Twelve-Month Outcomes of Trauma-Informed Interventions for Women With Co-occurring Disorders

Harvard University, Cambridge, Massachusetts, United States
Psychiatric Services (Impact Factor: 2.41). 11/2005; 56(10):1213-22. DOI: 10.1176/
Source: PubMed


Women with co-occurring mental health and substance use disorders frequently have a history of interpersonal violence, and past research has suggested that they are not served effectively by the current service system. The goal of the Women, Co-occurring Disorders, and Violence Study was to develop and test the effectiveness of new service approaches specifically designed for these women.
A quasi-experimental treatment outcome study was conducted from 2001 to 2003 at nine sites. Although intervention specifics such as treatment length and modality varied across sites, each site used a comprehensive, integrated, trauma-informed, and consumer-involved approach to treatment. Substance use problem severity, mental health symptoms, and trauma symptoms were measured at baseline, and follow-up data were analyzed with prospective meta-analysis and hierarchical linear modeling.
A total of 2,026 women had data at the 12-month follow-up: 1,018 in the intervention group and 1,008 in the usual-care group. For substance use outcomes, no effect was found. The meta-analysis demonstrated small but statistically significant overall improvement in women's trauma and mental health symptoms in the intervention relative to the usual-care comparison condition. Analysis of key program elements demonstrated that integrating substance abuse, mental health, and trauma-related issues into counseling yielded greater improvement, whereas the delivery of numerous core services yielded less improvement relative to the comparison group. A few person-level characteristics were associated with increases or decreases in the intervention effect. These neither moderated nor supplanted the effects of integrated counseling.
Outcomes for women with co-occurring disorders and a history of violence and trauma may improve with integrated treatment.

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Available from: Hortensia Amaro, Oct 06, 2015
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    • "Promising effects of integrated treatments for PTSD and alcohol use have been found (Back, Brady, Sonne, & Verduin, 2006; Back et al., 2012; Hien, Campbell, Ruglass, Hu, & Killeen, 2010), although generalizability is limited by small sample sizes, high attrition, absence of control groups, or lack of standardization across protocols. Studies also have found that integrated treatments are not more effective than standard alcohol treatments or health education controls (Cohen & Hien, 2006; Hien et al., 2009; Morrissey et al., 2005). Combined treatments are lengthy and complex, which can create challenges when working in low-resource settings where session attendance may be more problematic. "
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    ABSTRACT: We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.
    American Indian and Alaska native mental health research (Online) 10/2015; 22(3):1-20.
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    • "), longstanding and effective efforts to address IPV (Bair- Merritt et al., 2014; Garc ıa-Moreno et al., 2014; Ghandour, Campbell, & Lloyd, 2014; MacMillan et al., 2009; Miller et al., 2011; Ramsay, Rivas, & Feder, 2005); successful treatments for PTSD and complex PTSD (Cloitre et al., 2012; Engel et al., 2008; U.S. Department of Veterans Affairs National Center for PTSD, 2015; van der Kolk et al., 2014); interventions with adults to ameliorate the impact of adverse childhood experiences (Sikkema et al., 2007; Toussaint, VanDeMark, Bornemann, & Graeber, 2007), and models of trauma-informed care in other settings and with other populations (Gilbert et al., 2009; Morrissey et al., 2005). Based on a review of the literature and input by experts from the national strategy group, we developed an approach to TIPC that defines trauma broadly, addresses both recent and lifelong trauma, and includes an essential focus on provider support and well-being (Figure 1). "
    Women s Health Issues 05/2015; 25(3):193-197. DOI:10.1016/j.whi.2015.03.008 · 1.61 Impact Factor
    • "1269) Treatment to address mental health and trauma issues is an important component of blood borne virus prevention among sex workers (Surratt et al., 2012). Moreover, given the high rate of trauma reported by both male and female sex workers, integrated treatment that addresses both substance misuse and trauma (Cocozza et al., 2005; Morrissey et al., 2005) may be useful . Despite the high prevalence of mental health issues among male sex workers, we could find no research on the efficacy of interventions to address mental health among male sex workers. "
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    ABSTRACT: This study estimates the past year prevalence of and factors associated with sex trading (offering sex for money, drugs or something else) among 1796 men and women presenting to 342 drug misuse treatment agencies in England, and identifies service development and delivery implications. Secondary analysis of baseline data from a prospective cohort was conducted. Short Form-12 measured mental and physical wellbeing, psychiatric diagnoses were self-reported and the circumstances, motivation and readiness tool assessed readiness for/pressure to enter treatment. Logistic regression models determined associations with sex trading separately by sex. Inverse probability population weights were calculated, utilising demographics from the National Drug Treatment Monitoring System and agency specific data collection windows. The estimated prevalence rate of sex trading in the past 12 months was 5.1% (15.0% for women and 2.1% for men). For women, adjusted models identified crack use (aOR 1.83, 95% CI 1.22-2.74, p=0.004), previous treatment (aOR 3.00, 95% CI 1.31-6.86, p=0.010) and greater readiness for treatment (aOR 1.12, 95% CI 1.01-1.24, p=0.027) as independently associated with sex trading. For men, lower mental wellbeing (aOR 0.97, 95% CI 0.94-0.99, p=0.030) was independently associated and marginal effects were identified for syringe sharing (aOR 2.89, 95% CI 0.94-8.86, p=0.064) and unprotected sex (aOR 2.23, 95% CI 0.95-5.26, p=0.065). Sex trading among drug misusers is associated with additional health risks and specific treatment needs. Given the scale of the problem it is important that treatment providers have the competencies to adequately address the issue and provide accessible and appropriate services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and alcohol dependence 04/2015; 152. DOI:10.1016/j.drugalcdep.2015.04.017 · 3.42 Impact Factor
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