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Agarwal I, Draheim AA. Seeking Safety for women in incarceration: a systematic review. Arch Womens Ment Health 2024; 27:317-327. [PMID: 38147147 DOI: 10.1007/s00737-023-01411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE Seeking Safety is an evidence-based treatment for individuals with comorbid posttraumatic stress disorder and substance use disorder. This treatment shows promise to address the unique, unmet needs of women in prison. The current systematic literature review aims to highlight several critical gaps in research on Seeking Safety in forensic settings that need to be filled before Seeking Safety can be implemented in a widespread manner. METHODS PsycINFO, PubMed and Google scholar databases were used to identify studies that were published in English, included women in forensic settings, and incorporated Seeking Safety treatment. A total of seven studies met review criteria. The quality of studies was assessed with the mixed methods appraisal tool. RESULTS High risk of contamination, inclusion of small, predominantly White samples, high attrition rates, need for dose-response testing, and lack of follow-up data currently limit the ability to assess the efficacy of Seeking Safety in forensic settings. In addition, there is a lack of research on Seeking Safety's ability to reduce symptoms of substance use disorder for incarcerated women and further cultural adaptation may be needed. CONCLUSION Seeking Safety has the potential to address the underlying causes of incarceration for justice-involved women, but additional research addressing these identified gaps is needed to facilitate more widespread implementation.
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Affiliation(s)
- Ishita Agarwal
- Department of Psychology, Lawrence University, Appleton, WI, USA
| | - Amanda A Draheim
- Department of Psychology, Lawrence University, Appleton, WI, USA.
- Department of Psychology, Goucher College, 1021 Dulaney Valley Road, Baltimore, MD, 21204, USA.
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Lynch S, Weber S, Kaplan S, Craun E. Childhood and Adult Sexual Violence Exposures as Predictors of PTSD, Dissociation, and Substance Use in Women in Jail. JOURNAL OF CHILD SEXUAL ABUSE 2024; 33:424-440. [PMID: 37357921 DOI: 10.1080/10538712.2023.2226132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
Women involved in the criminal legal system report high rates of interpersonal violence, particularly sexual violence, and mental health problems. Although existing research has linked experiences of interpersonal violence to multiple negative mental health outcomes, few researchers have examined concurrent psychopathology as an outcome of child and adult sexual violence in system-involved women. The purpose of this study was to examine child sexual abuse (CSA) and adult sexual violence, while controlling for other forms of interpersonal violence, as predictors of current symptoms of posttraumatic stress disorder (PSTD), substance use disorder (SUD), and dissociation in women in jail in the Mountain West. Randomly selected participants (N = 146) completed clinician-administered measures of trauma histories and mental health symptoms. The majority of the women (73%) reported experiences of CSA and about half reported experiences of adult sexual violence. Over half of the women reported symptoms consistent with current probable PTSD, about 20% reported dissociation symptoms in a clinical range, and over 70% met criteria for a SUD in the past year. The proposed model was tested with path analysis. CSA significantly predicted current symptoms of PTSD while adult sexual violence exposure predicted symptoms of SUD and dissociation. These results illustrate the high rates of sexual violence exposure as well as the complexity of mental health needs associated with these exposures in system-involved women. Findings highlight the need to comprehensively assess incarcerated women's trauma exposure and psychological distress to better meet the needs of this population.
