Background and aims: Women with histories of interpersonal violence (IPV) experience high levels of posttraumatic stress disorder (PTSD), problematic substance use, and repeat victimization. Previous systematic reviews considering the effectiveness of integrated trauma-specific treatments to address PTSD and substance use have lacked subgroup analysis by gender or trauma type. Furthermore, mindfulness-based interventions for treating both issues together are under-researched. It is unclear what treatment components and contextual factors impacting implementation work best for women with IPV experiences. This narrative review examines a range of quantitative and qualitative data to explore: for which groups of women do integrated interventions work (subgroups)? How (mechanisms of action), and/or under what contexts (factors external to the intervention)? Methodology: A two-staged search strategy identified eligible studies. This process identified 20 controlled trials reporting on the effectiveness of psychological or mindfulness-based interventions for PTSD and substance use and 39 relevant supplementary information related to the trials. Narrative synthesis using thematic analysis was conducted on manuscripts identified in both stages. Findings: Safe social support and ongoing risks of violence were identified as contextual factors which may affect treatment outcomes, requiring attention by researchers and treatment providers. Whilst there was some evidence that reduced PTSD correlates with substance use decrease, there may be more than one pathway to substance use reduction among women with PTSD, requiring a focus on emotional regulation. Other 'active mechanisms' included different modalities of coping skills and support to rebuild connection with self and others. Lack of supplementary studies for trials involving past-focused treatment precluded detailed discussion of these models. Conclusions: Integrated PTSD and substance use treatment which teaches extensive coping skills to promote external safety, symptom stabilisation, and emotional regulation, combined with access to safe social support and external advocacy, may be particularly useful for women with more severe PTSD, or for those experiencing ongoing victimization for whom past-focused treatments are contraindicated. Long-term support and organisational trauma-informed practice in substance use treatment services should also be promoted.

The present study evaluates data from 116 forensic inpatients who underwent violent risk assessments, which included the Historical, Clinical, Risk-20 (HCR-20), from 2006 to 2013 as part of an opportunity to be conditionally discharged from state forensic facilities. Of the 116 inpatients, 58 were never released, 39 were released and returned to a hospital, and 19 were released and never returned. Results from analyses of variance and multinomial logistic regression found the risk management (R) scale of the HCR-20 successfully predicted group membership in that higher scores were associated with a greater likelihood of not being released from a forensic facility or returning to a forensic facility after release. The results of this study indicate that clinicians should consider community-based risk variables when evaluating forensic patients for potential return to the community. This research demonstrates that clinicians failing to fully consider dynamic risk factors associated with community integration jeopardize the quality and thoroughness of their violence risk assessment with regards to readiness for release. Copyright © 2016 John Wiley & Sons, Ltd.

Introduction and aims: The high prevalence of women experiencing co-occurring substance use, interpersonal abuse, and symptoms of post-traumatic stress disorder (PTSD) has led to international calls for trauma-specific substance use treatments and wider trauma-informed practice. The aim of this study was to explore how services in England have developed practice responses with limited historical precedence for this work. Design and Methods: A purposive sample of 14 practitioners from substance use, interpersonal violence and criminal justice services were chosen for their integrated practice. Semi-structured interviews exploring their understanding of the co-occurring issues, staged treatment models and wider traumainformed practice, and the challenges associated with this. Thematic analysis was employed. Results: Three key interlinking themes were identified: practitioners' philosophical approach; tailored clinical practice, and system responsiveness. Analyses identified the importance of relational, non-pathologising practice, extensive focus on physical and emotional safety, and cautionary approaches towards using trauma-specific treatments involving trauma disclosure. Challenges included poor service integration, time-limited treatments and tokenistic trauma informed practice. Discussion: Practitioners from across disciplines emulated important components of trauma-informed practice and promoted a 'safety-first' approach reliant on multi-agency working and wider system responses. Trauma-specific interventions required skilled and experienced practitioners, and longer treatment programmes comprising first stage work. Conclusions: In the context of limited gender-responsive substance use treatment in the UK, practitioners demonstrated integrated practice that supported the recommended staged PTSD model and trauma-informed practice. Organisational leadership and support from service commissioners and funders are recommended to promote growth of this approach across the UK. ARTICLE HISTORY