Modifications to the Trauma Recovery and Empowerment Model (TREM) for substance‐abusing women with histories of violence: Outcomes and lessons learned at a Colorado substance abuse treatment center

Toussaint, Danielle W.; VanDeMark, Nancy R.; Bornemann, Angela; Graeber, Carla

doi:10.1002/jcop.20187

Cited by 35 publications

(43 citation statements)

References 28 publications

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“…The group identified existing evidence-based strategies and frameworks to use as building blocks for an approach to TIPC. These frameworks and strategies included the patient-centered medical home (Agency for Healthcare Research and Quality, n.d.), trauma-informed care (Bloom, 2013;Harris & Fallot, 2001 Kolk et al, 2014); interventions with adults to ameliorate the impact of adverse childhood experiences (Sikkema et al, 2007;Toussaint, VanDeMark, Bornemann, & Graeber, 2007), and models of trauma-informed care in other settings and with other populations (Gilbert et al, 2009;Morrissey et al, 2005). Based on a review of the literature and input by experts from the national strategy group, we developed an approach to TIPC that defines trauma broadly, addresses both recent and lifelong trauma, and includes an essential focus on provider support and well-being (Figure 1).…”

Section: A Practical Approach To Trauma-informed Primary Carementioning

confidence: 97%

From Treatment to Healing: The Promise of Trauma-Informed Primary Care

Machtinger

Cuca

Khanna³

et al. 2015

Women's Health Issues

186

160

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In August 2013, a national strategy group convened in Washington, DC to clarify a framework for trauma-informed primary care (TIPC) for women. The group was motivated by an increasing body of research and experience revealing that people from all races, ethnicities, and socioeconomic backgrounds come to primary care with common conditions (e.g., heart, lung, and liver diseases, obesity, diabetes, depression, substance use, and sexually transmitted infections) that can be traced to recent and past trauma. These conditions are often stubbornly refractory to treatment, in part because we are not addressing the trauma and posttraumatic stress disorder (PTSD) that underlie and perpetuate them. The purpose of the strategy group was to review the evidence linking trauma to health and provide practical guidance to clinicians, researchers, and policymakers about the core components of an effective response to recent and past trauma in the setting of primary care. We describe the results of this work and advocate for the adoption of TIPC as a practical and ethical imperative for women's health and well-being. An Unrecognized OpportunityJanice 1 is a 45-year-old woman with poorly controlled diabetes, obesity, and alcoholism. She feels ashamed about her alcohol use and about her body. She fears that her clinician will be angry with her for not checking her blood sugar, not losing weight, and for missing multiple gynecology appointments. Janice's clinician has worked with her for over a year and is frustrated by their inability to make progress together on her health issues. Janice has never revealed to any of her clinicians that she was sexually abused during childhood nor that she is currently experiencing severe emotional abuse by her husband.For many people like Janice and her provider, understanding the connection between traumatic experiences and health can be transformative and healing. When patients understand that childhood and adult trauma underlie many illnesses and unhealthy behaviors, they often stop blaming themselves, feel more self-acceptance, and make progress toward health and well-being. Providers who understand this connection are able to create clinical environments that are less triggering for both patients and staff, identify referrals to appropriate trauma-specific services, and develop more effective therapeutic alliances and treatment plans with their patients.Our strategy group worked to clarify a practical framework for TIPC, a patient-centered approach that acknowledges and addresses the broad impact of both recent and lifetime trauma on health behaviors and outcomes. The goal of TIPC is to improve the efficacy and experience of primary care for both patients and providers by integrating an evidence-based response to this key social determinant of health. The Link between Trauma and Poor HealthThe Substance Abuse and Mental Health Services Administration defines trauma as "an event, series of events, or set of circumstances [e.g., childhood and adult physical, sexual, and emotional abuse; neglect;...

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Section: A Practical Approach To Trauma-informed Primary Carementioning

confidence: 97%

From Treatment to Healing: The Promise of Trauma-Informed Primary Care

Machtinger

Cuca

Khanna³

et al. 2015

Women's Health Issues

186

160

View full text Add to dashboard Cite

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“…[54] A modified version of TREM was evaluated in a residential setting and compared with treatment as usual. [35] Significantly, the authors found that addressing trauma using trauma-focused treatment was both safe and effective and led to improvements in multiple domains including trauma-related symptoms, mental health functioning and substance abuse treatment. Collaborative care [55] is a preventative treatment for PTSD and alcohol use disorders.…”

Section: Psychosocial Treatmentsmentioning

confidence: 97%

Epidemiology and Management of Alcohol Dependence in Individuals with Post-Traumatic Stress Disorder

McCarthy

Petrakis

2010

CNS Drugs

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Post-traumatic stress disorder (PTSD) is a chronic and disabling psychiatric disorder with an estimated lifetime prevalence of 7.8%. Co-morbid alcohol dependence is a common clinical occurrence with important clinical considerations. For example, in individuals with both PTSD and alcohol dependence, the symptoms of PTSD tend to be more severe, and there is evidence that these individuals are more prone to alcohol use relapse than non-co-morbid individuals. Co-morbidity of PTSD and alcohol dependence is also associated with a higher rate of psychosocial and medical problems and higher utilization of inpatient hospitalization than either disorder alone. This article highlights the epidemiology of alcohol dependence in PTSD and reviews the evidence for effective treatments. Management of these individuals requires an understanding of the epidemiology and an awareness of treatment interventions, which include both psychosocial treatments (e.g. Seeking Safety, Concurrent Treatment of PTSD and Cocaine Dependence, Transcend, Trauma Recovery and Empowerment Model) and pharmacotherapy (e.g. selective serotonin reuptake inhibitors [SSRIs] and topiramate). Effective treatment of co-morbid PTSD and alcohol dependence may include a combination of these psychosocial and pharmacological interventions. The key element seems to be to ensure an adequate intervention for each disorder administered collaboratively.

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“…Previous studies of TREM have been reported from primary substance abuse treatment settings within WCDVS (Amaro et al, 2007;Toussaint, VanDeMark, Bornemann, & Graeber, 2007). In both the Boston (Amaro et al, 2007) and the Colorado (Toussaint et al, 2007) sites, modifications (e.g., shorter overall length, more frequent sessions, and open-ended structure) were made to the usual implementation of TREM.…”

mentioning

confidence: 98%

“…In both the Boston (Amaro et al, 2007) and the Colorado (Toussaint et al, 2007) sites, modifications (e.g., shorter overall length, more frequent sessions, and open-ended structure) were made to the usual implementation of TREM. With these modifications, outcomes for women in TREM were significantly better than those for women receiving usual services in trauma-related and general mental health symptom domains, although not in drug or alcohol use severity.…”

mentioning

confidence: 99%