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Affiliation(s)
| | | | - Stephanie Kaplan
- Idaho State University, Pocatello, ID, USA
- Idaho State University, Boston, Massachusetts, USA
| | - Elizabeth Craun
- Idaho State University, Pocatello, ID, USA
- Idaho State University, Murray, UT, USA
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Key KD, Lewis L, Blanchard C, Sikorskii A, Patel M, Lucas T, Akintobi TH, Bailey S, Loney EH, Johnson JE. Study protocol: Exploring the use of Family Health Histories in the African American community to reduce health disparities in Flint, Michigan. RESEARCH SQUARE 2024:rs.3.rs-4131949. [PMID: 38645135 PMCID: PMC11030532 DOI: 10.21203/rs.3.rs-4131949/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Health disparities are costly and preventable differences in disease progression that disproportionately affect minority communities such as African Americans. Practices to reduce health disparities can be rooted in prevention, particularly through screening tools. Family Health History tools are preventative screening mechanisms meant to explore family history to better understand how an individual's health can potentially be predicted or impacted. These tools are underutilized in the African American community. Contributions to this underutilization include a lack of cultural tailoring in the tools, a lack of health literacy in community members, and a lack of effective health communication. The Family Health History Study will create a culturally appropriate Family Health History toolkit to increase family health history utilization and ultimately decrease health disparities. Methods The proposed sample will be composed of 195 African American adults ages 18 + who live in Genesee County, Michigan. The study consists of two phases: the development phase and the randomized pilot study phase. The goal of the development phase (n = 95) is to explore how Family Health History toolkits can be modified to better serve the African American community using a community based participatory research approach and to create a culturally tailored family health history toolkit. In the pilot study phase, 100 participants will be randomized to the culturally tailored toolkit or the current standard Family Health History toolkit. Outcomes will include feasibility and acceptability of the intervention. Discussion This study will result in a culturally appropriate Family Health History tool that is co-developed with community members that can be utilized by African American adults to better understand their family health histories. Trial Registration Clinicaltrials.gov: NCT05358964 Date: May 5, 2022.
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Hien DA, Papini S, Saavedra LM, Bauer AG, Ruglass LM, Ebrahimi CT, Fitzpatrick S, López-Castro T, Norman SB, Killeen TK, Back SE, Morgan-López AA. Project harmony: A systematic review and network meta-analysis of psychotherapy and pharmacologic trials for comorbid posttraumatic stress, alcohol, and other drug use disorders. Psychol Bull 2024; 150:319-353. [PMID: 37971855 PMCID: PMC10939977 DOI: 10.1037/bul0000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
We conducted a systematic review and network meta-analyses (NMA) of psychotherapy and pharmacologic treatments for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol or other drug use disorder (AOD). A comprehensive search spanning 1995-2019 yielded a pool of 39 studies for systematic review, including 24 randomized controlled trials for the NMA. Study interventions were grouped by target of treatment (PTSD + AOD, PTSD-only, and AOD-only) and approach (psychotherapy or medication). Standardized mean differences (SMD) from the NMA yielded evidence that at the end of treatment, integrated, trauma-focused therapy for PTSD + AOD was more effective at reducing PTSD symptoms than integrated, non-trauma-focused therapy (SMD = -0.30), AOD-focused psychotherapy (SMD = -0.29), and other control psychotherapies (SMD = -0.43). End-of-treatment alcohol use severity was less for AOD medication compared to placebo medication (SMD = -0.36) and trauma-focused therapy for PTSD + placebo medication (SMD = -0.67), and less for trauma-focused psychotherapy + AOD medication compared to PTSD medication (SMD = -0.53), placebo medication (SMD = -0.50), and trauma-focused psychotherapy + placebo medication (SMD = -0.81). Key limitations include the small number of studies in the NMA for pharmacologic treatments and the lack of demographic diversity apparent in the existing literature. Findings suggest room for new studies that can address limitations in study sample composition, sample sizes, retention, and apply new techniques for conducting comparative effectiveness in PTSD + AOD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Denise A Hien
- Department of Clinical Psychology, Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick
| | | | | | - Alexandria G Bauer
- Department of Clinical Psychology, Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick
| | | | - Chantel T Ebrahimi
- Department of Clinical Psychology, Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick
| | | | | | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego
| | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
