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ABSTRACT: Violence against women has been studied in thousands of research articles and books across multiple disciplines. The extraordinary range of subtopics alone makes it difficult for clinicians, teachers, and researchers to form a coherent picture of the phenomenon. This book comprehensively examines and integrates a vast and diverse literature base, drawing from divergent findings to reveal a picture of complexity and of intertwining risk and resilience factors. It is an excellent resource for doctoral dissertations in any of the three major fields covered: adult (female) victimization, substance abuse among women, and mental health issues for women. Readers who work in any of these fields will find this book a provocative and indispensable resource. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
10/2012;
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ABSTRACT: The purpose of this multisite clinical trial was to evaluate the effectiveness of a web-based version of the Community Reinforcement Approach, plus motivational incentives, within community-based, outpatient substance abuse treatment. This ongoing study is being conducted within the National Drug Abuse Treatment Clinical Trials Network, funded by the National Institute on Drug Abuse. Midway through the enrollment of 500 participants, the study is being implemented in 10 treatment programs across the United States. Information is provided on design, sample, intervention and technology, and preliminary lessons learned.
Psychological Services 05/2012; 9(2):212-4. · 1.08 Impact Factor
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Lesia M Ruglass, Gloria M Miele,
Denise A Hien,
Aimee N C Campbell,
Mei-Chen Hu,
Nathilee Caldeira,
Huiping Jiang,
Lisa Litt,
Therese Killeen,
Mary Hatch-Maillette,
Lisa Najavits,
Chanda Brown,
James A Robinson,
Gregory S Brigham,
Edward V Nunes
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ABSTRACT: We examined the association between the therapeutic alliance and treatment outcomes among 223 women with posttraumatic stress disorder (PTSD) and substance use disorders who participated in a multisite clinical trial of group treatments for trauma and addictions in the United States throughout 2004 and 2005. General linear models indicated that women who received Seeking Safety, a cognitive-behavioral treatment, had significantly higher alliance ratings than those in Women's Health Education, a control group. Alliance was related to significant decreases in PTSD symptoms and higher attendance in both interventions. Alliance was not related to substance use outcomes. Implications and limitations of the findings are discussed.
Substance Use & Misuse 04/2012; 47(6):695-707. · 1.10 Impact Factor
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Aimee N C Campbell,
Edward V Nunes, Gloria M Miele,
Abigail Matthews,
Daniel Polsky,
Udi E Ghitza,
Eva Turrigiano,
Genie L Bailey,
Paul VanVeldhuisen,
Rita Chapdelaine,
Autumn Froias,
Maxine L Stitzer,
Kathleen M Carroll,
Theresa Winhusen,
Sara Clingerman,
Livangelie Perez,
Erin McClure,
Bruce Goldman,
A Rebecca Crowell
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ABSTRACT: Computer-assisted interventions hold the promise of minimizing two problems that are ubiquitous in substance abuse treatment: the lack of ready access to treatment and the challenges to providing empirically-supported treatments. Reviews of research on computer-assisted treatments for mental health and substance abuse report promising findings, but study quality and methodological limitations remain an issue. In addition, relatively few computer-assisted treatments have been tested among illicit substance users. This manuscript describes the methodological considerations of a multi-site effectiveness trial conducted within the National Institute on Drug Abuse's (NIDA's) National Drug Abuse Treatment Clinical Trials Network (CTN). The study is evaluating a web-based version of the Community Reinforcement Approach, in addition to prize-based contingency management, among 500 participants enrolled in 10 outpatient substance abuse treatment programs. Several potential effectiveness trial designs were considered and the rationale for the choice of design in this study is described. The study uses a randomized controlled design (with independent treatment arm allocation), intention-to-treat primary outcome analysis, biological markers for the primary outcome of abstinence, long-term follow-up assessments, precise measurement of intervention dose, and a cost-effectiveness analysis. Input from community providers during protocol development highlighted potential concerns and helped to address issues of practicality and feasibility. Collaboration between providers and investigators supports the utility of infrastructures that enhance research partnerships to facilitate effectiveness trials and dissemination of promising, technologically innovative treatments. Outcomes from this study will further the empirical knowledge base on the effectiveness and cost-effectiveness of computer-assisted treatment in clinical treatment settings.
Contemporary clinical trials 11/2011; 33(2):386-95. · 1.51 Impact Factor
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Susan Tross,
Aimee N C Campbell,
Donald A Calsyn,
Lisa R Metsch,
James L Sorensen,
Steven Shoptaw,
Louise Haynes,
George E Woody,
Robert M Malow,
Lawrence S Brown, [......],
Robert E Booth,
Raul N Mandler,
Carmen Masson,
Beverly W Holmes,
Grant Colfax,
Audrey J Brooks,
Denise A Hien,
Bruce R Schackman,
P Todd Korthuis, Gloria M Miele
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ABSTRACT: HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years.
