Helping Vulnerable Populations: A Comprehensive Review of the Treatment Outcome Literature on Substance Use Disorder and PTSD

Najavits, Lisa M.; Hien, Denise A.

doi:10.1002/jclp.21980

Cited by 193 publications

(181 citation statements)

References 29 publications

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“…Women with a history of trauma are particularly vulnerable to revictimization, sexual abuse, shame, and stigma (Najavits & Hien, 2013). Studies have overwhelmingly demonstrated women with a diagnosis of post-traumatic stress disorder (PTSD) have increased rates of substance abuse and co-morbid psychiatric disorders (Banducci, Hoffman, Lejuez, & Koenen, 2014;Cohen, Field, Campbell, & Hien, 2013;Hien et al, 2010).…”

Section: Screening and Brief Intervention For Adverse Childhood Expermentioning

confidence: 99%

Screening Adults With Substance Use Disorder for Adverse Childhood Experiences

Chandler

Kalmakis²,

Murtha³

2018

UJAN

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Objective: The purpose of this study was to assess the incidence of adverse childhood experiences (ACEs) and the efficacy and feasibility of a trauma-informed screening for ACEs among individuals in a substance use disorder recovery program. Method: Individual interviews, questionnaires, and postinterview survey and reflections were used in this cross-sectional clinical translation project. Descriptive statistics were used to analyze demographics, ACE scores, protective childhood experiences, self-reported diagnoses, and postintervention survey data. Postinterview reflections were reviewed and grouped into common ideas as shared by participants, as well as interesting impressions, insights, and responses to the interviews. Results: Thirty clients participated in the interview process. Among the 29 participants who completed the questionnaires, all reported at least one ACE, and 82.8% reported six or more ACEs. In addition, 96.6% reported experiencing more than four protective factors. Twelve (40%) clients were referred for further mental health counseling after the interviews. Notable findings from the interviews were the general lack of awareness of the relationship between ACEs and current substance use disorder among participants. Gaining knowledge about the impact of ACEs on their recovery seemed to provide a sense of relief and a feeling that they were “normal.” Conclusions: The trauma-informed care approach is intended to promote mindfulness regarding the effect of ACEs on substance abuse in this population. Screening for ACEs is necessary if effective interventions are to be provided, with the goal of improving client outcomes.

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Section: Screening and Brief Intervention For Adverse Childhood Expermentioning

confidence: 99%

Screening Adults With Substance Use Disorder for Adverse Childhood Experiences

Chandler

Kalmakis²,

Murtha³

2018

UJAN

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“…Além disso, outros estudos observaram maior risco de suicídio nos grupos com histórico de consumo múltiplo de substâncias, sugerindo a importância da avaliação de transtornos associados à dependência [26][27][28][29][30] . A vulnerabilidade da população de dependentes quí-micos demanda tratamento especializado, que deve ser adequado às particularidades de cada caso, a depender da gravidade da dependência, da aceitação do paciente, da presença de comorbidades e do perfil sociodemográfico 31,32 . As formas de tratamento disponíveis vão desde o tratamento ambulatorial na atenção básica, nos Centros de Reabilitação Psicossocial e nos grupos de ajuda mútua, até a internação, seja ela voluntária ou involuntária, em hospitais gerais, hospitais psiquiátricos, clínicas especializadas e em comunidades terapêuticas 31,33 .…”

Section: Introductionunclassified

Perfil sociodemográfico e comorbidades psiquiátricas em dependentes químicos acompanhados em comunidades terapêuticas

Danieli

Ferreira

Nogueira

et al. 2017

J. bras. psiquiatr.

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RESUMOObjetivos: Analisar o perfil sociodemográfico, antecedentes pessoais/familiares e a prevalência de comorbidades psiquiátricas em uma amostra de dependentes de álcool e/ou substâncias psicoativas (SPAs) acompanhados em duas comunidades terapêuticas. Métodos: Trata-se de um estudo de prevalência, com coleta de dados realizada em uma amostra de 90 entrevistados por meio da aplicação de uma ficha de dados sociodemográficos/antecedentes pessoais e familiares e do Mini International Neuropsychiatric Interview versão Plus (MINI Plus). Os entrevistados foram divididos em três grupos: etilistas (grupo A), dependentes de SPAs ilícitas (Grupo B) e dependentes de álcool e SPAs ilícitas (grupo C). Resultados: Observou-se prevalência elevada de comorbidades psiquiátricas (88,8%) e, em específico, do transtorno depressivo maior (TDM) no grupo A (36,7%) e do transtorno de personalidade antissocial nos grupos B e C (46,7% e 30%, respectivamente). Foi possível traçar perfis pró-prios para cada grupo, havendo convergência quanto aos dados sociodemográficos para os grupos A e C e entre os grupos B e C para as comorbidades psiquiátricas. Conclusão: A vulnerabilidade sociodemográfica e a alta prevalência de comorbidades psiquiátricas denotam a fragilidade da população de dependentes químicos. Os perfis próprios de cada grupo evidenciam a importância de tratamento individualizado. ABSTRACTObjectives: Analyze the sociodemographic profile, personal/family antecedents and the prevalence of psychiatric comorbidities in a sample of alcohol and/or psychoactive substances (PAS) accompanied in two therapeutic communities. Methods: This is a prevalence study, having gathered data from a sample with 90 interviewee through a form with sociodemographic/personal/family antecedents data and the Mini International Neuropsychiatric Interview (MINI Plus). The interviewee were divided in three groups: alcohol dependent (group A), illicit PAS dependents (group B) and alcohol and illicit PAS (group C). Results: A high prevalence of psychiatric comorbidities (88.8%) and, specifically, the major depressive disorder (MDD) in group A (36.7%) and antisocial personality disorder in groups B and C