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Minozzi S, Saulle R, Amato L, Traccis F, Agabio R. Psychosocial interventions for stimulant use disorder. Cochrane Database Syst Rev 2024; 2:CD011866. [PMID: 38357958 PMCID: PMC10867898 DOI: 10.1002/14651858.cd011866.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Stimulant use disorder is a continuously growing medical and social burden without approved medications available for its treatment. Psychosocial interventions could be a valid approach to help people reduce or cease stimulant consumption. This is an update of a Cochrane review first published in 2016. OBJECTIVES To assess the efficacy and safety of psychosocial interventions for stimulant use disorder in adults. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, three other databases, and two trials registers in September 2023. All searches included non-English language literature. We handsearched the references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any psychosocial intervention with no intervention, treatment as usual (TAU), or a different intervention in adults with stimulant use disorder. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of 64 RCTs (8241 participants). Seventy-three percent of studies included participants with cocaine or crack cocaine use disorder; 3.1% included participants with amphetamine use disorder; 10.9% included participants with methamphetamine use disorder; and 12.5% included participants with any stimulant use disorder. In 18 studies, all participants were in methadone maintenance treatment. In our primary comparison of any psychosocial treatment to no intervention, we included studies which compared a psychosocial intervention plus TAU to TAU alone. In this comparison, 12 studies evaluated cognitive behavioural therapy (CBT), 27 contingency management, three motivational interviewing, one study looked at psychodynamic therapy, and one study evaluated CBT plus contingency management. We also compared any psychosocial intervention to TAU. In this comparison, seven studies evaluated CBT, two contingency management, two motivational interviewing, and one evaluated a combination of CBT plus motivational interviewing. Seven studies compared contingency management reinforcement related to abstinence versus contingency management not related to abstinence. Finally, seven studies compared two different psychosocial approaches. We judged 65.6% of the studies to be at low risk of bias for random sequence generation and 19% at low risk for allocation concealment. Blinding of personnel and participants was not possible for the type of intervention, so we judged all the studies to be at high risk of performance bias for subjective outcomes but at low risk for objective outcomes. We judged 22% of the studies to be at low risk of detection bias for subjective outcomes. We judged most of the studies (69%) to be at low risk of attrition bias. When compared to no intervention, we found that psychosocial treatments: reduce the dropout rate (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.74 to 0.91; 30 studies, 4078 participants; high-certainty evidence); make little to no difference to point abstinence at the end of treatment (RR 1.15, 95% CI 0.94 to 1.41; 12 studies, 1293 participants; high-certainty evidence); make little to no difference to point abstinence at the longest follow-up (RR 1.22, 95% CI 0.91 to 1.62; 9 studies, 1187 participants; high-certainty evidence); probably increase continuous abstinence at the end of treatment (RR 1.89, 95% CI 1.20 to 2.97; 12 studies, 1770 participants; moderate-certainty evidence); may make little to no difference in continuous abstinence at the longest follow-up (RR 1.14, 95% CI 0.89 to 1.46; 4 studies, 295 participants; low-certainty evidence); reduce the frequency of drug intake at the end of treatment (standardised mean difference (SMD) -0.35, 95% CI -0.50 to -0.19; 10 studies, 1215 participants; high-certainty evidence); and increase the longest period of abstinence (SMD 0.54, 95% CI 0.41 to 0.68; 17 studies, 2118 participants; high-certainty evidence). When compared to TAU, we found that psychosocial treatments reduce the dropout rate (RR 0.79, 95% CI 0.65 to 0.97; 9 studies, 735 participants; high-certainty evidence) and may make little to no difference in point abstinence at the end of treatment (RR 1.67, 95% CI 0.64 to 4.31; 1 study, 128 participants; low-certainty evidence). We are uncertain whether they make any difference in point abstinence at the longest follow-up (RR 1.31, 95% CI 0.86 to 1.99; 2 studies, 124 participants; very low-certainty evidence). Compared to TAU, psychosocial treatments may make little to no difference in continuous abstinence at the end of treatment (RR 1.18, 95% CI 0.92 to 1.53; 1 study, 128 participants; low-certainty evidence); probably make little to no difference in the frequency of drug intake at the end of treatment (SMD -1.17, 95% CI -2.81 to 0.47, 4 studies, 479 participants, moderate-certainty evidence); and may make little to no difference in the longest period of abstinence (SMD -0.16, 95% CI -0.54 to 0.21; 1 study, 110 participants; low-certainty evidence). None of the studies for this comparison assessed continuous abstinence at the longest follow-up. Only five studies reported harms related to psychosocial interventions; four of them stated that no adverse events occurred. AUTHORS' CONCLUSIONS This review's findings indicate that psychosocial treatments can help people with stimulant use disorder by reducing dropout rates. This conclusion is based on high-certainty evidence from comparisons of psychosocial interventions with both no treatment and TAU. This is an important finding because many people with stimulant use disorders leave treatment prematurely. Stimulant use disorders are chronic, lifelong, relapsing mental disorders, which require substantial therapeutic efforts to achieve abstinence. For those who are not yet able to achieve complete abstinence, retention in treatment may help to reduce the risks associated with stimulant use. In addition, psychosocial interventions reduce stimulant use compared to no treatment, but they may make little to no difference to stimulant use when compared to TAU. The most studied and promising psychosocial approach is contingency management. Relatively few studies explored the other approaches, so we cannot rule out the possibility that the results were imprecise due to small sample sizes.