The Impact of Trauma-Focused Group Therapy upon HIV Sexual Risk Behaviors in the NIDA Clinical Trials Network “Women and Trauma” Multi-Site Study

Hien, Denise A.; Campbell, Aimee N.C.; Killeen, Therese K.; Hu, Mei Chen; Hansen, Cheri; Jiang, Huiping; Hatch‐Maillette, Mary A.; Miele, Gloria M.; Cohen, Lisa R.; Gan, Weijin; Resko, Stella M.; Dibono, Michele; Wells, Elizabeth A.; Nunes, Edward V.

doi:10.1007/s10461-009-9573-7

Cited by 57 publications

(52 citation statements)

References 46 publications

(51 reference statements)

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“…Addressing coping skills and trauma among female drug users reduces HIV risk behaviours [54]. In addition, couples-based HIV prevention interventions among IDU may be effective in reducing risk behaviours while enhancing intimate relationships [55].…”

Section: Implications For Treatmentmentioning

confidence: 99%

Psychiatric, Behavioural and Social Risk Factors for HIV Infection Among Female Drug Users

2011

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Female drug users report greater psychopathology and risk behaviours than male drug users, putting them at greater risk for HIV. This mixed-methods study determined psychiatric, behavioural and social risk factors for HIV among 118 female drug users (27% (32/118) were HIV seropositive) in Barcelona. DSM-IV disorders were assessed using the Spanish Psychiatric Research Interview for Substance and Mental Disorders. 30 participants were interviewed in-depth. In stepwise multiple backward logistic regression, ever injected with a used syringe, antisocial personality disorder, had an HIV seropositive sexual partner and substance-induced major depressive disorder were associated with HIV seropositivity. Qualitative findings illustrate the complex ways in which psychiatric disorders and male drug-using partners interact with these risk factors. Interventions should address all aspects of female drug users' lives to reduce HIV.

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Section: Implications For Treatmentmentioning

confidence: 99%

Psychiatric, Behavioural and Social Risk Factors for HIV Infection Among Female Drug Users

2011

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“…Alcohol use disorders are disproportionately common among persons with PTSD, being the most common co-occurring psychiatric disorder among men with PTSD and the third most common among women with PTSD (Kessler et al, 1995). Severity of PTSD symptoms, particularly avoidance and arousal, tend to be higher among PTSD patients with cooccurring substance use disorders (Hien et al, 2010;Saladin et al, 1995). The relationship between PTSD and substance use may be explained in part by individuals with PTSD using alcohol and others substances to help to cope with their psychiatric symptoms (Jané-Llopis and Matytsina, 2006;Kaysen et al, 2007;Kessler et al, 1997;Saladin et al, 1995).…”

mentioning

confidence: 99%

Posttraumatic Stress Disorder Symptoms Mediate the Relationship Between Traumatic Experiences and Drinking Behavior Among Women Attending Alcohol Serving Venues in a South African Township

Watt

Ranby

Meade

et al. 2012

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: South Africa has high rates of traumatic experiences and alcohol abuse or dependence, especially among women. Traumatic experiences often result in symptoms of posttraumatic stress disorder (PTSD), and PTSD has been associated with hazardous drinking. This article examines the relationship between traumatic events and hazardous drinking among women who patronized alcohol-serving venues in South Africa and examines PTSD as a mediator of this relationship. Method: A total of 560 women were recruited from a Cape Town township. They completed a computerized assessment that included alcohol consumption, history of traumatic events, and PTSD symptoms. Mediation analysis examined whether PTSD symptoms mediated the relationship between the number of traumatic event categories experienced (range: 0-7) and drinking behavior. Results: The mean Alcohol Use Disorders Identifi cation Test score in the sample was 12.15 (range: 0-34, SD = 7.3), with 70.9% reaching criteria for hazardous drinking (AUDIT ≥ 8). The mean PTSD score was 36.32 (range: 17-85, SD = 16.3), with 20.9% meeting symptom criteria for PTSD (PTSD ChecklistCivilian Version ≥ 50). Endorsement of traumatic experiences was high, including adult emotional (51.8%), physical (49.6%), and sexual (26.3%) abuse; childhood physical (35.0%) and sexual (25.9%) abuse; and other types of trauma (83%). All categories of traumatic experiences, except the "other" category, were associated with hazardous drinking. PTSD symptoms mediated 46% of the relationship between the number of traumatic categories experienced and drinking behavior. Conclusions: Women reported high rates of hazardous drinking and high levels of PTSD symptoms, and most had some history of traumatic events. There was a strong relationship between traumatic exposure and drinking levels, which was largely mediated by PTSD symptoms. Substance use interventions should address histories of trauma in this population, where alcohol may be used in part to cope with past traumas. (J. Stud. Alcohol Drugs, 73, 549-558, 2012)

