98 results on '"Najavits LM"'
Search Results
2. Impact of the seeking safety program on clinical outcomes among homeless female veterans with psychiatric disorders.
- Author
-
Desai RA, Harpaz-Rotem I, Najavits LM, Rosenheck RA, Desai, Rani A, Harpaz-Rotem, Ilan, Najavits, Lisa M, and Rosenheck, Robert A
- Abstract
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]- Published
- 2008
- Full Text
- View/download PDF
3. A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence.
- Author
-
Weiss RD, Griffin ML, Kolodziej ME, Greenfield SF, Najavits LM, Daley DC, Doreau HR, and Hennen JA
- Abstract
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]
- Published
- 2007
- Full Text
- View/download PDF
4. It can be learned, but can it be taught? Results from a state-wide training initiative on PTSD and substance abuse.
- Author
-
Najavits LM and Kanukollu S
- Abstract
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]
- Published
- 2005
- Full Text
- View/download PDF
5. Seeking safety protocol for men and women.
- Author
-
Najavits LM and Najavits, Lisa M
- Published
- 2007
6. Beyond exposure: A healthy broadening of posttraumatic stress disorder treatment options: Commentary on Rubenstein et al. (2024).
- Author
-
Najavits LM
- Subjects
- Humans, Health Status, Research Design, Workforce, Stress Disorders, Post-Traumatic
- Abstract
This commentary on Rubenstein et al. (2024) applauds their sensitive historical exploration of exposure therapy for posttraumatic stress disorder (PTSD) and balanced review of the strengths and weaknesses of that approach. I offer five points to expand on their contribution. (a) Stringent exposure therapy workforce requirements limit scalability, thus restricting access for the large number of patients in need of PTSD treatment. (b) There are additional non-trauma-focused approaches that show efficacy for PTSD. (c) Results of exposure therapy trials should be interpreted in light of how much the study designs align with real-world conditions. (d) Some surprising results from the subfield of PTSD/substance use disorder could suggest new treatment options. (e) There is a need for stronger reporting of clinical worsening (iatrogenesis) outside of clinical trials. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
- Published
- 2024
- Full Text
- View/download PDF
7. A Seeking Safety Mobile App for Recovery from PTSD and Substance Use Disorder: Results of a Randomized Controlled Trial.
- Author
-
Najavits LM, Cha E, Demce MG, Gupta M, Haney AM, Logounov G, Miket A, Morency M, and Schulhof AE
- Subjects
- Humans, Treatment Outcome, Mental Health, Mobile Applications, Stress Disorders, Post-Traumatic complications, Stress Disorders, Post-Traumatic therapy, Stress Disorders, Post-Traumatic psychology, Substance-Related Disorders psychology
- Abstract
Background: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur frequently and have deleterious impact. Seeking Safety (SS) - an evidence-based, present-focused, coping skills model - lends itself to mobile app delivery., Objectives: A novel SS mobile app is compared to a control app that lacks the interactivity, social engagement, and feature-richness of the SS app. We hypothesized that the SS app would outperform the control on primary outcome variables (substance use, trauma symptoms) and at least two secondary variables., Methods: Outpatients with current PTSD and SUD ( n = 116) were randomized to the apps; assessed were pre, post (12 weeks), and 3-month follow-up in this online study., Results: The SS app outperformed the control on the primary outcomes, but not on secondary outcomes. Also both conditions evidenced significant change over time from pre to post, with gains sustained at follow-up. External medication and supports during the trial did not differ by condition., Conclusion: This first RCT on a SS mobile app had positive results for reduction in substance use and trauma symptoms compared to a control app. This is noteworthy as mental health mobile apps, in general, evidence few positive outcomes. Our substance use finding is also notable as psychosocial interventions in PTSD/SUD populations find it harder to achieve reduction in SUD than trauma symptoms. Our control app may have represented too strong a comparison and weakened our ability to find results on secondary outcomes by condition.
- Published
- 2024
- Full Text
- View/download PDF
8. A Randomized Controlled Trial for Gambling Disorder and PTSD: Seeking Safety and CBT.
- Author
-
Najavits LM, Ledgerwood DM, and Afifi TO
- Subjects
- Male, Humans, Female, Adaptation, Psychological, Cognition, Treatment Outcome, Stress Disorders, Post-Traumatic diagnosis, Stress Disorders, Post-Traumatic psychology, Stress Disorders, Post-Traumatic therapy, Gambling psychology, Cognitive Behavioral Therapy methods
- Abstract
Studies show a compelling association between gambling disorder and posttraumatic stress disorder. However, there have been no randomized controlled trials for this co-morbidity. The aim of the current study was to compare two evidence-based models, one that addresses both disorders and another that addresses gambling alone. Sixty-five men and women with gambling disorder and posttraumatic stress disorder were randomized to one of two treatment conditions delivered via telehealth, Seeking Safety (integrated treatment for gambling and posttraumatic stress disorder) or Cognitive-Behavioral Therapy for Pathological Gambling (for gambling alone), in a randomized controlled non-inferiority trial. Primary outcomes were net gambling losses and number of sessions gambling. Secondary outcomes were posttraumatic stress disorder symptoms, coping skills, general psychiatric symptoms, global functioning, and gambling cognitions. Assessment occurred at baseline, 6-weeks, 3 months (end of treatment) and 1-year. On most measures, including primary outcomes, participants improved significantly over time with no difference between treatment conditions. Seeking Safety patients had significantly higher session attendance. Effect sizes were large for gambling, posttraumatic stress disorder and coping. All other measures except one showed medium effect sizes. Therapeutic alliance, treatment satisfaction, and the telehealth format were all rated positively. This was the first randomized trial of Seeking Safety in a gambling disorder population. Seeking Safety showed comparable efficacy to an established gambling disorder intervention; and significantly higher Seeking Safety attendance indicates especially strong engagement. Our finding of overall comparable results between the two treatments is consistent with the comorbidity treatment literature.Trial registration: ClinicalTrials.gov NCT02800096; Registration date: June 14, 2016., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2023
- Full Text
- View/download PDF
9. Developing Signs of Safety: A Deaf-accessible counselling toolkit for trauma and addiction.
- Author
-
Anderson ML, Glickman NS, Wolf Craig KS, Sortwell Crane AK, Wilkins AM, and Najavits LM
- Subjects
- Counseling, Humans, Psychotherapy, Treatment Outcome, Behavior, Addictive complications, Behavior, Addictive therapy, Substance-Related Disorders complications, Substance-Related Disorders therapy
- Abstract
The U.S. Deaf community-more than half a million Americans who communicate using American Sign Language (ASL)-experiences higher rates of trauma exposure and substance use disorder (SUD) than the general population. Yet there are no evidence-based treatments for any behavioural health condition that have been evaluated for use with Deaf people. The driving aim of our work, therefore, has been to develop and formally evaluate a Deaf-accessible trauma/SUD counselling approach. Here we describe our initial intervention development work and a single-arm pilot that evaluated the feasibility, acceptability, and preliminary clinical efficacy of Signs of Safety-a Deaf-accessible toolkit to be used with an existing, widely adopted protocol for trauma and addiction (Seeking Safety). Preliminary efficacy results indicated clinically significant reductions in PTSD symptoms and frequency of alcohol use for the Seeking Safety/Signs of Safety model. Frequency of drug use did not change significantly-likely attributable to the mid-study legalization of recreational marijuana in our state. Next steps include the redesign and refilming of Signs of Safety based on pilot participant feedback, again using a Deaf-engaged development and production process. This new toolkit will be tested via a pilot randomized controlled trial designed based on present methodological lessons learned., (© 2021 John Wiley & Sons, Ltd.)
- Published
- 2021
- Full Text
- View/download PDF
10. PTSD / substance use disorder comorbidity: Treatment options and public health needs.
- Author
-
Najavits LM, Clark HW, DiClemente CC, Potenza MN, Shaffer HJ, Sorensen JL, Tull MT, Zweben A, and Zweben JE
- Abstract
Purpose of Review: Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorder (SUD) and is challenging to treat. We review all behavioral therapy models with at least one randomized controlled trial in a current PTSD/SUD population. We identify factors in selecting a model for clinical use, emphasizing a public health framework that balances the need for evidence with the need for feasibility in frontline settings., Recent Findings: Seven published models and 6 unpublished models are reviewed. Public health considerations for choosing a model include: whether it's been studied across a broad range of SUDs and in complex SUD patients; whether it can be conducted in group modality; its appeal to patients and providers; its cost; workforce requirements; and its ability to reduce substance use in addition to PTSD., Summary: There are two broad types of models: those that originated in the PTSD field versus the SUD field. Overall, the latter are stronger on public health factors and more feasible in SUD settings. Published models in this category include Relapse Prevention, BRENDA, and Seeking Safety. PTSD/SUD research is at an early stage and there is a need for methodology that quantifies "level of burden" (patients' socioeconomic disadvantages) across trials.