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesco Traccis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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Saraiya TC, Back SE, Jarnecke AM, Blakey SM, Bauer AG, Brown DG, Ruglass LM, Killeen T, Hien DA. Sex and Gender Differences in Co-Occurring Alcohol Use Disorder and PTSD. CURRENT ADDICTION REPORTS 2023; 10:617-627. [PMID: 39026610 PMCID: PMC11257080 DOI: 10.1007/s40429-023-00511-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 07/20/2024]
Abstract
Purpose of Review Research demonstrates a strong association between alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD). However, less is known about sex- and gender-based differences among individuals with AUD + PTSD. This narrative review examines recent literature in this area and aims to be a reference for future research endeavors. Recent Findings Extant literature shows that intertwining biological systems increase females' risk of developing PTSD and experiencing more adverse effects from AUD compared to males. Sex-based physiological differences further interact with gendered sociocultural environments to influence the risk of AUD + PTSD. Emerging research suggests potential gender-specific pathways between PTSD, coping, and AUD which may inform prevention and treatment. However, barriers to care are often gender-specific and tailored approaches are needed to improve reach and uptake. Summary Additional research is needed to examine intersectional and contextual factors that synergistically influence sex/gender differences in AUD + PTSD, particularly beyond cisgender identities, and mechanisms of action.
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Affiliation(s)
- Tanya C. Saraiya
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
- Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
| | - Amber M. Jarnecke
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | | | - Alexandria G. Bauer
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
| | - Delisa G. Brown
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | - Lesia M. Ruglass
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
- Department of Psychology, City College of New York, New York, NY, USA
| | - Therese Killeen
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | - Denise A. Hien
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
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Staton M, Tillson M, Levi MM, Dickson M, Webster M, Leukefeld C. Identifying and Treating Incarcerated Women Experiencing Substance Use Disorders: A Review. Subst Abuse Rehabil 2023; 14:131-145. [PMID: 38026785 PMCID: PMC10655602 DOI: 10.2147/sar.s409944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
While research on substance use disorder (SUD) treatment among justice-involved populations has grown in recent years, the majority of corrections-based SUD studies have predominantly included incarcerated men or men on community supervision. This review 1) highlights special considerations for incarcerated women that may serve as facilitating factors or barriers to SUD treatment; 2) describes selected evidence-based practices for women along the cascade of care for SUD including screening and assessment, treatment and intervention strategies, and referral to services during community re-entry; and 3) discusses conclusions and implications for SUD treatment for incarcerated women.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Mary M Levi
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Megan Dickson
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Matt Webster
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Carl Leukefeld
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
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Fradley MF, Kathryn Allison M, Steely Smith MK, Bossard M, Zielinski MJ. Justice-Involved, Sexually Victimized Women's Perspectives on the Acceptability of Receiving Trauma-Focused Therapy in Prison. Violence Against Women 2023; 29:2964-2985. [PMID: 37674415 DOI: 10.1177/10778012231200480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Incarcerated women report high rates of sexual victimization. Interviews with 63 previously incarcerated women survivors of sexual violence explored perceptions toward receiving trauma-focused therapy while incarcerated and postrelease trauma-focused therapy utilization. Nearly all participants (97%) recommended that trauma-focused therapy be available to incarcerated women. Most believed that prisons are acceptable places to receive trauma-focused therapy, without qualification (65%); some reported mixed feelings or indicated acceptability but identified factors that would increase acceptability (33%). Notably, most were currently experiencing trauma-related symptoms, but few had attended trauma-focused therapy following release. Findings indicate that access to prison-based trauma-focused therapy is necessary and acceptable.
