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Objective: Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeless Women Veterans Programs.Methods: The intervention consists of 25 sessions that cover topics to help build safety in clients' lives and is present-focused, offering psychoeducation and coping skills. A cohort of homeless women veterans (N=359) was recruited before Seeking Safety was implemented (phase I). After clinicians were trained and certified in Seeking Safety, a postimplementation cohort was recruited and offered Seeking Safety treatment (phase II, N=91). Phase I lasted from January 2000 to June 2003. Phase II lasted from June 2003 to December 2005. The intervention lasted for six months. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases.Results: There were few differences across groups at baseline. All women entering the Homeless Women Veterans Programs showed significant improvement on most clinical outcome measures over one year. The Seeking Safety cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of posttraumatic stress disorder, particularly in the avoidance and arousal clusters. However, the Seeking Safety cohort was significantly more likely to have used drugs in the past 30 days.Conclusions: Seeking Safety appears to have had a moderately beneficial impact on several clinical outcomes. Although the nonequivalent comparison groups and low follow-up rates limit the internal validity of these results, availability of Seeking Safety may be of benefit for homeless female veterans. It is noteworthy that it could be delivered and implemented by case managers with little or no prior counseling experience. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Although bipolar disorder and substance use disorder frequently co-occur, there is little information on the effectiveness of behavioral treatment for this population. Integrated group therapy, which addresses the two disorders simultaneously, was compared with group drug counseling, which focuses on substance use. The authors hypothesized that patients receiving integrated group therapy would have fewer days of substance use and fewer weeks ill with bipolar disorder. METHOD: A randomized controlled trial compared 20 weeks of integrated group therapy or group drug counseling with 3 months of posttreatment follow-up. Sixty-two patients with bipolar disorder and current substance dependence, treated with mood stabilizers for >or=2 weeks, were randomly assigned to integrated group therapy (N=31) or group drug counseling (N=31). The primary outcome measure was the number of days of substance use. The primary mood outcome was the number of weeks ill with a mood episode. RESULTS: Intention-to-treat analysis revealed significantly fewer days of substance use for integrated group therapy patients during treatment and follow-up. Groups were similar in the number of weeks ill with bipolar disorder during treatment and follow-up, although integrated group therapy patients had more depressive and manic symptoms. CONCLUSIONS: Integrated group therapy, a new treatment developed specifically for patients with bipolar disorder and substance dependence, appears to be a promising approach to reduce substance use in this population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate clinicians' knowledge of the dual diagnosis of posttraumatic stress disorder (PTSD) and substance use disorder (SUD) before and after a six-month intensive state-wide training on this topic. Methods: 225 clinicians in seven community-based substance abuse and mental health agencies in Connecticut completed a knowledge test on PTSD and SUD before and after the intensive training program. They also completed a measure of their professional and personal characteristics. The intensive program on PTSD and SUD included three full days of training, monthly on-site consultation meetings, and weekly telephone conference calls. All seven agencies implemented Seeking Safety, a manual-based intervention designed for PTSD and SUD, and the training focused on that treatment model as well as more general PTSD-SUD information. Results: Clinicians' knowledge in creased significantly from preto post-training, but only by 5%. At pre-training, their knowledge was already relatively high (68% of items correct). However, knowledge of basic facts on trauma and PTSD were known by only a minority of the sample even after the intensive training. Clinicians' professional and personal characteristics (e.g., degree, experience, age, gender) were not associated with their knowledge levels, nor was their own experience of trauma, PTSD, or SUD. Conclusions: It is unclear what educational methods might be most effective to teach clinicians about the dual diagnosis of PTSD and SUD. Knowledge levels on this topic range widely, and the small increase observed in this study suggests the need for further study and innovation. Evaluation of knowledge in relation to clinical practice is also needed. [ABSTRACT FROM AUTHOR]