Saturday, February 23, 2008
Dual Diagnosis PTSD and Substance Abuse Treatments and Issues / Part 3
Stephanie Covington has created a trauma specific model for women as well in 2003. In the introduction to her program, Covington (2003) discusses the integrated treatment approach focusing on women. "The connection between addiction and trauma for women is intricate and not easily disentangled" (p. 16). She goes on to discuss that the treatment provider cannot assume, when reviewing a patient with both addiction and trauma, that one is a primary problem and the other a secondary one. "Nor is it always beneficial to delay working on trauma symptoms until the client as been abstinent for a minimum time" (Covington, 2003, p. 16).
Women exposed to trauma and addicted to alcohol or another drug are considered to be at higher risk of mental disorder (Covington, 2003, p. 16). Studies, including those by Najavits, Weiss, and Shaw (1997) that indicate that comorbid mental disorders, medical problems, psychological problems, inpatient admissions, interpersonal problems; lower levels of functioning, compliance with aftercare, and motivation for treatment; and other significant life problems are more common among those with PTSD and substance abuse compared to among those that have one or other of the problems.
Co-occurring disorders are complex and the historical division in the fields of mental health and substance abuse typically result in contradictory treatments (Covington, 2003, p. 16).
Her model calls for a self-guided, quasi-self-help approach to healing dual-diagnosis PTSD and substance abuse. For example, the outline for one session focuses around asking the client to think of "recent incidents" (p. 191) of trauma, "substance use, self-harm, or other recent acting out behaviors". The purpose of the exercise is to put the patient in touch with their "red-flags", the triggers of their self-harm behavior.
Long-term reviews of treatment courses have yet to be conducted and a great deal more information must be assembled before it is possible to draw sustained conclusions about the methods of treatment that have a high degree of success for dual-diagnosis patients. There are a number of reviews of Seeking Safety, however. To date, four studies have evaluated Seeking Safety, the treatment program developed by Lisa Najavits; one of the four studies was conducted in a correctional setting. In all the studies, the patients had PTSD and substance use disorder. The first two studies evaluated groups that met twice a week for three months. The first study was a pilot, with the treatment in group format (Najavits, L.M. et al. 1998). Of twenty-seven outpatient women enrolled, seventeen (63%) completed the minimum six sessions. Results for these seventeen women showed an average attendance rate of 67% of sessions, as well as significant improvements in substance use, trauma-related symptoms, suicidal thoughts and risk, social adjustment, family functioning, problem-solving, depression, cognitions about substance use and didactic knowledge related to treatment.
The second study evaluated Seeking Safety in a correctional setting (Zlotnick, Najavits, and Rohsenow). Seventeen women participated in the trial, which used a group version of the treatment. The attendance rate was 83% of sessions and measures of client satisfaction were high. Of the seventeen women, nine (53%) no longer met criteria for PTSD by the end of the three-month treatment period; at a follow-up three months later, 46% still no longer met criteria for PTSD. Substance use could not be assessed while the women were in the prison's controlled environment, but a follow-up six weeks after release from prison indicated that 70% did not meet criteria for substance use disorder. The recidivism rate was 39% at a three-month follow-up, which is typical of this population. A study is under way to evaluate whether providing additional Seeking Safety sessions after release from prison might be beneficial.
Women exposed to trauma and addicted to alcohol or another drug are considered to be at higher risk of mental disorder (Covington, 2003, p. 16). Studies, including those by Najavits, Weiss, and Shaw (1997) that indicate that comorbid mental disorders, medical problems, psychological problems, inpatient admissions, interpersonal problems; lower levels of functioning, compliance with aftercare, and motivation for treatment; and other significant life problems are more common among those with PTSD and substance abuse compared to among those that have one or other of the problems.
Co-occurring disorders are complex and the historical division in the fields of mental health and substance abuse typically result in contradictory treatments (Covington, 2003, p. 16).
Her model calls for a self-guided, quasi-self-help approach to healing dual-diagnosis PTSD and substance abuse. For example, the outline for one session focuses around asking the client to think of "recent incidents" (p. 191) of trauma, "substance use, self-harm, or other recent acting out behaviors". The purpose of the exercise is to put the patient in touch with their "red-flags", the triggers of their self-harm behavior.
Long-term reviews of treatment courses have yet to be conducted and a great deal more information must be assembled before it is possible to draw sustained conclusions about the methods of treatment that have a high degree of success for dual-diagnosis patients. There are a number of reviews of Seeking Safety, however. To date, four studies have evaluated Seeking Safety, the treatment program developed by Lisa Najavits; one of the four studies was conducted in a correctional setting. In all the studies, the patients had PTSD and substance use disorder. The first two studies evaluated groups that met twice a week for three months. The first study was a pilot, with the treatment in group format (Najavits, L.M. et al. 1998). Of twenty-seven outpatient women enrolled, seventeen (63%) completed the minimum six sessions. Results for these seventeen women showed an average attendance rate of 67% of sessions, as well as significant improvements in substance use, trauma-related symptoms, suicidal thoughts and risk, social adjustment, family functioning, problem-solving, depression, cognitions about substance use and didactic knowledge related to treatment.
The second study evaluated Seeking Safety in a correctional setting (Zlotnick, Najavits, and Rohsenow). Seventeen women participated in the trial, which used a group version of the treatment. The attendance rate was 83% of sessions and measures of client satisfaction were high. Of the seventeen women, nine (53%) no longer met criteria for PTSD by the end of the three-month treatment period; at a follow-up three months later, 46% still no longer met criteria for PTSD. Substance use could not be assessed while the women were in the prison's controlled environment, but a follow-up six weeks after release from prison indicated that 70% did not meet criteria for substance use disorder. The recidivism rate was 39% at a three-month follow-up, which is typical of this population. A study is under way to evaluate whether providing additional Seeking Safety sessions after release from prison might be beneficial.
Labels: Dual-Diagnosis-Treatment, Post-Traumatic-Stress-Disorder, Substance-Abuse