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Affiliation(s)
- Marley F Fradley
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - M Kathryn Allison
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mollee K Steely Smith
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - MeeSoh Bossard
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Melissa J Zielinski
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
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Morgan‐López AA, Saavedra LM, Hien DA, Norman SB, Fitzpatrick SS, Ye A, Killeen TK, Ruglass LM, Blakey SM, Back SE. Differential symptom weighting in estimating empirical thresholds for underlying PTSD severity: Toward a "platinum" standard for diagnosis? Int J Methods Psychiatr Res 2023; 32:e1963. [PMID: 36789653 PMCID: PMC10485310 DOI: 10.1002/mpr.1963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/22/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Symptom counts as the basis for Post-Traumatic Stress Disorder (PTSD) diagnoses in the DSM presume each symptom is equally reflective of underlying disorder severity. However, the "equal weight" assumption fails to fit PTSD symptom data when tested. The present study developed an enhanced PTSD diagnosis based on (a) a conventional PTSD diagnosis from a clinical interview and (b) an empirical classification of full PTSD that reflected the relative clinical weights of each symptom. METHOD Baseline structured interview data from Project Harmony (N = 2658) was used. An enhanced diagnosis for full PTSD was estimated using an empirical threshold from moderated nonlinear factor analysis (MNLFA) latent PTSD scale scores, in combination with a full conventional PTSD diagnosis based on interview data. RESULTS One in 4 patients in the sample had a PTSD diagnosis that was inconsistent with their empirical PTSD grouping, such that the enhanced diagnostic standard reduced the diagnostic discrepancy rate by 20%. Veterans, and in particular female Veterans, were at greatest odds for discrepancy between their underlying PTSD severity and DSM diagnosis. CONCLUSION Psychometric methodologies that differentially weight symptoms can complement DSM criteria and may serve as a platform for symptom prioritization for diagnoses in future editions of DSM.
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Affiliation(s)
| | - Lissette M. Saavedra
- Community Health Research DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Denise A. Hien
- Center of Alcohol & Substance Use StudiesRutgers University–New BrunswickPiscatawayNew JerseyUSA
| | - Sonya B. Norman
- Department of PsychiatryUniversity of CaliforniaSan DiegoVirginiaUSA
| | | | - Ai Ye
- Department of Psychology & NeuroscienceL.L. Thurstone Psychometric LaboratoryUNC‐Chapel HillChapel HillNorth CarolinaUSA
- Department PsychologieLudwig‐Maximilians‐UniversitätMunichGermany
| | - Therese K. Killeen
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H. Johnson VA Medical CenterCharlestonSouth CarolinaUSA
| | - Lesia M. Ruglass
- Department of PsychologyCity College of New YorkNew YorkNew YorkUSA
| | - Shannon M. Blakey
- Community Health Research DivisionRTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H. Johnson VA Medical CenterCharlestonSouth CarolinaUSA
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10
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Hoover LV, Yu HP, Duval ER, Gearhardt AN. Investigating gender differences in the co-occurrence of PTSD and food addiction. Appetite 2023; 187:106605. [PMID: 37236363 DOI: 10.1016/j.appet.2023.106605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) commonly co-occurs with substance use disorders (SUDs). Past studies suggest PTSD is also associated with food addiction (compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). However, research investigating gender differences has been limited (e.g., restricted samples) and mixed. We aim to investigate the risk of co-occurring PTSD and food addiction in a community sample for all