- Published
- 2020
- Full Text
- View/download PDF
11. Concerns About Potential Bias in a Randomized Clinical Trial of Integrated Prolonged Exposure Therapy vs Seeking Safety Integrated Coping Skills Therapy.
- Author
-
Najavits LM
- Subjects
- Adaptation, Psychological, Humans, Alcoholism, Cognitive Behavioral Therapy, Implosive Therapy, Stress Disorders, Post-Traumatic
- Published
- 2019
- Full Text
- View/download PDF
12. A Randomized Controlled Trial for Veterans with PTSD and Substance Use Disorder: Creating Change versus Seeking Safety.
- Author
-
Najavits LM, Krinsley K, Waring ME, Gallagher MW, and Skidmore C
- Subjects
- Adaptation, Psychological, Adolescent, Adult, Aged, Cognition, Female, Humans, Male, Middle Aged, Patient Compliance, Patient Satisfaction, Quality of Life, Self Efficacy, Treatment Outcome, Young Adult, Psychotherapy methods, Stress Disorders, Post-Traumatic complications, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders complications, Substance-Related Disorders therapy, Veterans psychology
- Abstract
Background: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur in military veterans and other populations., Objective: To conduct a randomized controlled trial to compare a new past-focused treatment (Creating Change; CC), to a well-established, evidence-based present-focused treatment for PTSD/SUD (Seeking Safety; SS), on symptoms of both disorders. CC guides patients to process the past through exploration of PTSD/SUD life themes and memories whereas SS focuses on coping skills in the present., Methods: Fifty-two male and female veterans with current PTSD/SUD were randomized (n = 26 per treatment) and assessed at baseline, end-of-treatment and 3-month follow-up. They received 17 individual one-hour sessions., Results: Intent-to-treat analyses indicated that both conditions improved over time, with no difference between conditions, on PTSD, alcohol use, and drug use (our primary outcomes) as well as mental health symptoms, quality of life, self-efficacy, and SUD cognitions. Effect sizes were medium except for alcohol use, which was large. Change over time reflected improvement from baseline to end-of-treatment, with gains sustained at follow-up, although alcohol use showed continued improvement from end-of-treatment to follow-up. Both treatments evidenced a strong safety profile; and attendance, alliance, and treatment satisfaction were also very strong. Conclusions/importance: CC has promise as a PTSD/SUD therapy with strong public health relevance and the potential to fill important gaps in the field. We used minimal exclusionary criteria to obtain a real-world sample, which was severe-predominantly substance-dependent with chronic PTSD and additional psychiatric diagnoses. Future research is warranted, especially on nonveteran samples and treatment mechanisms of action.
- Published
- 2018
- Full Text
- View/download PDF
13. A randomized controlled trial of a gender-focused addiction model versus 12-step facilitation for women veterans.
- Author
-
Najavits LM, Enggasser J, Brief D, and Federman E
- Subjects
- Adaptation, Psychological, Adult, Diagnostic and Statistical Manual of Mental Disorders, Female, Humans, Middle Aged, Outcome Assessment, Health Care methods, Psychiatric Status Rating Scales, Severity of Illness Index, Sex Factors, Behavior, Addictive psychology, Behavior, Addictive therapy, Patient Education as Topic methods, Psychotherapy, Multiple methods, Substance-Related Disorders diagnosis, Substance-Related Disorders psychology, Substance-Related Disorders therapy, Veterans psychology, Women psychology
- Abstract
Background and Objectives: Substance use disorder (SUD) has increased among women, including military veterans, yet SUD treatment was historically designed for males. This randomized controlled trial compared 12 individual sessions of a gender-focused SUD recovery model, A Woman's Path to Recovery (WPR) to an evidence-based, non-gender-focused SUD model, 12-Step Facilitation (TSF) for 66 women veterans with current severe SUD., Methods: The primary outcome was substance use; secondary outcomes were associated problems (e.g., psychological); coping skills, and 12-step attendance, with assessment at baseline, end-of-treatment, and 3-month followup., Results: Substance use decreased over time, with no difference between conditions. Decreases occurred from baseline to end-of-treatment and baseline to followup and, for drug severity, also from end-of-treatment to followup. Effect sizes were large for alcohol and medium otherwise. Secondary outcomes were largely consistent with this pattern of improvement. Urinalysis/breathalyzer supported self-report. Treatment attendance was 62% for WPR and 57% for TSF (not significantly different). Twelve-step group attendance, surprisingly, did not increase in either condition., Discussion and Conclusions: WPR provides a useful addition to women's SUD treatment options, with outcomes no different than an established evidence-based model, TSF. Both showed positive impact on substance use and related areas. Our lack of differences based on gender-focus may reflect women veterans being acculturated to a male military environment. Limitations include lack of an untreated control, a sample limited to veterans, and use of a large effect size for power assumptions., Scientific Significance: This is the first RCT of a gender-focused approach for women veterans with SUD. (Am J Addict 2018;27:210-216)., (© 2018 American Academy of Addiction Psychiatry.)
- Published
- 2018
- Full Text
- View/download PDF
14. Seeking Safety Pilot Outcome Study at Walter Reed National Military Medical Center.
- Author
-
Najavits LM, Lande RG, Gragnani C, Isenstein D, and Schmitz M
- Subjects
- Adaptation, Psychological, Adult, Female, Humans, Male, Middle Aged, Patient Outcome Assessment, Pilot Projects, Psychometrics instrumentation, Psychometrics methods, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy, Cognitive Behavioral Therapy instrumentation, Cognitive Behavioral Therapy standards, Military Personnel psychology, Program Evaluation methods
- Abstract
Post-traumatic stress disorder (PTSD) and substance use disorder are two of the most prominent psychiatric disorders among military service members. Seeking Safety (SS) is an evidence-based behavioral therapy model for this comorbidity. This article reports results of a study of SS conducted in a military setting. Our pilot trial addressed outcomes, feasibility, and satisfaction. SS was conducted as is to evaluate its impact without adaptation for military culture. The sample was 24 outpatient service members (from the Army, Navy, Air Force, and Marines) with 33% minority representation. Inclusion criteria were current PTSD and/or SUD. Ten clinicians participated in this study after receiving SS training. Results showed significant improvements on most outcomes, including substance use on the Brief Addiction Monitor; PTSD symptoms on the PTSD Checklist-Military Version (total and criterion D); and the Trauma Symptom Checklist-40 (sexual abuse trauma index and anxiety subscale); functioning on the Sheehan Disability Scale (total and family subscale); psychopathology on the Zung Depression Scale total; the Behavior and Symptom Identification Scale (BASIS)-24 (total and subscales depression functioning, emotional liability, and psychosis); and the Brief Symptom Inventory-18 (total and anxiety subscale); and coping on the Coping Self-Efficacy Scale (total). Satisfaction was strong. Discussion includes methodology limitations and next steps., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)
- Published
- 2016
- Full Text
- View/download PDF
15. A Pilot Study of Seeking Safety in a Sample of German Women Outpatients with Substance Dependence and Posttraumatic Stress Disorder.
- Author
-
Kaiser D, Grundmann J, Schulze C, Stubenvoll M, Kosar M, Junker M, Najavits LM, and Schäfer I
- Subjects
- Adult, Female, Follow-Up Studies, Humans, Middle Aged, Outpatients, Patient Satisfaction, Pilot Projects, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy, Adaptation, Psychological, Stress Disorders, Post-Traumatic psychology, Substance-Related Disorders psychology
- Abstract
Seeking Safety is an integrated coping skills therapy for substance use disorder (SUD) and posttraumatic stress disorder (PTSD). Our aim was to examine the effects of Seeking Safety in a sample of female German outpatients with current SUD and PTSD. A total of 53 women were offered 12 weekly sessions of Seeking Safety, conducted in group modality. Women (N=33) who attended at least six sessions were considered minimum-dose completers and were in the analysis. We measured PTSD and substance use symptoms using the Posttraumatic Diagnostic Scale (PDS) and the Addiction Severity Index (ASI-Lite) at end-of-treatment and three-month follow-up. Additional measures were the Brief Symptom Checklist (BSI) and the Inventory of Interpersonal Problems (IIP-25). Our sample reported chronic SUD, multiple prior detoxifications, and serious childhood trauma. We found medium to large effect sizes for improvements in PTSD symptoms, general psychopathology, and interpersonal problems at end-of-treatment, all of which were sustained at follow-up. Alcohol use improved significantly only at follow-up. This study suggests that the model was associated with positive effects, at least in a subgroup of women attending a minimum of sessions. Limitations include the lack of a control condition as well as an intention-to-treat analysis.