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“…PTSD is known to influence treatment adherence rates, with higher levels of PTSS being predictive of both lower adherence to treatment, and lower treatment retention (Najavits & Hien, 2013;Kubiak, 2004) Furthermore, higher levels of PTSS predict substance use relapse (Norman, Take, Anderson, & Brown, 2007;Ford, Hawke, Alessi, Ledgerwood, & Petry, 2007). This influence on treatment and relapse makes PTSD prohibitive of successful SUD treatment, especially as time spent in treatment is one of the only known predictors of treatment success in drug and alcohol rehabilitation (Hubbard, Craddock, & Anderson, 2003).…”

Section: Treating Ptsd and Sud Concurrentlymentioning

confidence: 99%

“…In a review of comorbid PTSD and SUD treatment programs, Seeking Safety was deemed largely efficacious (Najavits & Hien, 2013). The authors note that Seeking Safety does not worsen symptoms of either SUD or PTSD, and in many instances the symptoms of both SUD and PTSD improve.…”

Section: Treating Ptsd and Sud Concurrentlymentioning

confidence: 99%

“…Although Seeking Safety has been evaluated in long term and residential programs, those programs were not specifically identified as TCs (Najavits & Hien, 2013 (Stalker, Palmer, Wright, & Gebotys, 2005). Furthermore, 48% of participants showed clinically significant change in PTSS at 12 months post discharge, and 39% of participants showed a clinically significant change in global symptom severity.…”

Section: Concurrent Treatment In the Therapeutic Communitymentioning

confidence: 99%

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Posttraumatic stress disorder in a therapeutic community for substance use disorders: an evaluation of the influence

Perryman¹

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The purpose of this body of research is twofold. First, to investigate posttraumatic stress disorder (PTSD) in a sample of adults undergoing substance use disorder (SUD) treatment in a therapeutic community (TC) and, second, to apply major psychological theories to help understand the nature of this comorbidity in ways that inform treatment. The focal theories of this research are: emotion dysregulation (Gratz & Roemer, 2004), and revised Reinforcement Sensitivity Theory (rRST; Corr, 2008;Gray & McNaughton, 2000). Rash Impulsiveness will be included as an important dimension of rRST that has been consistently linked to substance misuse. Chapter 1 presents an overview of research related to the thesis as a whole. In Chapter .72, p < .00). Furthermore, the correlations between PTSS and two of the facets of rRST, BAS and fight-flight-freeze sensitivity (FFFS), were significantly correlated (r = -.23 and .49, p < .01, respectively). BAS sensitivity was shown to negatively correlate with PTSS, indicating that lower BAS sensitivity related to higher PTS severity. No relationship was found between the Behavioural Inhibition System (BIS) and PTSS. Finally, Rash Impulsivity significantly correlated with PTSS at intake, r = .50, p < .00. Contrary to hypotheses, and previous research, Rash Impulsivity did not significantly correlate with retention. Theoretical mechanisms linking PTSS and substance misuse were investigated further, with tests of theoretical models in which individual difference factors (facets of the rRST) were related to retention and outcomes from treatment, and facets of emotional dysregulation were tested as mediators of this relationship. Upon investigation through linear regression, no suitable variable was found the mediate the relationship between PTSS and retention.iii The final moderated mediated model, therefore, was not suitable for this population. Limited moderation, though, occurred between the two facets of rRST and retention. Specifically, investigation of the simple slopes showed that FFFS and Rash Impulsivity both moderate the relationship between PTSD and retention at high (+1 SD) and mean scores. These findings indicate that high levels of both facets do interact with PTSD to negatively influence treatment retention.The null findings for both mediation and the moderated mediation model contradict previous research, and may be due to homogeneity in scores across the population. Overall, some implications for treatment can be extrapolated. First, PTSD is highly prevalent in the TC population, and should be assessed using psychometrically valid measures, such as the PCL-C, and addressed in treatment. Second, treatment for SUD does not exacerbate PTSD; on the contrary, PTSS significantly decreased during TC treatment. Finally, as there is solid theoretical support to suggest an influence of emotion dysregulation and Rash Impulsiveness on retention and outcomes, more research needs to be conducted on the role of these two constructs with the intent of creating a better suited rehabi...

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Helping Vulnerable Populations: A Comprehensive Review of the Treatment Outcome Literature on Substance Use Disorder and PTSD

Cited by 193 publications

References 29 publications

Screening Adults With Substance Use Disorder for Adverse Childhood Experiences

Screening Adults With Substance Use Disorder for Adverse Childhood Experiences

Perfil sociodemográfico e comorbidades psiquiátricas em dependentes químicos acompanhados em comunidades terapêuticas

Posttraumatic stress disorder in a therapeutic community for substance use disorders: an evaluation of the influence

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