participants and stratified by gender. Additionally, we conducted risk ratios for problematic substance use and obesity to allow for within-sample comparisons. METHOD We utilized a sample of 318 participants recruited from Amazon Mechanical Turk (mean age = 41.2, 47.8% men, 78.0% white) to address existing gaps in the literature on PTSD and food addiction. We calculated risk ratios (adjusted for sociodemographic covariates) using modified Poisson regression with 95% confidence intervals. Results were also gender stratified. RESULTS Risk of food addiction (Risk Ratio (RR) = 6.42, 95% CI [4.10, 10.07], problematic alcohol use (RR) = 3.86, 95% CI [2.25,6.62], problematic smoking (RR) = 3.93, 95% CI [2.22, 6.97], and problematic nicotine vaping (RR) = 5.41, 95% CI [2.41, 11.14] were higher for those meeting criteria for PTSD. Risk of problematic cannabis use, and risk of obesity were not significantly higher for those meeting criteria for PTSD. Gender-stratified results suggest risk of food addiction may be higher for men (RR) = 8.54, 95% CI [4.49, 16.25] compared to women (RR) = 4.32, 95% CI [2.16, 8.62]. DISCUSSION Food addiction, but not obesity, appears to co-occur with PTSD more strongly than other types of problematic substance use (alcohol, cannabis, cigarettes, nicotine vaping). This risk appears to be particularly high for men compared to women. Assessing for food addiction in those with PTSD, particularly in men, may assist in identifying high-risk groups.
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Affiliation(s)
- Lindzey V Hoover
- Department of Psychology, University of Michigan, Ann Arbor, USA.
| | - Hayley P Yu
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Elizabeth R Duval
- Department of Psychology, University of Michigan, Ann Arbor, USA; Department of Psychiatry, University of Michigan, Ann Arbor, USA
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Malik N, Facer-Irwin E, Dickson H, Bird A, MacManus D. The Effectiveness of Trauma-Focused Interventions in Prison Settings: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:844-857. [PMID: 34711095 DOI: 10.1177/15248380211043890] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is overrepresented in prison relative to community populations and can be difficult to manage in an environment which can inherently exacerbate trauma-related symptomology. Little is known about the effectiveness of trauma-focused interventions in prison and less is known about factors that moderate the effectiveness of these interventions. AIM/METHODS We examined the effectiveness of trauma-focused interventions in prison relative to prison controls using meta-analytic techniques. We further used meta-regression analysis to examine treatment, methodological and participant-level moderators to determine factors that increased the effectiveness of these interventions. RESULTS From 16 studies eligible for the meta-analysis, we found a small but significant effect size for trauma-focused interventions. Phase 2 trauma processing interventions and interventions delivered individually led to greater reductions in PTSD symptoms. Studies utilizing an active treatment control resulted in smaller effect sizes than those using waitlist or no contact controls. Treatment length, study quality, outcome type, and gender were not significant moderators of treatment effectiveness. CONCLUSION Findings from this review are encouraging but should be interpreted with caution. Results suggest that trauma processing therapies, and individual modality trauma-focused interventions can be effective and delivered successfully in prison. However, inadequate comparison groups do not allow a firm conclusion to be drawn. There is a need for high quality Randomized Controlled Trial's that additionally measure Complex PTSD, utilize a modular treatment approach, and include treatments recommended in the National Institute for health and Care Excellence (NICE) guidelines such as Trauma-focused CBT and Eye Movement Desensitization Reprocessing (EMDR).