- Published
- 2015
- Full Text
- View/download PDF
16. Attitudes toward Substance Abuse Clients: An Empirical Study of Clinical Psychology Trainees.
- Author
-
Mundon CR, Anderson ML, and Najavits LM
- Subjects
- Adult, Education, Medical, Graduate, Female, Humans, Male, Middle Aged, Young Adult, Attitude of Health Personnel, Psychology, Clinical, Substance-Related Disorders
- Abstract
Despite the high prevalence of substance use disorder (SUD) and its frequent comorbidity with mental illness, individuals with SUD are less likely to receive effective SUD treatment from mental health practitioners than SUD counselors. Limited competence and interest in treating this clinical population are likely influenced by a lack of formal training in SUD treatment. Using a factorial survey-vignette design that included three clinical vignettes and a supplementary survey instrument, we investigated whether clinical psychology doctoral students differ in their level of negative emotional reactions toward clients with SUD versus major depressive disorder (MDD); whether they differ in their attributions for SUD versus MDD; and how their negative emotional reactions and attributions impact their interest in pursuing SUD clinical work. Participants were 155 clinical psychology graduate-level doctoral students (72% female). Participants endorsed more negative emotional reactions toward clients with SUD than toward clients with MDD. They were also more likely to identify poor willpower as the cause for SUD than for MDD. More than a third reported interest in working with SUD populations. Highest levels of interest were associated with prior professional and personal experience with SUD, four to six years of clinical experience, and postmodern theoretical orientation.
- Published
- 2015
- Full Text
- View/download PDF
17. Blending Aboriginal and Western healing methods to treat intergenerational trauma with substance use disorder in Aboriginal peoples who live in northeastern Ontario, Canada.
- Author
-
Marsh TN, Coholic D, Cote-Meek S, and Najavits LM
- Subjects
- Culture, Humans, Indians, North American, Medicine, Traditional methods, Mental Disorders complications, Mental Disorders therapy, Ontario, Power, Psychological, Spirituality, Health Promotion methods, Health Services, Indigenous, Stress, Psychological complications, Stress, Psychological therapy, Substance-Related Disorders complications, Substance-Related Disorders therapy
- Abstract
As with many Indigenous groups around the world, Aboriginal communities in Canada face significant challenges with trauma and substance use. The complexity of symptoms that accompany intergenerational trauma and substance use disorders represents major challenges in the treatment of both disorders. There appears to be an underutilization of substance use and mental health services, substantial client dropout rates, and an increase in HIV infections in Aboriginal communities in Canada. The aim of this paper is to explore and evaluate current literature on how traditional Aboriginal healing methods and the Western treatment model "Seeking Safety" could be blended to help Aboriginal peoples heal from intergenerational trauma and substance use disorders. A literature search was conducted using the keywords: intergenerational trauma, historical trauma, Seeking Safety, substance use, Two-Eyed Seeing, Aboriginal spirituality, and Aboriginal traditional healing. Through a literature review of Indigenous knowledge, most Indigenous scholars proposed that the wellness of an Aboriginal community can only be adequately measured from within an Indigenous knowledge framework that is holistic, inclusive, and respectful of the balance between the spiritual, emotional, physical, and social realms of life. Their findings indicate that treatment interventions must honour the historical context and history of Indigenous peoples. Furthermore, there appears to be strong evidence that strengthening cultural identity, community integration, and political empowerment can enhance and improve mental health and substance use disorders in Aboriginal populations. In addition, Seeking Safety was highlighted as a well-studied model with most populations, resulting in healing. The provided recommendations seek to improve the treatment and healing of Aboriginal peoples presenting with intergenerational trauma and addiction. Other recommendations include the input of qualitative and quantitative research as well as studies encouraging Aboriginal peoples to explore treatments that could specifically enhance health in their respective communities.
- Published
- 2015
- Full Text
- View/download PDF
18. The problem of dropout from "gold standard" PTSD therapies.
- Author
-
Najavits LM
- Abstract
Understanding of posttraumatic stress disorder (PTSD) has increased substantially in the past several decades. There is now more awareness of the many different types of trauma that can lead to PTSD, greater refinement of diagnostic criteria, and the development and testing of various treatments for it. As implementation of PTSD therapies has increased, there is also increased attention to the key issues of retention and dropout. Retention refers to the percentage of patients who stay in a treatment for its intended dose, and dropout is the opposite (the percentage who leave prior to the intended dose); both of which have major implications for treatment outcomes. The two PTSD therapies most studied in relation to retention and dropout are Prolonged Exposure and Cognitive Processing Therapy, which have been the subject of massive, formal, multi-year dissemination roll-outs. Both of these evidence-based treatments are defined as gold-standard therapies for PTSD and showed positive outcomes and reasonable retention of patients in randomized controlled trials (RCTs). But an emerging picture based on real-world practice indicates substantial dropout. Such real-world studies are distinct from RCTs, which have consistently evidenced far lower dropout rates, but under much more restricted conditions (e.g. a more selective range of patients and clinicians). In this paper, the phenomena of retention and dropout are described based on real-world studies of Prolonged Exposure and Cognitive Processing Therapy, including rates, characteristics of patients, clinicians, and programs in relation to retention and dropout, and identification of clinical issues and future research on these topics. It is suggested that the term "gold-standard" evidence-based treatments should be reserved for treatments that evidence both positive results in RCTs but also feasibility and strong retention in real-world settings.
- Published
- 2015
- Full Text
- View/download PDF
19. How Do Females With PTSD and Substance Abuse View 12-Step Groups? An Empirical Study of Attitudes and Attendance Patterns.
- Author
-
Najavits LM, de Haan H, and Kok T
- Subjects
- Adolescent, Adult, Age Distribution, Cross-Sectional Studies, Databases, Factual, Diagnosis, Dual (Psychiatry), Female, Humans, Massachusetts, Middle Aged, Psychiatric Status Rating Scales, Stress Disorders, Post-Traumatic diagnosis, Substance Abuse Treatment Centers, Substance-Related Disorders diagnosis, Substance-Related Disorders therapy, Young Adult, Health Knowledge, Attitudes, Practice, Self-Help Groups statistics & numerical data, Stress Disorders, Post-Traumatic psychology, Substance-Related Disorders psychology
- Abstract
Background: Self-help groups are beneficial for many people with addiction, predominantly through 12-step models. Yet obstacles to attendance also occur., Objectives: We explored attendance patterns and attitudes toward self-help groups by 165 outpatient females with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD), the first study of its kind., Methods: Cross-sectional self-report data compared adults versus adolescents, and those currently attending self-help versus not attending. We also explored attendance in relation to perceptions of the PTSD/SUD relationship and symptom severity., Results: Adults reported higher attendance at self-help than adolescents, both lifetime and currently. Among current attendees, adults also attended more weekly groups than adolescents. Yet only a minority of both age cohorts attended any self-help in the past week. Adults perceived a stronger relationship between PTSD and SUD than adolescents, but both age groups gave low ratings to the fact that self-help groups do not address PTSD. That item also had low ratings by both those currently attending and not attending self-help. Analysis of those not currently attending identified additional negative attitudes toward self-help (spirituality, addiction as a life-long illness, sayings, and the fellowship). Symptom severity was not associated with attendance, but may reflect a floor effect. Finally, a surprising finding was that all-female groups were not preferred by any subsample. Conclusions/Importance. Creative solutions are needed to address obstacles to self-help among this population. Addressing trauma and PTSD, not just SUD, was valued by females we surveyed, and may be more helpful than all-female groups per se.
- Published
- 2015
- Full Text
- View/download PDF
20. Screening of current post-traumatic stress disorder in patients with substance use disorder using the Depression, Anxiety and Stress Scale (DASS-21): a reliable and convenient measure.
- Author
-
Kok T, de Haan HA, van der Meer M, Najavits LM, and De Jong CA
- Subjects
- Adult, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Psychometrics, Reproducibility of Results, Young Adult, Psychiatric Status Rating Scales, Stress Disorders, Post-Traumatic complications, Stress Disorders, Post-Traumatic diagnosis, Substance-Related Disorders complications, Substance-Related Disorders diagnosis
- Abstract
Background: Several instruments have been developed and validated as screens for post-traumatic stress disorder (PTSD) in substance use disorder (SUD) patients. Unfortunately, many of these instruments have one or several disadvantages (e.g. low specificity, low sensitivity or high costs). No research has been conducted on instruments that screen simultaneously for other psychiatric disorders, which would be a potentially time-saving and cost-effective approach. In the current study we tested the psychometric properties of the Depression, Anxiety and Stress Scale (DASS) as a screen for PTSD., Methods: The DASS was assessed in an inpatient facility during intake with 58 patients and again 4 weeks after admission. Another 138 patients were assessed 4 weeks after admission only. The results were compared to the Clinician-Administered PTSD Scale (CAPS) that was also administered after 4 weeks of abstinence., Results: ROC curve analyses showed an area under the curve of 0.84 for the DASS at intake and 0.78 for the DASS after 4 weeks' abstinence., Conclusion: The DASS is therefore a reliable and convenient measure to use as a screen for PTSD in SUD patients., (© 2014 S. Karger AG, Basel.)