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“…With the development of the Patient-Centered Outcomes Research Institute (PCORI), much focus has recently turned both to considering which kinds of patients or subgroups are best served by a particular treatment. Indeed these kinds of analyses have come to be critical for comorbidity research, where the heterogeneity in the psychiatric population is very high (Hien, Campbell, Killeen, et al, 2010; Nunes et al, 2011) and, where frequently, the most severe patient groups tend to benefit from the targeted treatment, whereas the less severe patients may require less individualized or specialized interventions.…”

Section: Secondary Analytic Methodologymentioning

confidence: 99%

“…The two papers focusing on mediators (Hien, Campbell, Killeen et al, 2010; Hien, Campbell, Ruglass et al, 2010; Hien, Jiang, Campbell, et al, 2010; Morgan-Lopez et al, 2013) had been specified a priori in the protocol as exploratory papers. These papers examined the impact of the comorbid symptom improvement testing several possible hypotheses regarding changing symptom domains (i.e., PTSD versus SUD) and the differential impact of treatment upon these two outcome domains.…”

Section: “Women and Trauma” Case Examplementioning

confidence: 99%

Maximizing Effectiveness Trials in PTSD and SUD Through Secondary Analysis: Benefits and Limitations Using the National Institute on Drug Abuse Clinical Trials Network "Women and Trauma" Study as a Case Example

Hien¹,

Campbell²,

Ruglass³

et al. 2015

Journal of Substance Abuse Treatment

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Recent federal legislation and a renewed focus on integrative care models underscore the need for economical, effective, and science-based behavioral health care treatment. As such, maximizing the impact and reach of treatment research is of great concern. Behavioral health issues, including the frequent co-occurrence of substance use disorders (SUD) and posttraumatic stress disorder (PTSD), are often complex, with a myriad of factors contributing to the success of interventions. Although treatment guides for comorbid SUD/PTSD exist, most patients continue to suffer symptoms following the prescribed treatment course. Further, the study of efficacious treatments has been hampered by methodological challenges (e.g., overreliance on “superiority” designs (i.e., designs structured to test whether or not one treatment statistically surpasses another in terms of effect sizes) and short term interventions). Secondary analyses of randomized controlled clinical trials offer potential benefits to enhance understanding of findings and increase the personalization of treatment. This paper offers a description of the limits of randomized controlled trials as related to SUD/PTSD populations, highlights the benefits and potential pitfalls of secondary analytic techniques, and uses a case example of one of the largest effectiveness trials of behavioral treatment for co-occurring SUD/PTSD conducted within the National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) and producing 19 publications. The paper concludes with implications of this secondary analytic approach to improve addiction researchers’ ability to identify best practices for community-based treatment of these disorders. Innovative methods are needed to maximize the benefits of clinical studies and better support SUD/PTSD treatment options for both specialty and non-specialty healthcare settings. Moving forward, planning for and description of secondary analyses in randomized trials should be given equal consideration and care to the primary outcome analysis.

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The Impact of Trauma-Focused Group Therapy upon HIV Sexual Risk Behaviors in the NIDA Clinical Trials Network “Women and Trauma” Multi-Site Study

Cited by 57 publications

References 46 publications

Psychiatric, Behavioural and Social Risk Factors for HIV Infection Among Female Drug Users

Psychiatric, Behavioural and Social Risk Factors for HIV Infection Among Female Drug Users

Posttraumatic Stress Disorder Symptoms Mediate the Relationship Between Traumatic Experiences and Drinking Behavior Among Women Attending Alcohol Serving Venues in a South African Township

Maximizing Effectiveness Trials in PTSD and SUD Through Secondary Analysis: Benefits and Limitations Using the National Institute on Drug Abuse Clinical Trials Network "Women and Trauma" Study as a Case Example

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