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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,
Study Context
2 Columbia
Results
Therapist Characteristics
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).
Variable
Age
Race: % White
Yrs Formal Education
Yrs of Drug Tx Exp
Yrs at Program
Clients w/ Trauma Hx: %
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).
M/%
39.9
58.3
17.2
6.9
4.4
71.9
Range Across Sites
Counselors Supervisors
N=18
N=18
25 – 51
30 – 58
50.0
66.7
6 – 20
16 – 22
1 – 10
0 – 20
1 – 11
1 – 17
10 – 90
30 – 100
Summary
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).
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.
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.
Long Island Node Team
Denise Hien, Lead Investigator
Gloria Miele, Training Director
Lisa Cohen, Protocol Manager
Aimee Campbell, Project Director
University New York State Psychiatric Institute
Edward Nunes, Node PI
Eva Petkova, Statistician
Jennifer Lima, Node Coordinator
David Liu, NIDA Liaison
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.
Participating Sites
Data Analysis Issues
Kirkland, WA
Stamford, CT
Brooklyn, NY
Columbus, OH
Charleston, SC
Jacksonville, FL
Miami, FL
Design
Sample Characteristics (N=353)
Variable
a
Age
Race: White (%)
Yrs Educationb
c
Married : (%)
Lifetime Convictions
Chronic Medical Problemsd: % yes
Mental Health Visits 30de
12-Step Attendancef
g
CAPS Total Score
BSI Depression Subscaleh
a
b
M (SD) / %
38.9 (9.8)
56.0
12.5 (2.5)
15.0
5.2 (9.3)
Range Across Sites
32.3 – 46.4
8.8 – 97.1
11.6 – 13.2
0 – 40.0
1.6 – 11.8
45
10.4 (9.6)
16.1 (12.7)
26 – 86
5.4 – 19.1
4.7 – 24.4
56.4 (17.5)
6.7 (5.1)
45.6 – 66.9
4.1 – 8.1
c
d
Chi-sq=73.9(6), p-value<0.001; Chi-sq =48.1(6), p-value<0.001; Chi-sq=73.7(30), p-value<0.001;
;e
f
g
Chi-sq=20.1(6), p-value=0.003 Chi-sq =96.2(6), p-value<0.001; Chi-sq =57.7(6), p-value<0.001; Chih
sq =31.8(6), p-value<.001; Chi-sq=18.9(6), p-value<0.001
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).
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
Implications/Conclusion
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.
Acknowledgements
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.