- Published
- 2015
- Full Text
- View/download PDF
21. Peer-led seeking safety: results of a pilot outcome study with relevance to public health.
- Author
-
Najavits LM, Hamilton N, Miller N, Griffin J, Welsh T, and Vargo M
- Subjects
- Adaptation, Psychological, Adult, Checklist, Humans, Pilot Projects, Risk Factors, Stress Disorders, Traumatic diagnosis, Stress Disorders, Traumatic psychology, Substance Abuse Treatment Centers, Substance-Related Disorders diagnosis, Substance-Related Disorders psychology, Surveys and Questionnaires, Time Factors, Treatment Outcome, Young Adult, Leadership, Peer Group, Psychotherapy, Group, Stress Disorders, Traumatic rehabilitation, Substance-Related Disorders rehabilitation
- Abstract
Abstract There is a rich history of peer-led recovery efforts related to substance use disorder (SUD). Yet we know of no peer-led approaches for co-occurring SUD and trauma-related problems. This combination is widespread, has impact on multiple life domains, and presents major recovery challenges. In this pilot, we evaluated peer-led Seeking Safety (SS). SS is the most evidence-based and widely implemented therapy for SUD with co-occurring PTSD or other trauma-related problems. Eighteen women in residential substance-abuse treatment participated. All met SUD criteria (primarily opiate and cocaine dependence); most had a comorbid mental health disorder; and they had elevated trauma-related symptoms. The 25 SS topics were conducted twice-weekly. Participants were assessed at baseline and end-of-treatment, with some measures also collected monthly. Results showed significant positive outcomes in trauma-related problems (the Trauma Symptom Checklist-40); psychopathology (the Brief Symptom Inventory); functioning (the BASIS-32, including impulsive-addictive behavior); self-compassion (the Self-Compassion Scale); and SS coping skills. Effect sizes were consistently large. SS satisfaction and fidelity ratings were high. Substance use levels could not be assessed due to the residential setting. Qualitative data indicated enthusiasm for peer-SS by both peers and staff. Study limitations, future research, and public health relevance are discussed.
- Published
- 2014
- Full Text
- View/download PDF
22. Pilot study of Creating Change, a new past-focused model for PTSD and substance abuse.
- Author
-
Najavits LM and Johnson KM
- Subjects
- Adult, Chronic Disease, Female, Humans, Male, Middle Aged, Pilot Projects, Stress Disorders, Post-Traumatic complications, Substance-Related Disorders complications, Treatment Outcome, Young Adult, Behavior Therapy, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy
- Abstract
Background and Objectives: Creating Change (CC) is a new past-focused behavioral therapy model developed for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD). It was designed to address current gaps in the field, including the need for a past-focused PTSD/SUD model that has flexibility, can work with complex clients, responds to the staffing and resource limitations of SUD and other community-based treatment programs, can be conducted in group or individual format, and engages clients and clinicians. It was designed to follow the style, tone, and format of Seeking Safety, a successful present-focused PTSD/SUD model. CC can be used in conjunction with SS and/or other models if desired., Methods: We conducted a pilot outcome trial of the model with seven men and women outpatients diagnosed with current PTSD and SUD, who were predominantly minority and low-income, with chronic PTSD and SUD. Assessments were conducted pre- and post-treatment., Results: Significant improvements were found in multiple domains including some PTSD and trauma-related symptoms (eg, dissociation, anxiety, depression, and sexual problems); broader psychopathology (eg, paranoia, psychotic symptoms, obsessive symptoms, and interpersonal sensitivity); daily life functioning; cognitions related to PTSD; coping strategies; and suicidal ideation (altogether 19 variables, far exceeding the rate expected by chance). Effect sizes were consistently large, including for both alcohol and drug problems. No adverse events were reported., Discussion and Conclusions: Despite study methodology limitations, CC is promising., Scientific Significance: Clients can benefit from past-focused therapy that addresses PTSD and SUD in integrated fashion., (© American Academy of Addiction Psychiatry.)
- Published
- 2014
- Full Text
- View/download PDF
23. Does seeking safety reduce PTSD symptoms in women receiving physical disability compensation?
- Author
-
Anderson ML and Najavits LM
- Subjects
- Adaptation, Psychological physiology, Adult, Diagnosis, Dual (Psychiatry), Disabled Persons statistics & numerical data, Female, Follow-Up Studies, Humans, Middle Aged, Patient Education as Topic methods, Patient Education as Topic statistics & numerical data, Program Evaluation statistics & numerical data, Psychotherapy, Group statistics & numerical data, Severity of Illness Index, Stress Disorders, Post-Traumatic complications, Stress Disorders, Post-Traumatic psychology, Substance-Related Disorders complications, Substance-Related Disorders psychology, Treatment Outcome, Disabled Persons psychology, Pensions statistics & numerical data, Program Evaluation methods, Psychotherapy, Group methods, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy
- Abstract
Objective: This secondary analysis investigated the impact of 12 sessions of Seeking Safety (SS) on reducing posttraumatic stress disorder (PTSD) symptoms in a sample of dually diagnosed women with physical disabilities versus nondisabled (ND) women. SS is an evidence-based and widely implemented manualized therapy for PTSD and/or substance use disorder. It is a present-focused model that promotes coping skills and psychoeducation., Design: As part of the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN), 353 participants with current PTSD and substance use disorder (SUD) were randomly assigned to partial-dose SS or Women's Health Education (WHE) group therapy conducted in community-based substance abuse treatment programs. The women were categorized as participants with disabilities (PWD; n = 20) or ND (n = 333) based on the question, "Do you receive a pension for a physical disability?" PTSD was assessed on the Clinician-Administered PTSD Scale (CAPS) at baseline and follow-ups after treatment (1 week, 3 months, 6 months, and 12 months)., Results: PWD experienced sustained reductions in PTSD symptoms when treated with SS but not WHE. Indeed, PTSD symptoms of PWD in WHE returned to baseline levels of severity by 12-month follow-up. This pattern of results was not observed among ND women, who sustained improvements on PTSD in both treatment conditions., Implications: These results suggest strong potential for using SS to treat PTSD among women with physical disabilities, and speak to the genuine need to address trauma and PTSD more directly with PWD. Our results are also consistent with other findings from the NIDA CTN trial, in which virtually all significant results evidenced SS outperforming WHE.
- Published
- 2014
- Full Text
- View/download PDF
24. Differences between U.S. substance abuse treatment facilities that do and do not offer domestic violence services.
- Author
-
Cohn A and Najavits LM
- Subjects
- Diagnosis, Dual (Psychiatry), Health Care Surveys, Humans, Regression Analysis, Substance-Related Disorders complications, United States, Counseling, Domestic Violence prevention & control, Health Services Accessibility, Substance Abuse Treatment Centers organization & administration, Substance-Related Disorders therapy
- Abstract
Objective: Victimization by and perpetration of domestic violence are associated with co-occurring mental and substance use disorders., Methods: This study used data from the National Survey of Substance Abuse Treatment Services to examine differences in organizational factors, treatment approaches offered, and client-level factors among 13,342 substance abuse treatment facilities by whether or not they offered domestic violence services., Results: Only 36% of the facilities offered domestic violence services. Those that offered such services were more likely than those that did not to treat clients with co-occurring disorders. Principal-components analysis reduced eight treatment approaches to two factors: psychosocial services and traditional substance abuse services. Regression models indicated that the frequency with which psychosocial services were offered depended on the percentage of clients with co-occurring disorders who were being treated in the facility and whether or not that facility offered domestic violence services. Specifically, facilities that did not offer domestic violence services and that had a high percentage of clients with co-occurring disorders were more likely to offer psychosocial services than facilities that offered domestic violence services. A larger proportion of facilities offering domestic violence services offered traditional substance abuse treatment services, compared with facilities not offering domestic violence services, but this relationship was not contingent on the percentage of clients with co-occurring disorders at each facility., Conclusions: Improved efforts should be made to tailor treatments to accommodate the links between domestic violence, mental disorders, and substance abuse.
- Published
- 2014
- Full Text
- View/download PDF
25. Posttraumatic stress disorder and substance use disorder comorbidity among individuals with physical disabilities: findings from the National Comorbidity Survey Replication.