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Affiliation(s)
- Nabeela Malik
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Older Adults Psychiatry, North East London Foundation NHS Trust, London, England, United Kingdom
| | - Emma Facer-Irwin
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Psychology, School of Health and Social Care, University of Essex, Colchester, United Kingdom
- Joint first author
| | - Hannah Dickson
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Annie Bird
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Deirdre MacManus
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Consultant Forensic Psychiatrist; HMP Wandsworth, South London and Maudsley NHS Trust, London, England, United Kingdom
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12
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Hien DA, Morgan-López AA, Saavedra LM, Ruglass LM, Ye A, López-Castro T, Fitzpatrick S, Killeen TK, Norman SB, Ebrahimi CT, Back SE. Project Harmony: A Meta-Analysis With Individual Patient Data on Behavioral and Pharmacologic Trials for Comorbid Posttraumatic Stress and Alcohol or Other Drug Use Disorders. Am J Psychiatry 2023; 180:155-166. [PMID: 36475373 PMCID: PMC10016363 DOI: 10.1176/appi.ajp.22010071] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Treatment efficacy for co-occurring posttraumatic stress disorder (PTSD) and substance use disorders is well established, yet direct evidence for comparative effectiveness across treatments is lacking. The present study compared the effectiveness of several behavioral and pharmacological therapies for adults with co-occurring PTSD and alcohol or other drug use disorders. METHODS A systematic search of PsycINFO, MEDLINE, and ClinicalTrials.gov was conducted through December 2020 for trials targeting PTSD, alcohol or other drug use disorders, or both disorders (36 studies, N=4,046). Primary outcomes were severity scores for PTSD, alcohol use, and drug use, estimated via moderated nonlinear factor analysis. Propensity score weight-adjusted multilevel models were used. Model-predicted effect sizes were estimated for each treatment, and comparative effect sizes for each active arm against treatment as usual, at end of treatment and at 12-month follow-up. RESULTS Compared with treatment as usual, combining trauma-focused therapy and pharmacotherapy for substance use disorders showed the largest comparative effect sizes for PTSD severity (d=-0.92, 95% CI=-1.57, -0.30) and alcohol use severity (d=-1.10, 95% CI=-1.54, -0.68) at end of treatment. Other treatments with large comparative effect sizes included pharmacotherapies for alcohol or other drug use disorders, trauma-focused integrated therapies, and trauma-focused nonintegrated therapies. Reductions in outcomes for PTSD symptoms and alcohol use were observed for nearly all treatments. CONCLUSIONS The findings provide support for treating comorbid PTSD and substance use disorders using a variety of approaches, with alcohol-targeted pharmacotherapies and trauma-focused behavioral therapies as a combination of treatments that lead to early and sustained improvements in PTSD and alcohol use severity. Further treatment development is indicated for combining behavioral and pharmacological treatments for synergized impact and understanding the mechanisms of action and conditions under which each treatment type is optimized.
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Affiliation(s)
- Denise A Hien
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Antonio A Morgan-López
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Lissette M Saavedra
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Lesia M Ruglass
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Ai Ye
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Teresa López-Castro
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Skye Fitzpatrick
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Therese K Killeen
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Sonya B Norman
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Chantel T Ebrahimi
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
| | - Sudie E Back
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, Piscataway, N.J. (Hien, Ruglass, Ebrahimi); Department of Psychology, City College of New York, New York (Ruglass, López-Castro); L.L. Thurstone Psychometric Laboratory, Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill (Ye); Department of Psychology, York University, Toronto (Fitzpatrick); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and Ralph H. Johnson VA Medical Center, Charleston (Killeen, Back); Department of Psychiatry, University of California, San Diego, and VA San Diego Healthcare System (Norman);Department of Psychology, New School, New York (Ebrahimi)
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13
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Johnstone S, Dela Cruz GA, Kalb N, Tyagi SV, Potenza MN, George TP, Castle DJ. A systematic review of gender-responsive and integrated substance use disorder treatment programs for women with co-occurring disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:21-42. [PMID: 36283062 DOI: 10.1080/00952990.2022.2130348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/16/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
Background: Integrated and gender-responsive interventions, designed to target co-occurring substance use and psychiatric disorders in women, may be effective in addressing gender-specific challenges.Objectives: This systematic review aims to identify integrated gender-responsive substance use disorder treatments for women, summarize evaluations of these treatments, and address gaps in the literature.Methods: We searched PsycINFO, PubMed, and MEDLINE on September 24, 2021, and March 10, 2022. Included articles were randomized-controlled trials, secondary analyses of naturalistic studies, or open-label studies of integrated and gender-responsive treatments from any year that assessed both substance use and mental health/trauma outcomes.Results: We identified N = 24 studies (participants = 3,396; 100% women) examining Seeking Safety, Helping Women Recover and Beyond Trauma, A Woman's Path to Recovery, Modified Trauma Recovery and Empowerment Model (TREM), Breaking the Cycle, VOICES, Understanding and Overcoming Substance Misuse, Women's Recovery Group, Female Specific Cognitive Behavioral Therapy, and Moment by Moment in Women's Recovery. Across treatments there were significant improvements over time; Seeking Safety, Helping Women Recover, and TREM were associated with significantly better substance use and mental health outcomes relative to the comparison groups.Conclusions: Integrated gender-responsive treatments are a promising approach to treating women with co-occurring substance use and mental health concerns, and broad clinical implementation stands to benefit women. However, there remains a lack of studies evaluating substance use treatments in women with severe mental illness (e.g., psychotic-spectrum disorders) who differ in their needs and capacity.
