What works for whom and why: A narrative systematic review of interventions for reducing post-traumatic stress disorder and problematic substance use among women with experiences of interpersonal violence

Abstract

Background and aims: Women with histories of interpersonal violence (IPV) experience high levels of posttraumatic stress disorder (PTSD), problematic substance use, and repeat victimization. Previous systematic reviews considering the effectiveness of integrated trauma-specific treatments to address PTSD and substance use have lacked subgroup analysis by gender or trauma type. Furthermore, mindfulness-based interventions for treating both issues together are under-researched. It is unclear what treatment components and contextual factors impacting implementation work best for women with IPV experiences. This narrative review examines a range of quantitative and qualitative data to explore: for which groups of women do integrated interventions work (subgroups)? How (mechanisms of action), and/or under what contexts (factors external to the intervention)? Methodology: A two-staged search strategy identified eligible studies. This process identified 20 controlled trials reporting on the effectiveness of psychological or mindfulness-based interventions for PTSD and substance use and 39 relevant supplementary information related to the trials. Narrative synthesis using thematic analysis was conducted on manuscripts identified in both stages. Findings: Safe social support and ongoing risks of violence were identified as contextual factors which may affect treatment outcomes, requiring attention by researchers and treatment providers. Whilst there was some evidence that reduced PTSD correlates with substance use decrease, there may be more than one pathway to substance use reduction among women with PTSD, requiring a focus on emotional regulation. Other 'active mechanisms' included different modalities of coping skills and support to rebuild connection with self and others. Lack of supplementary studies for trials involving past-focused treatment precluded detailed discussion of these models. Conclusions: Integrated PTSD and substance use treatment which teaches extensive coping skills to promote external safety, symptom stabilisation, and emotional regulation, combined with access to safe social support and external advocacy, may be particularly useful for women with more severe PTSD, or for those experiencing ongoing victimization for whom past-focused treatments are contraindicated. Long-term support and organisational trauma-informed practice in substance use treatment services should also be promoted.

Motivations for Treatment Engagement in a Residential Substance Use Disorder Treatment Program: A Qualitative Study

“…Similar to findings from the literature, participants cited the value of integrated treatment for SUD and co-occurring disorders, 43 including post-traumatic stress disorder (PTSD) associated with various forms of trauma. 44 , 45 Recognizing the utility of this integrated approach, participants also highlighted the benefits of participating in a year-long program—frequently contrasting it with their previous experiences with short-term treatment. While the recommended length of time in treatment should be an individualized decision based on clinical assessment and medical necessity, 46 our findings are consistent with published studies indicating that increased treatment length is associated with improved outcomes, especially for those with psychiatric co-morbidities 47 - 49 and those previously involved with the criminal justice system.…”

“We have to put the fire out first before we start rebuilding the house”: practitioners’ experiences of supporting women with histories of substance use, interpersonal abuse and symptoms of post-traumatic stress disorder

“…That is to say, one that recognises the impact of IPA and is non-pathologising, strengths-based, and centred on 'growthfostering relationships.' These are core components of treatment long since promoted by advocates of gender responsive addiction treatment (Covington 2000), TIP (Fallot and Harris 2005;Mills 2015), and integrated trauma-specific treatments aimed at women (Bailey et al 2019).…”

[…] you feel there’s nowhere left to go: the barriers to support among women who experience substance use and domestic abuse in the UK

“…This caution raises key questions addressed by this research in relation to what level of support women are able to secure and the extent to which they are supported by health and social care professionals to link with other services to meet their needs. A study by Bailey et al, (2019) also highlighted how some practitioners from substance use, IPV, and criminal justice services in England, were trying to emulate support that was consistent with gender specific trauma-informed practice.…”