- Author
-
Anderson ML, Ziedonis DM, and Najavits LM
- Subjects
- Adult, Comorbidity, Female, Health Surveys, Humans, Male, Middle Aged, United States, Disabled Persons statistics & numerical data, Stress Disorders, Post-Traumatic epidemiology, Substance-Related Disorders epidemiology
- Abstract
Co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) affects multiple domains of functioning and presents complex challenges to recovery. Using data from the National Comorbidity Study Replication, a national epidemiological study of mental disorders (weighted N = 4,883), the current study sought to determine the prevalence of PTSD and SUD, the symptom presentation of these disorders, and help-seeking behaviors in relation to PTSD and SUD among individuals with physical disabilities (weighted n = 491; nondisabled weighted n = 4,392). Results indicated that individuals with physical disabilities exhibited higher rates of PTSD, SUD, and comorbid PTSD/SUD than nondisabled individuals. For example, they were 2.6 times more likely to meet criteria for lifetime PTSD, 1.5 times more likely for lifetime SUD, and 3.6 times more likely for lifetime PTSD/SUD compared to their nondisabled peers. Additionally, individuals with physical disabilities endorsed more recent/severe PTSD symptoms and more lifetime trauma events than nondisabled individuals with an average of 5 different trauma events compared to 3 in the nondisabled group. No significant pattern of differences was noted for SUD symptom presentation, or for receipt of lifetime or past-year PTSD or SUD treatment. Implications of these findings and recommendations for future research are discussed., (Copyright © 2014 International Society for Traumatic Stress Studies.)
- Published
- 2014
- Full Text
- View/download PDF
26. Therapy for posttraumatic stress and alcohol dependence.
- Author
-
Najavits LM
- Subjects
- Female, Humans, Male, Alcoholism drug therapy, Implosive Therapy, Naltrexone therapeutic use, Narcotic Antagonists therapeutic use, Stress Disorders, Post-Traumatic drug therapy
- Published
- 2013
- Full Text
- View/download PDF
27. Efficacy of "seeking safety" in a Dutch population of traumatized substance-use disorder outpatients: study protocol of a randomized controlled trial.
- Author
-
Kok T, de Haan HA, van der Meer M, Najavits LM, and DeJong CA
- Subjects
- Adolescent, Adult, Clinical Protocols, Cognitive Behavioral Therapy, Female, Humans, Male, Middle Aged, Netherlands, Patient Selection, Research Design, Severity of Illness Index, Stress Disorders, Post-Traumatic complications, Stress Disorders, Post-Traumatic psychology, Substance-Related Disorders complications, Substance-Related Disorders psychology, Surveys and Questionnaires, Treatment Outcome, Adaptation, Psychological, Outpatients, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy
- Abstract
Background: Traumatic experiences and, more specifically, posttraumatic stress disorder (PTSD) are highly prevalent among substance use disorder (SUD) patients. This comorbidity is associated with worse treatment outcomes in substance use treatment programs and more crisis interventions. International guidelines advise an integrated approach to the treatment of trauma related problems and SUD. Seeking Safety is an integrated treatment program that was developed in the United States. The aim of the current study is to test the efficacy of this program in the Netherlands in an outpatient SUD population., Methods/design: A randomized controlled trial (RCT) will be used to test the efficacy of Seeking Safety compared to Cognitive Behavioral Therapy (CBT) in a population of SUD outpatients. Each treatment will consist of 12 group sessions. The primary outcome measure will be substance use severity. Secondary outcome measures are PTSD and trauma symptoms, coping skills, functioning, and cognitions. Questionnaires will be administered at the start of treatment, at the end of treatment (three months after the start of treatment) and at follow-up (six months after the start of treatment)., Discussion: This study protocol presents a RCT in which the efficacy of an integrated treatment for comorbid PTSD and SUD, Seeking Safety, is evaluated in a SUD outpatient population compared to CBT. It is expected that the intervention group will show significantly more improvement in substance use severity compared to the control group at end-of-treatment and at follow-up. Furthermore, a lower drop-out rate is expected for the intervention group. If the intervention proves to be effective, it can be implemented. A cost-effectiveness analysis will be conducted to evaluate the two treatments., Trial Registration: The protocol for this study is registered with the Netherlands Trial Register with number NTR3084 and approved by the local medical ethical committee (METC\11270.haa).
- Published
- 2013
- Full Text
- View/download PDF
28. Helping vulnerable populations: a comprehensive review of the treatment outcome literature on substance use disorder and PTSD.
- Author
-
Najavits LM and Hien D
- Subjects
- Comorbidity, Humans, Stress Disorders, Post-Traumatic epidemiology, Substance-Related Disorders epidemiology, Treatment Outcome, Vulnerable Populations, Psychotherapy methods, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy
- Abstract
We review treatment studies for comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD). Results show positive outcomes on multiple domains. Most models had more effect on PTSD than SUD, suggesting SUD is harder to treat. Seeking Safety (SS) is the most studied model. It shows positive outcomes, and is the only treatment outperforming a control on both PTSD and SUD. Partial-dose SS had more mixed results than the full dose. This first-generation of PTSD/SUD research addresses complex samples excluded from "gold standard" PTSD-alone literature. Treatments for PTSD/SUD are generally longer than PTSD-alone treatments and present-focused, emphasizing stabilization and coping. The few models with past-focused (exposure-based) components also incorporated present-focused approaches for these vulnerable clients. We discuss public health perspectives to advance the field., (© 2013 Wiley Periodicals, Inc.)
- Published
- 2013
- Full Text
- View/download PDF
29. The case of Jared.
- Author
-
Najavits LM
- Subjects
- Adult, Body Dysmorphic Disorders epidemiology, Body Dysmorphic Disorders psychology, Body Dysmorphic Disorders therapy, Comorbidity, Depressive Disorder, Major epidemiology, Depressive Disorder, Major psychology, Depressive Disorder, Major therapy, Humans, Male, Personality Disorders epidemiology, Personality Disorders psychology, Personality Disorders therapy, Suicide, Attempted psychology, Adult Survivors of Child Abuse psychology, Stress Disorders, Post-Traumatic epidemiology, Stress Disorders, Post-Traumatic psychology, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders epidemiology, Substance-Related Disorders psychology, Substance-Related Disorders therapy
- Published
- 2013
- Full Text
- View/download PDF
30. Validation of two screening instruments for PTSD in Dutch substance use disorder inpatients.
- Author
-
Kok T, de Haan HA, van der Velden HJ, van der Meer M, Najavits LM, and de Jong CA
- Subjects
- Adult, Female, Hospitalization, Humans, Male, Netherlands, Psychometrics, ROC Curve, Self Report, Surveys and Questionnaires standards, Psychiatric Status Rating Scales standards, Stress Disorders, Post-Traumatic diagnosis, Substance-Related Disorders psychology
- Abstract
Posttraumatic stress disorder (PTSD) is highly prevalent in substance use disorder (SUD) populations. Because resources for extensive and thorough diagnostic assessment are often limited, reliable screening instruments for PTSD are needed. The aim of the current study was to test two short PTSD measures for diagnostic efficiency in predicting PTSD compared to the Clinician-Administered PTSD Scale (CAPS). The sample consisted of 197 SUD patients receiving residential substance use treatment who completed questionnaires regarding substance use and trauma-related symptoms, all abstinent from substance for 4weeks. The PTSD section of the Mini International Neuropsychiatric Interview plus (MINIplus) and the Self-Report Inventory for PTSD (SRIP) are compared to the CAPS. Results showed low sensitivity (.58) and high specificity (.91) for the PTSD section of the MINIplus. The SRIP showed high sensitivity (.80) and moderately high specificity (.73) at a cut-off score of 48. The prevalence of PTSD as measured with the CAPS was 25.4% current and 46.2% lifetime. Results indicate that the MINIplus, a short clinical interview, has insufficient quality as a screener for PTSD. The SRIP, however, is a reliable instrument in detecting PTSD in a SUD inpatient population in The Netherlands. Screening for PTSD is time efficient and increases detection of PTSD in SUD treatment settings., (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
31. Seeking safety therapy for pathological gambling and PTSD: a pilot outcome study.
- Author
-
Najavits LM, Smylie D, Johnson K, Lung J, Gallop RJ, and Classen CC
- Subjects
- Adult, Ambulatory Care methods, Female, Follow-Up Studies, Gambling complications, Humans, Male, Middle Aged, Pilot Projects, Psychometrics, Severity of Illness Index, Stress Disorders, Post-Traumatic complications, Surveys and Questionnaires, Treatment Outcome, Gambling therapy, Patient Acceptance of Health Care, Stress Disorders, Post-Traumatic therapy
- Abstract
This pilot study evaluated Seeking Safety (SS) therapy for seven outpatients with current comorbid pathological gambling (PG) and posttraumatic stress disorder (PTSD). This represents the first treatment outcome study of this population, and included both genders and 29% minorities. We found significant improvements in: PTSD/trauma (the PTSD Checklist criterion B symptoms; the Trauma Symptom Inventory overall mean and subscales anxiety, dissociation, sexual abuse trauma index, sex problems; and the World Assumptions Scale benevolence subscale); gambling (the Gamblers Beliefs Questionnaire overall mean and subscales illusion of control); functioning (the Basis-32 overall mean and depression/anxiety subscale); psychopathology (the Brief Symptom Inventory overall mean and subscales anxiety and depression; and the Addiction Severity Index, ASI, psychiatric composite score); self-compassion (the Self-Compassion Scale overall mean and subscales isolation, overidentified, and self-judgment); and helping alliance (the Helping Alliance Questionnaire overall mean). One variable indicated worsening (employment composite subscale on the ASI), possibly reflecting measurement issues. SS attendance was excellent. PTSD onset occurred prior to PG onset for most of the sample, and most believed the two disorders were related. Overall, we found that SS can be effectively conducted for comorbid PTSD and PG, with improvements in numerous domains and high acceptability. Limitations are discussed.
