“Seeking safety”: Outcome of a new cognitive‐behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence

Abstract

Women with current posttraumatic stress disorder (PTSD) comprise 30-59% of substance abuse treatment samples and experience a more severe course than women with either disorder alone. As yet, no effective treatment for this population has been identified. This paper reports outcome results on 17 women who completed a new manual-based 24-session cognitive behavioral group therapy protocol treatment, based on assessments at pretreatment, during treatment, posttreatment, and at 3-month follow-up. Results showed significant improvements in substance use, trauma-related symptoms, suicide risk, suicidal thoughts, social adjustment, family functioning, problem solving, depression, cognitions about substance use, and didactic knowledge related to the treatment. Patients' treatment attendance, alliance, and satisfaction were also very strong. Treatment completers were more impaired than dropouts, yet more engaged in the treatment. Overall, our data suggest that women with PTSD and substance abuse can be helped when provided with a treatment designed for them. All results are clearly tentative, however, due to the lack of a control group, multiple comparisons, and absence of assessment of dropouts.

Substance abuse treatment entry, retention, and outcome in women: A review of the literature

“…A number of studies have demonstrated the effectiveness of gender-specific treatment as it relates to the specialized needs of substance-using women (Elk et al, 1995;Hien et al, 2004;Jansson et al, 1996;Kelly et al, 2000;Linehan et al, 1999;Luthar and Suchman, 2000;Mackie-Ramos and Rice, 1988;Najavits et al, 1998;Reynolds et al, 1995;Volpicelli et al, 2000;Washington, 2001;Welle et al, 1998). These studies have examined services to address psychosocial needs that are more prevalent in women, as well as certain subpopulations, or specialized interventions for a particular subgroup of women.…”

“…A study that examined the specialized treatment needs of substance-abusing women with PTSD (Najavits et al, 1998) reviewed outcome data for Seeking Safety, a cognitive-behavioral group intervention designed specifically for this population. Psychosocial assessments found significant improvements post treatment and at follow-up in a variety of domains, including increased substance abstinence, decreased subtle trauma symptoms, decreased depression, and decreased suicidal thoughts and risk (not assessed at follow-up).…”

“…Treatment interventions for other specific subpopulations of women with substance use disorders include reduction of alcohol use among pregnant women (Reynolds et al, 1995), contingency management to increase abstinence from cocaine in pregnant women (Elk et al, 1995), a comprehensive services model for pregnant women (Jansson et al, 1996), parenting skills for methadone-maintained mothers (Luthar and Suchman, 2000), relapse prevention for women with PTSD co-occurring with substance use (Hien et al, 2004;Najavits et al, 1996;Najavits et al, 1998), relapse prevention for women with marital distress and alcohol dependence (Kelly et al, 2000), dialectical behavior therapy for patients with co-occurring borderline personality disorder and drug dependence (Linehan et al, 1999), and prisonbased single-gender drug treatment for women offenders (Pelissier et al, 2003), among others (Mackie-Ramos and Rice, 1988;Washington, 2001). While these interventions are in the early stages of clinical investigation (e.g., pilot testing, open trials, non-randomized controlled trials), results of these studies hold promise for effectively treating specific subgroups of women with substance use disorders.…”

Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment

“…Integrated PTSD and SUD treatments are increasingly being implemented in community substance abuse treatment programs (Brady et al, 2001;Finkelstein et al, 2004 ;Hien et al, 2004 ;Najavits et al, 1998 ). There is a general consensus in the literature that, despite concerns over adverse reactions or negative experiences attributed to treatment, patients who do engage in non-psychopharmacological interventions see significant improvements in PTSD symptoms (Seedat et.al., 2005).…”

Neurowissenschaften und Traumatherapie

“…Somit könnte eine frühe Behandlung der traumatischen Ereignisse die Chancen für eine erfolgreiche Drogentherapie erhöhen (Ouimette, Ahrens & Moos 1997). Auch könnten einige der bestehenden Behandlungsmethoden für PTBS allein und Drogenabhängigkeit allein problematisch sein, wenn die jeweils andere Störung unbehandelt weiterbesteht (Najavits, Weiss, Shaw & Muenz, 1998). …”