1. Treatment for PTSD and SUD:
Site Differences and Implications for Outcomes
D Hien1, A Campbell1, G Miele2, L Cohen1, & E Nunes2
1Columbia University School of Social Work, 2 Columbia University New York State Psychiatric Institute
Study Context
Results
Many substance-dependent women seeking treatment have been exposed to chronic interpersonal violence and may suffer psychiatric sequelae of trauma in the form of posttraumatic stress disorder (PTSD).
Women with trauma histories and substance use disorders (SUDs) present significant challenges to clinicians, including poorer treatment outcomes, engagement and retention, higher frequency of relapse, use of multiple substances, co-occurring psychiatric diagnoses, and treatment drop-out (Dansky et al.1995, Hien et al., 2000; Zweben et al.1994).
The majority of substance abuse programs do not regularly assess for trauma histories, so women do not receive treatment for comorbid trauma-related problems (Brown et al., 1999).
An integrated model is recommended by both clinicians and researchers as more likely to succeed, more cost-effective, and more sensitive to these patient’s unique needs (Brady et al., 1994; Evans et al., 1995; Najavits et al., 1996; Sullivan & Evans, 1994).
CTN Women and Trauma study took one of the next steps in advancing research in this area through a randomized control trial comparing Seeking Safety (SS) to an attention control group (WHE) in the context of ongoing community-based substance abuse treatment.
Summary
Consistent across sites:
High levels of multiple trauma exposure with clinically significant PTSD symptoms.
High percentage of sexual assaults (range=85%-100%).
High rates of service utilization (i.e. 12 step, medical and mental health visits).
Low overall depression levels, but with clinically significant subgroup with higher depression scores.
Differences across sites:
Types of other traumatic experiences reported.
Types of drugs used and drug diagnosis.
Recruitment success linked to type of CTP population and number of available intakes.
Long Island Node Team
Denise Hien, Lead Investigator Edward Nunes, Node PI
Gloria Miele, Training Director Eva Petkova, Statistician
Lisa Cohen, Protocol Manager Jennifer Lima, Node Coordinator
Aimee Campbell, Project Director David Liu, NIDA Liaison
Participating Sites
Data Analysis Issues
Kirkland, WA
Stamford, CT
Intervention Delivery: weeks in treatment, number and type of treatment received, group size, session length
Therapist: characteristics, adherence level, alliance
Treatment as Usual: gender specific services, trauma services, length, modality
Brooklyn, NY
Columbus, OH
Charleston, SC
Implications/Conclusion
Jacksonville, FL
Though all participants met PTSD and SUD diagnoses as per study inclusion criteria, findings show that within this sample population there was substantial variability across sites in terms of types of trauma exposure, types of drugs used and specific drug use diagnoses.
Clinicians and researchers need to be aware of the potential for such differences when developing or delivering treatment interventions so as to best meet needs of this heterogeneous group.
Miami, FL
Design
Acknowledgements
Measure Description: (1) PTSD Severity - CAPS-Clinician Administered PTSD Scale (Blake et al., 1990), measures frequency and intensity of signs and symptoms of PTSD and overall symptom severity. (2) Substance Use – Addiction Severity Index (ASI, McLellan et al., 1992) alcohol and drug composite scores (includes 30 day use and drug/alcohol problems).
Participation in this study made possible by NIDA CTN Long Island Regional Node (NIDA/NIH Grant U10 DA13035).
We would like to acknowledge the dedicated staff and participants who made this study possible.