- Published
- 2013
- Full Text
- View/download PDF
32. Supporting the education goals of post-9/11 veterans with self-reported PTSD symptoms: a needs assessment.
- Author
-
Ellison ML, Mueller L, Smelson D, Corrigan PW, Torres Stone RA, Bokhour BG, Najavits LM, Vessella JM, and Drebing C
- Subjects
- Adult, Community Mental Health Services methods, Community Mental Health Services organization & administration, Counseling, Female, Health Services Research, Humans, Male, Mental Health, United States, United States Department of Veterans Affairs, Veterans Health, Vocational Guidance, Educational Status, Needs Assessment, Stress Disorders, Post-Traumatic psychology, Stress Disorders, Post-Traumatic rehabilitation, Training Support organization & administration, Veterans education, Veterans psychology
- Abstract
Purpose: The influx of young adult veterans with mental health challenges from recent wars combined with newly expanded veteran education benefits has highlighted the need for a supported education service within the Veterans Administration. However, it is unknown how such a service should be designed to best respond to these needs. This study undertook a qualitative needs assessment for education supports among veterans with post-9/11 service with self-reported PTSD symptoms., Methods: Focus groups were held with 31 veterans, 54% of whom were under age 30. Transcripts were analyzed and interpreted using a thematic approach and a Participatory Action Research team., Results: Findings indicate a need for age relevant services that assist with: education planning and access, counseling for the G.I. Bill, accommodations for PTSD symptoms, community and family re-integration, and outreach and support., Conclusions and Implications for Practice: The veterans recommended that supported education be integrated with the delivery of mental health services, that services have varied intensity, and there be linkages between colleges and the Veterans Health Administration.
- Published
- 2012
- Full Text
- View/download PDF
33. Expanding the boundaries of PTSD treatment.
- Author
-
Najavits LM
- Subjects
- Female, Humans, Male, Cognitive Behavioral Therapy, Couples Therapy, Implosive Therapy, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy
- Published
- 2012
- Full Text
- View/download PDF
34. Rates of trauma-informed counseling at substance abuse treatment facilities: reports from over 10,000 programs.
- Author
-
Capezza NM and Najavits LM
- Subjects
- Adolescent, Adult, Comorbidity, Counseling methods, Female, Health Care Surveys, Humans, Male, Pregnancy, Stress Disorders, Post-Traumatic epidemiology, Substance Abuse Treatment Centers methods, Substance Abuse Treatment Centers statistics & numerical data, Substance-Related Disorders epidemiology, United States, Counseling statistics & numerical data, Stress Disorders, Post-Traumatic therapy, Substance Abuse Treatment Centers organization & administration, Substance-Related Disorders rehabilitation
- Abstract
Objective: Trauma-informed treatment increasingly is recognized as an important component of service delivery. This study examined differences in treatment-related characteristics of facilities that offer moderate or high levels of trauma-informed counseling versus those that offer no or low levels of such counseling., Methods: Responses from 13,223 substance abuse treatment facilities surveyed in 2009 by the National Survey of Substance Abuse Treatment Services (NSSATS) were used., Results: A majority (66.6%) of facilities reported using trauma counseling sometimes or always or often. Facilities that provided moderate or high levels of trauma counseling were more likely to provide additional treatment services, such as disease testing and specialized group therapy, as well as child care, employment counseling, and other ancillary services., Conclusions: A majority of facilities reported provision of trauma counseling. Additional training and resources may be needed for programs that reported low rates of trauma counseling.
- Published
- 2012
- Full Text
- View/download PDF
35. Dissociation, PTSD, and substance abuse: an empirical study.
- Author
-
Najavits LM and Walsh M
- Subjects
- Adult, Female, Humans, Psychiatric Status Rating Scales, Dissociative Disorders diagnosis, Dissociative Disorders psychology, Stress Disorders, Post-Traumatic diagnosis, Stress Disorders, Post-Traumatic psychology, Substance-Related Disorders psychology
- Abstract
Few studies have examined the relationship between posttraumatic stress disorder (PTSD), substance use disorder, and dissociation. We studied 77 women with current PTSD and substance dependence, classified into high- versus low-dissociation groups per the Dissociative Experiences Scale. They were compared on trauma- and substance-related symptoms, cognitions, coping skills, social adjustment, trauma history, psychiatric symptoms, and self-harm/suicidal behaviors. We found the high-dissociation group consistently more impaired than the low-dissociation group. Also, the sample overall evidenced relatively high levels of dissociation, indicating that even in the presence of recent substance use, dissociation remains a major psychological phenomenon. Indeed, the high-dissociation group reported stronger expectation that substances could manage their psychiatric symptoms. The high-dissociation group also had more trauma-related symptoms and childhood histories of emotional abuse and physical neglect. The discussion addresses methodology, the "chemical dissociation" hypothesis, and the need for a more nuanced understanding of how substances are experienced in relation to dissociative phenomena.
- Published
- 2012
- Full Text
- View/download PDF
36. Creating trauma-informed correctional care: a balance of goals and environment.
- Author
-
Miller NA and Najavits LM
- Abstract
Background: Rates of posttraumatic stress disorder and exposure to violence among incarcerated males and females in the US are exponentially higher than rates among the general population; yet, abrupt detoxification from substances, the pervasive authoritative presence and sensory and environmental trauma triggers can pose a threat to individual and institutional stability during incarceration., Objective: The authors explore the unique challenges and promises of trauma-informed correctional care and suggest strategies for administrative support, staff development, programming, and relevant clinical approaches., Method: A review of literature includes a comparison of gendered responses, implications for men's facilities, and the compatibility of trauma recovery goals and forensic programming goals., Results: Trauma-informed care demonstrates promise in increasing offender responsivity to evidence-based cognitive behavioral programming that reduces criminal risk factors and in supporting integrated programming for offenders with substance abuse and co-occurring disorders., Conclusions: Incorporating trauma recovery principles into correctional environments requires an understanding of criminal justice priorities, workforce development, and specific approaches to screening, assessment, and programming that unify the goals of clinical and security staff.
- Published
- 2012
- Full Text
- View/download PDF
37. Pathological gambling and posttraumatic stress disorder: a study of the co-morbidity versus each alone.
- Author
-
Najavits LM, Meyer T, Johnson KM, and Korn D
- Subjects
- Adult, Comorbidity, Cross-Sectional Studies, Female, Gambling psychology, Health Surveys, Humans, Male, Middle Aged, Quality of Life, Socioeconomic Factors, Stress Disorders, Post-Traumatic diagnosis, Stress Disorders, Post-Traumatic psychology, Substance-Related Disorders epidemiology, Suicide, Attempted statistics & numerical data, Gambling diagnosis, Gambling epidemiology, Health Status, Severity of Illness Index, Stress Disorders, Post-Traumatic epidemiology
- Abstract
This report is the first empirical study to compare pathological gambling (PG), posttraumatic stress disorder (PTSD), and their co-occurrence. The sample was 106 adults recruited from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Using a cross-sectional design, the three groups were rigorously diagnosed and compared on various measures including sociodemographics, psychopathology (e.g., dissociation, suicidality, comorbid Axis I and II disorders), functioning, cognition, life history, and severity of gambling and PTSD. Overall, the PG group reported better psychological health and higher functioning than PTSD or BOTH; and there were virtually no differences between PTSD and BOTH. This suggests that it is the impact of PTSD, rather than comorbidity per se, that appears to drive a substantial increase in symptoms. We also found high rates of additional co-occurring disorders and suicidality in PTSD and BOTH, which warrants further clinical attention. Across the total sample, many reported a family history of substance use disorder (59%) and gambling problems (34%), highlighting the intergenerational impact of these. We also found notable subthreshold PTSD and gambling symptoms even among those not diagnosed with the disorders, suggesting a need for preventive care. Dissociation measures had mixed results. Discussion includes methodology considerations and future research areas.
