We compared the effectiveness of Seeking Safety (SS), an integrated cognitive behavioral treatment for substance use disorder (SUD) and post-traumatic stress disorder (PTSD), to an active comparison health education group (Women's Health Education [WHE]) within NIDA's Clinical Trials Network. We randomized 353 women to receive 12 sessions of SS (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment at post-treatment and 3-, 6-, and 12-months post-treatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS) and PTSD Symptom Scale-Self Report (PSS-SR), and substance use (self-reported abstinence in the prior 7 days and days per week of any substance use). 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, when 46% of participants were abstinent. Study results do not favor SS over WHE as an adjunct to SUD treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript in community based drug treatment, revealing a significant need for therapeutic approaches that can address adverse psychiatric consequences (e.g., Shore, Vollmer, & Tatum, 1989;Breslau, Davis, Andreski, & Peterson, 1991;Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). Yet, treatment research in this area remains limited.Quasi-experimental and small controlled studies (i.e., Finkelstein et al., 2004) suggest that a services model integrating cognitive behavioral treatment for trauma with substance abuse services can result in modest improvements in outcome (e.g., Amaro et al., 2007;Morrissey et al., 2005). For PTSD without co-occurring substance abuse, cognitive behavioral approaches have shown evidence of efficacy (e.g., Cloitre, Koenen, Cohen, & Han, 2002;Foa, Rothbaum, & Riggs, 1991). There has been concern, however, that discomfort aroused by focusing on the trauma could be harmful in substance dependent patients, who might escalate substance use or flee treatment. At the same time, the demand for specific interventions for patients with trauma and substance abuse has been mounting in community-based treatment systems (Cohen, Dickow, Horner, Zweben, & Balabis, 2003;Morrissey et al.).To address this need, Najavits (2002) developed Seeking Safety (SS), anintegrated cognitive behavioral treatment of PTSD and substance use disorder. Thus far, SS has been researched in various studies including a multisite controlled trial with homeless women veterans (Desai, Harpaz-Rotem, Najavits, & Rosenheck, 2008); two randomized control trials with low-income urban women and adolescent girls (Hien, Cohen, Miele, Litt & Capstick, 2004;Najavits, Gallop, & Weiss, 2006);...

Objective-The purpose of the analysis was to examine the temporal course of improvement in Posttraumatic Stress Disorder (PTSD) and substance use disorder symptoms among women in outpatient substance abuse treatment.Method-Participants were 353 women randomized to 12 sessions of trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and at 1-week, 3-, 6-, and 12-months post treatment. A continuous Markov model was fit on participants' four defined responder categories (non-responder, substance use responder, PTSD responder or global responder [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 follow-up.Results-Non-responders, substance use responders and global responders tended to maintain original classification; PTSD responders were significantly more likely to transition to global responders over time, indicating maintained PTSD improvement was associated with subsequent substance use improvement. Trauma-focused treatment was significantly more effective in achieving substance use improvement compared to the health education group, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions.Conclusions-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 symptomatology.

Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition ϫ Time interactions nor Site ϫ Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude.

In this article, we present key lessons that we have learned from (1) a long program of research on an empirically supported treatment, brief strategic family therapy (BSFT), and (2) our ongoing research and training efforts related to transporting BSFT to the front lines of practice. After briefly presenting the rationale for working with the family when addressing behavior problems and substance abuse in adolescent populations, particularly among Hispanic adolescents, we summarize key findings from our 30-year program of research. The article closes by identifying barriers to the widespread adoption of empirically supported treatments and by presenting current work within the National Institute on Drug Abuse's Clinical Trials Network that attempts to address these barriers and obstacles.

Acculturative stress in relation to anxiety symptoms has not been examined empirically in young Hispanic populations. The present study, conducted with 138 pre-adolescent Hispanic youngsters, investigated this relationship. The findings suggested that acculturative stress was related to physiological, concentration, and worrisome symptoms of anxiety. After decomposing acculturative stress, it became evident that perceived discrimination accounted for a large proportion of the variance in the relationship between acculturative stress and anxiety. Immigration-related stress was mostly associated with worry symptoms. Finally, total daily hassles were an independent predictor of concentration and physiological anxiety symptoms. Implications for prevention interventions and future research are discussed.

The psychometric properties of the Acculturative Stress Inventory for Children (ASIC) were examined with a sample of 139 Hispanic children. This self-report instrument was studied using the items of the Societal, Attitudinal, Familial, and Environmental Acculturative Stress Scale for Children (SAFE-C; Chavez, Moran, Reid, & Lopez, 1997), which had face validity for acculturative stress. The psychometric properties of the ASIC were examined by conducting an exploratory principal-axis factor analysis, which yielded a two-factor solution. The first factor includes 8 items assessing perceived discrimination and the 4 items of the second factor measure immigration-related experiences. Evidence of internal consistency and test-retest reliability for the 2 factors and the total scale were found to be adequate. In addition, sufficient estimates of convergent, discriminant, and predictive validity were obtained. Implications for future research of acculturative stress in children involving the ASIC are discussed.

Underrepresentation in clinical trials limits the extent to which ethnic minorities benefit from advances in substance abuse treatment. The objective of this article is to share the knowledge gained within the Clinical Trials Network (CTN) of the National Institute on Drug Abuse and other research on recruiting and retaining ethnic minorities into substance abuse clinical trials. The article includes a discussion of two broad areas for improving inclusion— community involvement and cultural adaptation. CTN case studies are included to illustrate three promising strategies for improving ethnic minority inclusion: respondent-driven sampling, community-based participatory research, and the cultural adaptation of the recruitment and retention procedures. The article concludes with two sections describing a number of methodological concerns in the current research base and our proposed research agenda for improving ethnic minority inclusion that builds on the CTN experience.

Despite the fact that the number of Hispanic individuals in need of treatment for substance use problems is increasing internationally, no studies have investigated the extent to which therapists can provide empirically supported treatments to Spanish-speaking clients with adequate fidelity. Twenty-three bilingual Hispanic therapists from five community outpatient treatment programs in the United States were randomly assigned to deliver either three sessions of motivational enhancement therapy (MET) or an equivalent number of drug counseling-as-usual sessions (CAU) in Spanish to 405 Spanish-speaking clients randomly assigned to these conditions. Independent ratings of 325 sessions indicated the adherence/competence rating system had good to excellent interrater reliability and indicated strong support for an a priori defined fundamental MET skill factor. Support for an advanced MET skill factor was relatively weaker. The rating scale indicated significant differences in therapists' MET adherence and competence across conditions. These findings indicate that the rating system has promise for assessing the performance of therapists who deliver MET in Spanish and suggest that bilingual Spanish-speaking therapists from the community can be trained to implement MET with adequate fidelity and skill using an intensive multisite training and supervision model.