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Attendance and Substance Use Outcomes for the Seeking Safety Program: Sometimes Less is More.

Journal of Consulting and Clinical Psychology 2012;80(1):29-42. [doi: 10.1037/a0026361]

Denise A. Hien, PhD (Columbia University College of Physicians and Surgeons, GNY Node), Antonio A. Morgan-Lopez, PhD (University of North Carolina at Chapel Hill), Aimee N. C. Campbell, MSW, PhD (New York State Psychiatric Institute, GNY Node), Lissette M. Saavedra, PhD (RTI International), Elwin Wu, PhD (Columbia University), Lisa R. Cohen, PhD (New York State Psychiatric Institute, GNY Node), Lesia M. Ruglass, PhD (City College of New York, GNY Node), Edward V. Nunes, MD (Columbia University College of Physicians and Surgeons, GNY Node).

This study uses data from the largest effectiveness trial to date on treatment of co-occurring posttraumatic stress and substance use disorders (National Drug Abuse Treatment Clinical Trials Network protocol CTN-0015), applying advances in statistical methodology to model treatment attendance and membership turnover in rolling groups. Women receiving outpatient substance abuse treatment (N=353) were randomized to 12 sessions of Seeking Safety of a health education control condition (Women's Health Education). Assessments were completed at baseline and at 1 week, 3, 6, and 12 months post-treatment. Outcome measures were alcohol and cocaine use in the prior 30 days captured using the Addiction Severity Index. Latent class pattern mixture modeling (LCPMM) was used to estimate attendance patterns and to test for treatment effects within and across latent attendance patterns and group membership turnover. Across LCPMM analyses for alcohol and cocaine use, similar treatment attendance patterns emerged: Completers never decreased below an 80% probability of attendance, droppers never exceeded a 41% probability of attendance, and titrators demonstrated a 50% to 80% probability of attendance. Among completers, there were significant decreases in alcohol use from baseline to 1-week post-treatment, followed by nonsignificant increases in alcohol during follow-up. No differences between treatment conditions were detected. Titrators in Seeking Safety had lower rates of alcohol use from 1-week through 12-month follow-up compared with control participants. Droppers had nonsignificant increases in alcohol during both study phases. Cocaine use findings were similar but did not reach significant levels.

Conclusions: The impact of client self-modulation of treatment dosage and group membership composition may influence behavioral treatment outcomes among this population. Providers should consider that female patients with comorbid PTSD and SUD may be in the best position to determine when, how often, or which sessions to attend; such perspectives might not only be empowering to patients but more efficacious as well. (Article (Peer-Reviewed), PDF, English, 2012)

Keywords: Alcohol | Cocaine | Community health services | 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 | Journal of Consulting and Clinical Psychology (journal)

Document No: 786, PMID: 22182262, PMCID: PMC3682930.

Submitted by CTN Dissemination Librarians, 12/31/2011

Campbell, Aimee N. C. search mail
Cohen, Lisa R. search mail
Hien, Denise search mail
Morgan-Lopez, Antonio A. search
Nunes, Edward V. search mail
Ruglass, Lesia M. search
Saavedra, Lissette M. search
Wu, Elwin search
NIDA-CTN-0015 search www
Greater New York (Lead) search www
Florida Node Alliance search www
Ohio Valley search www
Pacific Northwest search www
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