- Published
- 2011
- Full Text
- View/download PDF
38. Treatments for PTSD and pathological gambling: what do patients want?
- Author
-
Najavits LM
- Subjects
- Adult, Boston, Comorbidity, Data Collection, Female, Gambling psychology, Humans, Male, Middle Aged, Ontario, Patient Satisfaction, Stress Disorders, Post-Traumatic psychology, Complementary Therapies, Gambling therapy, Patient Preference psychology, Psychotherapy, Psychotropic Drugs therapeutic use, Self Care psychology, Stress Disorders, Post-Traumatic therapy
- Abstract
This study explored the treatment preferences of 106 people with posttraumatic stress disorder (PTSD), pathological gambling (PG), or both. It is the first know study of its type for this comorbidity. Sixteen different treatment types were rated, with a broad array of modalities including manualized psychotherapies, medication, self-help, alternative therapies, coaching, and self-guided treatments (use of books and computerized therapy). A consistent finding was that PTSD treatments were rated more highly than PG treatments, even among those with both disorders. Further, of the sixteen treatment types, the sample expressed numerous preferences for some over others. For example, among PG treatments, self-help was the highest-rated. Among PTSD treatments, psychotherapies were the highest-rated; and individual therapy was rated higher than group therapy. For both PG and PTSD, medications were rated lower than other treatment types. Non-standard treatments (i.e., computerized treatment, books, coaching, family therapy, alternative therapies) were generally rated lower than other types. Discussion includes implications for the design of treatments, as well as methodological limitations.
- Published
- 2011
- Full Text
- View/download PDF
39. Treatment utilization of pathological gamblers with and without PTSD.
- Author
-
Najavits LM
- Subjects
- Adaptation, Psychological, Adult, Attitude to Health, Comorbidity, Female, Gambling psychology, Humans, Life Change Events, Male, Mental Health Services statistics & numerical data, Middle Aged, Stress Disorders, Post-Traumatic psychology, Gambling epidemiology, Severity of Illness Index, Stress Disorders, Post-Traumatic epidemiology, Stress Disorders, Post-Traumatic therapy
- Abstract
This paper represents the first study of treatment utilization among pathological gamblers with and without PTSD. Comorbidity of PG and PTSD is increasingly recognized as an important association, both in its rate and clinical severity. The sample comprised 106 adults from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Four areas were addressed: current treatment utilization, lifetime treatment utilization, specific treatments utilized, and satisfaction with treatments. Results indicated that the presence of PTSD was associated with higher treatment utilization (for current utilization, PTSD was higher than PG; and for lifetime, PTSD and PTSD/PG were both higher than PG). Indeed, only a minority of the PG group had ever attended current or lifetime treatment, whereas the majority of PTSD and PTSD/PG had. Yet notably, those with PG who utilized current treatment had no less satisfaction, number of treatment types, nor number of days in treatment than the other two groups. For all three groups, the most common current treatments were individual therapy and psychiatric medications. Study strengths include a rigorously diagnosed sample; an extensive interview-based assessment of treatment utilization, and identification of both current and lifetime utilization. Limitations include the inability to explore change over time or test-retest reliability of responses.
- Published
- 2010
- Full Text
- View/download PDF
40. PTSD among a treatment sample of repeat DUI offenders.
- Author
-
Peller AJ, Najavits LM, Nelson SE, LaBrie RA, and Shaffer HJ
- Subjects
- Adult, Aged, Alcoholic Intoxication diagnosis, Alcoholic Intoxication psychology, Alcoholic Intoxication rehabilitation, Alcoholism diagnosis, Alcoholism psychology, Alcoholism rehabilitation, Comorbidity, Cross-Sectional Studies, Diagnosis, Computer-Assisted, Female, Follow-Up Studies, Humans, Life Change Events, Male, Massachusetts, Middle Aged, Patient Admission legislation & jurisprudence, Patient Admission statistics & numerical data, Personality Assessment statistics & numerical data, Prospective Studies, Reproducibility of Results, Secondary Prevention, Stress Disorders, Post-Traumatic diagnosis, Stress Disorders, Post-Traumatic psychology, Stress Disorders, Post-Traumatic rehabilitation, Young Adult, Accidents, Traffic legislation & jurisprudence, Accidents, Traffic prevention & control, Alcoholic Intoxication epidemiology, Alcoholism epidemiology, Stress Disorders, Post-Traumatic epidemiology
- Abstract
Recent studies indicate that posttraumatic stress disorder (PTSD) is one of the most common psychiatric comorbidities among driving-under-the-influence (DUI) offenders in treatment. Investigation of DUI offenders' PTSD and clinical characteristics could have important implications for prevention and treatment. This prospective study examined the demographic and clinical characteristics of repeat DUI offenders with PTSD symptoms at baseline and 1-year follow-up. Seven hundred twenty-nine DUI offenders admitted to a 2-week inpatient program participated in the study. Participants with PTSD evidenced more severe psychiatric comorbidity and reported a higher DUI recidivism rate at 1-year than those without PTSD. This study suggests a need to address PTSD among DUI offenders, as well as to further develop methodologies for accurately reporting DUI recidivism.
- Published
- 2010
- Full Text
- View/download PDF
41. Improving PTSD/substance abuse treatment in the VA: a survey of providers.
- Author
-
Najavits LM, Norman SB, Kivlahan D, and Kosten TR
- Subjects
- Data Collection, Diagnosis, Dual (Psychiatry), Humans, Stress Disorders, Post-Traumatic complications, Substance-Related Disorders complications, United States, Attitude of Health Personnel, Quality of Health Care statistics & numerical data, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy, United States Department of Veterans Affairs
- Abstract
We surveyed 205 Veterans Affairs (VA) staff on treatment of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and the combination (PTSD/SUD). The survey was anonymous and VA-wide. PTSD/SUD was perceived as more difficult to treat than either disorder alone; gratification in the work was stronger than difficulty (for PTSD, SUD, and PTSD/SUD); and difficulty and gratification appeared separate constructs. Respondents endorsed views that represent expert treatment for the comorbidity; however, there was also endorsement of "myths." Thus, there is a need for more training, policy clarifications, service integration, and adaptations for veterans returning from Iraq and Afghanistan. Limitations are described.
- Published
- 2010
- Full Text
- View/download PDF
42. A pilot study of seeking safety therapy with OEF/OIF veterans.
- Author
-
Norman SB, Wilkins KC, Tapert SF, Lang AJ, and Najavits LM
- Subjects
- Adult, Afghan Campaign 2001-, Checklist methods, Cognitive Behavioral Therapy, Follow-Up Studies, Humans, Male, Middle Aged, Pilot Projects, Time Factors, Warfare, Young Adult, Stress Disorders, Post-Traumatic psychology, Stress Disorders, Post-Traumatic rehabilitation, Substance-Related Disorders psychology, Substance-Related Disorders rehabilitation, Veterans
- Abstract
PTSD and substance use disorder (SUD) are highly prevalent among veterans returning from Iraq and Afghanistan (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF). Seeking Safety (SS) is a cognitive-behavioral psychotherapy for co-occurring PTSD/SUD. This pilot study with fourteen male OEF/OIF veterans suggests that SS may help to reduce alcohol use, PTSD, and depression in some participants at clinically significant levels, even when providing less than half of the full model. We emphasize several SS features as especially helpful: the case management component to help engage clients in further mental health and SUD care, offering PTSD as an entry point, and emphasis on community resources. Issues particular to veterans include reintegration to civilian life and supporting their connection with other veterans.
- Published
- 2010
- Full Text
- View/download PDF
43. Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD.
- Author
-
Zlotnick C, Johnson J, and Najavits LM
- Subjects
- Adult, Analysis of Variance, Female, Humans, Pilot Projects, Psychiatric Status Rating Scales, Surveys and Questionnaires, Time Factors, Treatment Outcome, Cognitive Behavioral Therapy methods, Prisoners psychology, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy
- Abstract
This randomized controlled pilot study compared a cognitive-behavioral therapy (Seeking Safety; SS) plus treatment-as-usual (TAU) to TAU-alone in 49 incarcerated women with substance use disorder (SUD) and posttraumatic stress disorder (PTSD; full or subthreshold). Seeking Safety consisted of a voluntary group treatment during incarceration and individual treatment after prison release. TAU was required in the prison and comprised 180 to 240 hours of individual and group treatment over 6 to 8 weeks. Assessments occurred at intake, 12 weeks after intake, and 3 and 6 months after release from prison. There were no significant differences between conditions on all key domains (PTSD, SUD, psychopathology, and legal problems); but both conditions showed significant improvements from intake to later time points on all of these outcomes across time. Secondary analyses at follow-up found trends for SS participants improving on clinician-rated PTSD symptoms and TAU participants worsening on self-reported PTSD symptoms. Also, SS demonstrated continued improvement on psychopathology at 3 and 6 months, whereas TAU did not. However, alcohol use improved more for TAU during follow-up. Satisfaction with SS was high, and a greater number of SS sessions was associated with greater improvement on PTSD and drug use. Six months after release from prison, 53% of the women in both conditions reported a remission in PTSD. Study limitations include lack of assessment of SS outcomes at end of group treatment; lack of blind assessment; omission of the SS case management component; and possible contamination between the two conditions. The complex needs of this population are discussed.