While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs.
While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.
The American Journal of Drug and Alcohol Abuse 09/2011; 37(5):283-93. · 1.55 Impact Factor
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ABSTRACT: Research-based approaches to HIV risk reduction are available but not readily adopted by community-based treatment programs. This exploratory survey study assessed staff (N=116) attitudes as a function of direct research participation, treatment program type, and study performance within seven methadone maintenance and eight psychosocial outpatient substance abuse treatment programs that participated in the NIDA Clinical Trials Network HIV risk reduction trials. Clinical staff who directly participated in the research reported intervention components as useful and were more likely to report perceived increases in HIV testing/referrals compared to staff who did not directly participate. However, those directly involved reported less positive attitudes about clinical impact and research impression. Results suggest a positive influence of research participation on awareness of program services, but also the need to address practical and professional issues related to research collaboration. Effectiveness trials offer a valuable opportunity to assess provider-level factors associated with adoption and implementation.
Journal of drug issues 01/2011; 41(4):441-446. · 0.38 Impact Factor
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Denise A Hien,
Huiping Jiang,
Aimee N C Campbell,
Mei-Chen Hu, Gloria M Miele,
Lisa R Cohen,
Gregory S Brigham,
Carrie Capstick,
Agatha Kulaga,
James Robinson,
Lourdes Suarez-Morales,
Edward V Nunes
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ABSTRACT: The purpose of the analysis was to examine the temporal course of improvement in symptoms of posttraumatic stress disorder (PTSD) and substance use disorder among women in outpatient substance abuse treatment.
Participants were 353 women randomly assigned to 12 sessions of either trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and posttreatment at 1 week and after 3, 6, and 12 months. A continuous Markov model was fit on four defined response categories (nonresponse, substance use response, PTSD response, or global response [improvement in both PTSD and substance use]) to investigate the temporal association between improvement in PTSD and substance use symptom severity during the study's treatment phase. A generalized linear model was applied to test this relationship over the follow-up period.
Subjects exhibiting nonresponse, substance use response, or global response tended to maintain original classification; subjects exhibiting PTSD response were significantly more likely to transition to global response over time, indicating maintained PTSD improvement was associated with subsequent substance use improvement. Trauma-focused treatment was significantly more effective than health education in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions.
PTSD severity reductions were more likely to be associated with substance use improvement, with minimal evidence of substance use symptom reduction improving PTSD symptoms. Results support the self-medication model of coping with PTSD symptoms and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.
American Journal of Psychiatry 11/2009; 167(1):95-101. · 12.54 Impact Factor
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Denise A Hien,
Elizabeth A Wells,
Huiping Jiang,
Lourdes Suarez-Morales,
Aimee N C Campbell,
Lisa R Cohen, Gloria M Miele,
Therese Killeen,
Gregory S Brigham,
Yulei Zhang, [......],
Candace Hodgkins,
Mary Hatch-Maillette,
Chanda Brown,
Agatha Kulaga,
Allison Kristman-Valente,
Melissa Chu,
Robert Sage,
James A Robinson,
David Liu,
Edward V Nunes
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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.
Journal of Consulting and Clinical Psychology 09/2009; 77(4):607-19. · 4.85 Impact Factor
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Susan Tross,
Aimee N C Campbell,
Lisa R Cohen,
Donald Calsyn,
Martina Pavlicova, Gloria M Miele,
Mei-Chen Hu,
Louise Haynes,
Nancy Nugent,
Weijin Gan,
Mary Hatch-Maillette,
Raul Mandler,
Paul McLaughlin,
Nabila El-Bassel,
Paul Crits-Christoph,
Edward V Nunes
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ABSTRACT: Because drug-involved women are among the fastest growing groups with AIDS, sexual risk reduction intervention for them is a public health imperative.
To test effectiveness of HIV/STD safer sex skills building (SSB) groups for women in community drug treatment.
Randomized trial of SSB versus standard HIV/STD Education (HE); assessments at baseline, 3 and 6 months.
Women recruited from 12 methadone or psychosocial treatment programs in Clinical Trials Network of National Institute on Drug Abuse. Five hundred fifteen women with >or=1 unprotected vaginal or anal sex occasion (USO) with a male partner in the past 6 months were randomized.
In SSB, five 90-minute groups used problem solving and skills rehearsal to increase HIV/STD risk awareness, condom use, and partner negotiation skills. In HE, one 60-minute group covered HIV/STD disease, testing, treatment, and prevention information.
Number of USOs at follow-up.
A significant difference in mean USOs was obtained between SSB and HE over time (F = 67.2, P < 0.0001). At 3 months, significant decrements were observed in both conditions. At 6 months, SSB maintained the decrease and HE returned to baseline (P < 0.0377). Women in SSB had 29% fewer USOs than those in HE.
