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Treatment for PTSD and SUD: Site Differences and Implications for Outcomes D Hien1, A Campbell1, G Miele2, L Cohen1, & E Nunes2 1Columbia University School of Social Work, Study Context 2 Columbia Results Therapist Characteristics Many substance-dependent women seeking treatment have been exposed to chronic interpersonal violence and may suffer psychiatric sequelae of trauma in the form of posttraumatic stress disorder (PTSD). Variable Age Race: % White Yrs Formal Education Yrs of Drug Tx Exp Yrs at Program Clients w/ Trauma Hx: % Women with trauma histories and substance use disorders (SUDs) present significant challenges to clinicians, including poorer treatment outcomes, engagement and retention, higher frequency of relapse, use of multiple substances, co-occurring psychiatric diagnoses, and treatment drop-out (Dansky et al.1995, Hien et al., 2000; Zweben et al.1994). The majority of substance abuse programs do not regularly assess for trauma histories, so women do not receive treatment for comorbid trauma-related problems (Brown et al., 1999). M/% 39.9 58.3 17.2 6.9 4.4 71.9 Range Across Sites Counselors Supervisors N=18 N=18 25 – 51 30 – 58 50.0 66.7 6 – 20 16 – 22 1 – 10 0 – 20 1 – 11 1 – 17 10 – 90 30 – 100 Summary An integrated model is recommended by both clinicians and researchers as more likely to succeed, more cost-effective, and more sensitive to these patient’s unique needs (Brady et al., 1994; Evans et al., 1995; Najavits et al., 1996; Sullivan & Evans, 1994). Consistent across sites: High levels of multiple trauma exposure with clinically significant PTSD symptoms. High percentage of sexual assaults (range=85%-100%). High rates of service utilization (i.e. 12 step, medical and mental health visits). Low overall depression levels, but with clinically significant subgroup with higher depression scores. CTN Women and Trauma study took one of the next steps in advancing research in this area through a randomized control trial comparing Seeking Safety (SS) to an attention control group (WHE) in the context of ongoing community-based substance abuse treatment. Long Island Node Team Denise Hien, Lead Investigator Gloria Miele, Training Director Lisa Cohen, Protocol Manager Aimee Campbell, Project Director University New York State Psychiatric Institute Edward Nunes, Node PI Eva Petkova, Statistician Jennifer Lima, Node Coordinator David Liu, NIDA Liaison Differences across sites: Types of other traumatic experiences reported. Types of drugs used and drug diagnosis. Recruitment success linked to type of CTP population and number of available intakes. Participating Sites Data Analysis Issues Kirkland, WA Stamford, CT Brooklyn, NY Columbus, OH Charleston, SC Jacksonville, FL Miami, FL Design Sample Characteristics (N=353) Variable a Age Race: White (%) Yrs Educationb c Married : (%) Lifetime Convictions Chronic Medical Problemsd: % yes Mental Health Visits 30de 12-Step Attendancef g CAPS Total Score BSI Depression Subscaleh a b M (SD) / % 38.9 (9.8) 56.0 12.5 (2.5) 15.0 5.2 (9.3) Range Across Sites 32.3 – 46.4 8.8 – 97.1 11.6 – 13.2 0 – 40.0 1.6 – 11.8 45 10.4 (9.6) 16.1 (12.7) 26 – 86 5.4 – 19.1 4.7 – 24.4 56.4 (17.5) 6.7 (5.1) 45.6 – 66.9 4.1 – 8.1 c d Chi-sq=73.9(6), p-value<0.001; Chi-sq =48.1(6), p-value<0.001; Chi-sq=73.7(30), p-value<0.001; ;e f g Chi-sq=20.1(6), p-value=0.003 Chi-sq =96.2(6), p-value<0.001; Chi-sq =57.7(6), p-value<0.001; Chih sq =31.8(6), p-value<.001; Chi-sq=18.9(6), p-value<0.001 Measure Description: (1) PTSD Severity - CAPS-Clinician Administered PTSD Scale (Blake et al., 1990), measures frequency and intensity of signs and symptoms of PTSD and overall symptom severity. (2) Substance Use – Addiction Severity Index (ASI, McLellan et al., 1992) alcohol and drug composite scores (includes 30 day use and drug/alcohol problems). Intervention Delivery: weeks in treatment, number and type of treatment received, group size, session length Therapist: characteristics, adherence level, alliance Treatment as Usual: gender specific services, trauma services, length, modality Implications/Conclusion Though all participants met PTSD and SUD diagnoses as per study inclusion criteria, findings show that within this sample population there was substantial variability across sites in terms of types of trauma exposure, types of drugs used and specific drug use diagnoses. Clinicians and researchers need to be aware of the potential for such differences when developing or delivering treatment interventions so as to best meet needs of this heterogeneous group. Acknowledgements Participation in this study made possible by NIDA CTN Long Island Regional Node (NIDA/NIH Grant U10 DA13035). We would like to acknowledge the dedicated staff and participants who made this study possible.