- Published
- 2009
- Full Text
- View/download PDF
44. Psychotherapies for trauma and substance abuse in women: review and policy implications.
- Author
-
Najavits LM
- Subjects
- Battered Women psychology, Female, Humans, Needs Assessment organization & administration, Professional-Patient Relations, Spouse Abuse statistics & numerical data, Stress Disorders, Post-Traumatic psychology, Substance Abuse Treatment Centers organization & administration, Substance-Related Disorders psychology, Counseling methods, Psychotherapy, Group methods, Spouse Abuse therapy, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy, Women's Health
- Abstract
Women are subject to high rates of interpersonal violence. One frequent co-occurring issue is substance abuse, which may arise posttrauma as a way to cope. In this article, psychosocial therapies for co-occurring trauma and substance abuse are reviewed. Description of empirically studied models is provided, as well as results of the empirical studies. Overall, this area of work suggests positive growth in the availability of new models but very limited empirical work thus far for all but one model. Directions for the future include the need for greater study of treatments in this area, as well as the need to address issues beyond specific models (e.g., workforce issues, access to care, and changing the culture of treatment systems). Policy implications are also offered.
- Published
- 2009
- Full Text
- View/download PDF
45. Seeking safety therapy: clarification of results.
- Author
-
Desai RA, Harpaz-Rotem I, Najavits LM, and Rosenheck RA
- Subjects
- Humans, Stress Disorders, Post-Traumatic rehabilitation, Substance-Related Disorders rehabilitation, Data Interpretation, Statistical, Ill-Housed Persons psychology, Outcome and Process Assessment, Health Care methods, Outcome and Process Assessment, Health Care statistics & numerical data, Safety
- Published
- 2009
- Full Text
- View/download PDF
46. Gender differences in cocaine dependence.
- Author
-
Najavits LM and Lester KM
- Subjects
- Adult, Attitude, Cocaine-Related Disorders rehabilitation, Data Interpretation, Statistical, Family, Female, Humans, Male, Mental Disorders complications, Motivation, Psychiatric Status Rating Scales, Sex Characteristics, Treatment Outcome, Unemployment psychology, Wounds and Injuries complications, Wounds and Injuries psychology, Cocaine-Related Disorders psychology
- Abstract
Aims: This study examined gender differences among treatment-seeking cocaine-dependent outpatients (e.g., on demographics, psychopathology, and substance abuse)., Participants: Participants were 2376 adults with cocaine dependence entering a multisite randomized controlled trial of psychosocial therapies., Findings: Women, compared to men, had less severe lifetime substance use problems but a higher pattern of psychiatric, medical, social/family, and employment problems; they also had more positive expectations and opinions about treatment., Conclusions: Women may be willing to engage in treatment but may have challenging economic and psychosocial concerns over and above their addiction.
- Published
- 2008
- Full Text
- View/download PDF
47. Research- and community-based clinicians' attitudes on treatment manuals.
- Author
-
Barry DT, Fulgieri MD, Lavery ME, Chawarski MC, Najavits LM, Schottenfeld RS, and Pantalon MV
- Subjects
- Adult, Connecticut, Diffusion of Innovation, Female, Guideline Adherence, Humans, Male, Middle Aged, Professional Competence, Substance-Related Disorders psychology, Attitude of Health Personnel, Evidence-Based Medicine, Manuals as Topic, Patient Care Team, Research Personnel psychology, Substance Abuse Treatment Centers, Substance-Related Disorders rehabilitation
- Abstract
We assessed the attitudes of 18 research- and 22 community-based substance abuse clinicians on treatment manuals. Research and community clinicians exhibited favorable attitudes toward manuals, and the majority (72% and 77%, respectively) reported an interest in learning more about substance use disorder (SUD) treatment manuals. Among community clinicians, greater years of experience was significantly associated with less favorable attitudes toward treatment manuals. Research clinicians endorsed significantly higher ratings for the importance attached to "theoretical rationale/overview" and "main session points to address" than community clinicians. Findings suggest that community SUD clinicians are already familiar with and have positive attitudes toward manuals, but specific subgroups have concerns that should be addressed.
- Published
- 2008
- Full Text
- View/download PDF
48. Clinical challenges in the treatment of patients with posttraumatic stress disorder and substance abuse.
- Author
-
Schäfer I and Najavits LM
- Subjects
- Comorbidity, Diagnosis, Dual (Psychiatry), Humans, Psychotherapy methods, Stress Disorders, Post-Traumatic drug therapy, Stress Disorders, Post-Traumatic epidemiology, Substance-Related Disorders drug therapy, Substance-Related Disorders epidemiology, Treatment Outcome, Stress Disorders, Post-Traumatic therapy, Substance-Related Disorders therapy
- Abstract
Purpose of Review: The aim of this article is to review the current literature on co-occuring posttraumatic stress disorder and substance-use disorder, with an emphasis on clinical aspects and emerging treatments., Recent Findings: In clinical populations (focusing on either disorder), about 25-50% have a lifetime dual diagnosis of posttraumatic stress disorder and substance-use disorder. Patients with both disorders have a more severe clinical profile than those with either disorder alone, lower functioning, poorer well being, and worse outcomes across a variety of measures. In recent years, several promising treatment programs have been developed specifically for co-occuring posttraumatic stress disorder and substance-use disorder, with one model having been established as effective thus far., Summary: Comorbid posttraumatic stress disorder/substance-use disorder is a frequent diagnosis in clinical populations that severely affects course and outcome. Treatment approaches appropriate for this vulnerable population need to be evaluated further and implemented in routine practice.
- Published
- 2007
- Full Text
- View/download PDF
49. Implementing an evidence-based practice: Seeking Safety Group.
- Author
-
Brown VB, Najavits LM, Cadiz S, Finkelstein N, Heckman JP, and Rechberger E
- Subjects
- Adult, Attitude of Health Personnel, Benchmarking, Evidence-Based Medicine, Female, Humans, Patient Satisfaction, Qualitative Research, Safety, Stress Disorders, Post-Traumatic psychology, Substance-Related Disorders psychology, Substance-Related Disorders rehabilitation, Treatment Outcome, Behavior Therapy, Diffusion of Innovation, Stress Disorders, Post-Traumatic rehabilitation
- Abstract
This article presents findings from a multisite study on adopting and implementing an evidence-based practice, Seeking Safety, for women with co-occurring disorders and experiences of physical and sexual abuse. It focuses on what implementation decisions different sites made to optimize the compatibility of Seeking Safety with the site's needs and experiences and on issues posed by Rogers (1995) as relevant to successful diffusion of an innovative practice. A total of 157 clients and 32 clinicians reported on satisfaction with various aspects of the model. Cross-site differences are also examined. Results show that Seeking Safety appears to be an intervention that clinicians perceive as highly relevant to their practice, and one that adds value. Clients perceive the treatment as uniquely touching on their needs in a way that previous treatments had not.
- Published
- 2007
- Full Text
- View/download PDF
50. Six-month treatment outcomes of cocaine-dependent patients with and without PTSD in a multisite national trial.
- Author
-
Najavits LM, Harned MS, Gallop RJ, Butler SF, Barber JP, Thase ME, and Crits-Christoph P
- Subjects
- Adult, Alcoholics Anonymous, Alcoholism diagnosis, Alcoholism epidemiology, Alcoholism rehabilitation, Cocaine-Related Disorders diagnosis, Cocaine-Related Disorders epidemiology, Cognitive Behavioral Therapy methods, Comorbidity, Counseling methods, Diagnosis, Dual (Psychiatry), Female, Follow-Up Studies, Humans, Hypnotics and Sedatives, Male, Marijuana Abuse diagnosis, Marijuana Abuse epidemiology, Marijuana Abuse rehabilitation, Psychoanalytic Therapy methods, Social Support, Stress Disorders, Post-Traumatic diagnosis, Stress Disorders, Post-Traumatic epidemiology, Substance-Related Disorders diagnosis, Substance-Related Disorders epidemiology, Substance-Related Disorders rehabilitation, United States, Cocaine-Related Disorders rehabilitation, Psychotherapy methods, Stress Disorders, Post-Traumatic rehabilitation
- Abstract
Objective: This study examined 6-month treatment outcomes among 428 cocaine-dependent outpatients with (n = 34) and without (n = 394) posttraumatic stress disorder (PTSD) in a randomized controlled multisite clinical trial of manual-based psychotherapies for substance use disorder (SUD)., Method: Assessments were completed at baseline and monthly during the 6-month treatment. With longitudinal mixed-effects models, we compared outcomes between SUD-PTSD and SUD-only patients and also examined rates of within-group change., Results: Results indicated a highly consistent pattern: the SUD-PTSD patients were more impaired to begin with and remained so across time compared with SUD-only patients (with the exception of substance use and addiction-related legal and employment problems, which did not differ between groups). Also, the SUD-PTSD patients improved less than SUD-only patients in alcohol use and the majority of addiction-related psychosocial problems. However, the two groups did not differ significantly in improvement over time on drug use or global psychological severity., Conclusions: The greater impairment and relative lack of improvement of SUD-PTSD patients, compared with those with SUD-only, suggest a need for dual-diagnosis treatments that more directly target their areas of difficulty.
- Published
- 2007
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.