Skills building interventions can produce ongoing sexual risk reduction in women in community drug treatment.
JAIDS Journal of Acquired Immune Deficiency Syndromes 08/2008; 48(5):581-9. · 4.43 Impact Factor
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ABSTRACT: Methods for the training and fidelity monitoring of behavioral interventions in multi-site addictions research are reviewed, including five published studies and seven ongoing studies sponsored by the National Institute on Drug Abuse-funded Clinical Trials Network.
Methods are categorized and reviewed consistent with a technology model of treatment delivery. Topics include: therapist selection, training, certification, and supervision; selection, training, and certification of supervisors; scales and processes used for monitoring of the quality of treatment; and processes followed to provide new training for replacement staff once trials have begun.
The review reveals both a wide array of procedures and emerging standards for multi-site trials. Methodological weakness was observed with respect to limited empirical support for many adherence scales, little or no evaluation of supervisory processes, and no evaluation of re-training practices.
Methods used in multi-site trials are important not only to ensure validity of those trials, but also to inform the wider dissemination of empirically based treatment into community agencies. Studies examining noted weaknesses are needed. Training and fidelity models that delegate responsibility to participating sites appear most relevant for establishing best practices for dissemination of behavioral interventions. The effectiveness of these distributed training and supervision models should be subjected to empirical study at a level of rigor comparable to the evaluation of their corresponding treatments.
Drug and Alcohol Dependence 04/2007; 87(2-3):107-18. · 3.38 Impact Factor
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ABSTRACT: This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.
Drug and Alcohol Dependence 02/2007; 86(1):1-21. · 3.38 Impact Factor
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ABSTRACT: The authors' goal was to compare the efficacy of a manualized cognitive behavior therapy that addresses both posttraumatic stress disorder (PTSD) and substance abuse (seeking safety) with a manualized cognitive behavior therapy that addresses only substance abuse (relapse prevention) and with standard community care for the treatment of comorbid posttraumatic stress disorder (PTSD) and substance use disorder.
One hundred seven women from an urban, low-income population who had comorbid PTSD and substance use disorder were randomly assigned to receive the two kinds of cognitive behavior therapy or received standard community treatment. Participants were recruited from both community and clinical populations and evaluated with structured clinical instruments. Forty-one women received seeking safety therapy, 34 received relapse prevention therapy, and 32 received standard community care.
At the end of 3 months of treatment, participants in both cognitive behavior therapy conditions had significant reductions in substance use, PTSD, and psychiatric symptoms, but community care participants worsened over time. Both groups receiving cognitive behavior therapy sustained greater improvement in substance use and PTSD symptoms at 6-month and 9-month follow-ups than subjects in the community care group.
Seeking safety and relapse prevention are efficacious short-term treatments for low-income urban women with PTSD, substance use disorder, and other psychiatric symptoms.
American Journal of Psychiatry 09/2004; 161(8):1426-32. · 12.54 Impact Factor
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ABSTRACT: A great deal of data implicate parental drug use as a potential risk factor for child abuse; however, theories for understanding the links between maternal drug use and antisocial behavior have yet to be examined empirically. This case-control study investigated correlates of adult antisocial behavior among 279 inner-city mothers in 3 comparison groups: drug abusers (n = 112), depressed mothers (n = 73), and nonsubstance abusing controls (n = 94). Using hierarchical regression techniques and mediational analyses controlling for ethnicity, current depression, and family history of substance abuse, support was provided for an emotion-focused coping style as a link between addictive and antisocial behavior. These results highlight the importance of focusing on emotion regulation models in the prevention and treatment of violence in drug-abusing women.
Psychology of Addictive Behaviors 04/2003; 17(1):49-55. · 2.09 Impact Factor
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ABSTRACT: Evidence suggests that motivation to change may mediate the effect of diagnostic severity on treatment outcome, however, this relationship has not been directly tested. This prospective study tested the mediating effect of motivation to change on the relationship between the severity of DSM-IV substance use disorders at treatment entry and subsequent treatment utilization and substance use. Participants consisted of 150 (89 men and 62 women) alcohol, cocaine, and heroin users entering treatment who completed interviews assessing DSM-IV diagnostic severity (Substance Dependence Severity Scale, SDSS) and substance-specific motivation to change (University of Rhode Island Change Assessment Scale, URICA). All participants were reinterviewed over a 6-month period. DSM-IV alcohol dependence severity predicted less alcohol use and formal treatment use and greater motivation to change and self-help use. Similar associations were demonstrated among cocaine users. Motivation to change alcohol use was not associated with substance use or treatment utilization. The results suggest that alcohol dependence severity has a direct positive effect on motivation to change at treatment entry. However, the effect of alcohol and cocaine dependence severity on treatment utilization and substance use is not mediated by motivation to change substance use at the beginning of a treatment episode.
Addictive Behaviors 27(2):207-25. · 2.09 Impact Factor
