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Pathways to Change: Use Trajectories Following Trauma-Informed Treatment of Women with Co-Occurring Post-Traumatic Stress Disorder and Substance Use Disorders.

Drug and Alcohol Review 2015;34(3):242-251. [doi: 10.1111/dar.12230]

Teresa López-Castro, PhD, Mei-Chen Hu, PhD, Santiago Papini, MA, Lesia M. Ruglass, PhD, Denise A. Hien, PhD (all from City College of New York and Columbia University, GNY Node).

Despite advances toward integration of care for women with co-occurring substance use disorder (SUD) and post-traumatic stress disorder (PTSD), low abstinence rates following SUD/PTSD treatment remain the norm. The utility of investigating distinct substance use trajectories is a critical innovation in the detection and refining of effective interventions for this clinical population. The present study reanalyzed data from the largest randomized clinical trial to date for co-occuring SUD and PTSD in women (National Drug Abuse Treatment Clinical Trials Network protocol CTN-0015, "Women's Treatment for Trauma and Substance Use Disorders"). Randomized participants (n=353) received one of two interventions in addition to treatment as usual for SUD: 1) trauma-informed integrative treatment for PTSD/SUD (Seeking Safety); or 2) an active control psychoeducation course on women's health (Women's Health Education).

The present study utilized latent growth mixture models (LGMM) with multiple groups to estimate women's substance use patterns during the 12-month follow-up period. Findings provided support for three different trajectories of substance use in the post-treatment year: 1) consistently low likelihood and use frequency; 2) consistently high likelihood and use frequency; and 3) high likelihood and moderate use frequency. Covariate analyses revealed improvement in PTSD severity was associated with membership in a specific substance use trajectory, although receiving trauma-informed treatment was not. Additionally, SUD severity, age, and after-care efforts were shown to be related to trajectory membership.

Conclusions: Findings highlight the necessity of accounting for heterogeneity in post-treatment substance use, relevance of trauma-informed care in SUD recovery, and benefits of incorporating methodologies like LGMM when evaluating SUD treatment outcomes. For women dually diagnosed with PTSD and SUD, the current study established the presence of several varied cilnical presentations linked to substance use following treatment, each with potentially different needs, vulnerabilities, and strengths. Results of this study also point to opportunities for tailing interventions to the specific clinical presentation and potential impact of these choices on a woman's trajectory of recovery. (Article (Peer-Reviewed), PDF, English, 2015)

Keywords: Co-occurring disorders | CTN platform/ancillary study | Gender-specific interventions | Post-traumatic stress disorder (PTSD) | Seeking Safety program | Trauma | Women | Women's Health Education program | Drug and Alcohol Review (journal)

Document No: 1134, PMID: 25735200.

Submitted by CTN Dissemination Librarians, 3/11/2015.


Hien, Denise A. mail
Hu, Mei-Chen
López-Castro, Teresa mail
Papini, Santiago mail
Ruglass, Lesia M. mail
NIDA-CTN-0015 www

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Supported by a grant from the National Institute on Drug Abuse to the University of Washington Alcohol and Drug Abuse Institute.
The materials on this site have neither been created nor reviewed by NIDA.
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