.10400609] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This article presents findings from a multisite study on adopting and implementing an evidence-based practice, Seeking Safety, for women with co-occurring disorders and experiences of physical and sexual abuse. It focuses on what implementation decisions different sites made to optimize the compatibility of Seeking Safety with the site's needs and experiences and on issues posed by Rogers (1995) as relevant to successful diffusion of an innovative practice. A total of 157 clients and 32 clinicians reported on satisfaction with various aspects of the model. Cross-site differences are also examined. Results show that Seeking Safety appears to be an intervention that clinicians perceive as highly relevant to their practice, and one that adds value. Clients perceive the treatment as uniquely touching on their needs in a way that previous treatments had not.
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Affiliation(s)
- Vivian B Brown
- PROTOTYPES, Centers for Innovation in Health, Mental Health, and Social Services, Los Angeles, CA, USA.
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30
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Schneider R, Cronkite R, Timko C. Lifetime physical and sexual abuse and substance use treatment outcomes in men. J Subst Abuse Treat 2008; 35:353-61. [PMID: 18342478 DOI: 10.1016/j.jsat.2008.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 01/15/2008] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
Abstract
Although lifetime physical and sexual abuse are common among substance use disorder (SUD) patients, few studies have examined the impact of abuse on treatment outcomes, particularly for men. Men with lifetime physical (n = 49), sexual (n = 49), or no abuse (n = 117) history were assessed at entry to outpatient SUD treatment and at 6 and 12 months postintake. Men with a history of physical or sexual abuse had more severe drug problems at intake, but by 6 months, there were no group differences in drug use. However, relative to men without an abuse history, men with a sexual abuse history had more severe psychiatric problems at all three time points and were more likely to report significant suicidality at intake and 6 months. Findings suggest that men with a history of sexual abuse benefit from SUD treatment, but additional intervention may be warranted to remedy persisting psychiatric distress.
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Affiliation(s)
- Renee Schneider
- Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, CA 94025, USA.
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31
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Najavits LM, Gallop RJ, Weiss RD. Seeking safety therapy for adolescent girls with PTSD and substance use disorder: a randomized controlled trial. J Behav Health Serv Res 2007; 33:453-63. [PMID: 16858633 DOI: 10.1007/s11414-006-9034-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This randomized, controlled trial evaluated a manualized psychotherapy, Seeking Safety (SS), for posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in adolescent females. To our knowledge, no prior study has evaluated any psychotherapy designed for this population. SS was compared to treatment as usual (TAU) for 33 outpatients, at intake, end-of-treatment, and 3 months follow-up. SS evidenced significantly better outcomes than TAU in a variety of domains at posttreatment, including substance use and associated problems, some trauma-related symptoms, cognitions related to SUD and PTSD, and several areas of pathology not targeted in the treatment (e.g., anorexia, somatization). Effect sizes were generally in the moderate to high range. Some gains were sustained at follow-up. SS appears a promising treatment for this population, but needs further study and perhaps additional clinical modification.
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