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Affiliation(s)
- Samantha Johnstone
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gil Angela Dela Cruz
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Kalb
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Smita Vir Tyagi
- Departments of Psychiatry and Neuroscience and the Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N Potenza
- Forensic Consultation and Assessment Team, CAMH, Toronto, Ontario, Canada
- Child Study Centre, Connecticut Mental Health Center, New Haven, CT, USA
- Women's Health Research, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Tony P George
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David J Castle
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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Marsh TN, Eshakakogan C, Eibl JK, Spence M, Morin KA, Goertzen A, Gauthier GJ, Gauthier-Frolick D, Tahsin F, Sayers CD, Ozawanimke CA, Bissaillion CB, Nootchtai CC, Marsh DC. Implementation and evaluation of a two-eyed seeing approach using traditional healing and seeking safety in an indigenous residential treatment program in Northern Ontario. Int J Circumpolar Health 2022; 81:2125172. [PMID: 36149060 PMCID: PMC9518291 DOI: 10.1080/22423982.2022.2125172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Indigenous clients in need of residential care for substance use disorders (SUD) often present with the diagnosis of substance use disorder (SUD) combined with intergenerational trauma (IGT) or both. SUD is exceedingly prevalent amongst Indigenous peoples due to the health impacts of colonisation, residential school trauma, and IGT on this population’s health. We evaluated the effectiveness of a Two-Eyed Seeing approach in a four-week harm reduction residential treatment programme for clients with a history of SUD and IGT. This treatment approach blended Indigenous Healing practices with Seeking Safety based on Dr. Teresa Marsh’s research work known as Indigenous Healing and Seeking Safety (IHSS). The data presented in this study was drawn from a larger trial. This qualitative study was undertaken in collaboration with the Benbowopka Treatment Centre in Blind River, Northern Ontario, Canada. Patient characteristic data were collected from records for 157 patients who had enrolled in the study from April 2018 to February 2020. Data was collected from the Client Quality Assurance Survey tool. We used the qualitative thematic analysis method to analyse participants’ descriptive feedback about the study. Four themes were identified: (1) Motivation to attend treatment; (2) Understanding Benbowopka’s treatment programme and needs to be met; (3) Satisfaction with all interventions; and (4) Moving forward. We utilised a conceptualised descriptive framework for the four core themes depicted in the medicine wheel. This qualitative study affirmed that cultural elements and the SS Western model were highly valued by all participants. The impact of the harm reduction approach, coupled with traditional healing methods, further enhanced the outcome. This study was registered with clinicaltrials.gov (identifier number NCT0464574).
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Affiliation(s)
- T N Marsh
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | | | - J K Eibl
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.,Sudbury, ON, Canada
| | - M Spence
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - K A Morin
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.,Sudbury, ON, Canada.,Markham, ON, Canada
| | - A Goertzen
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - G J Gauthier
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | | | - F Tahsin
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | | | | | | | | | - D C Marsh
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.,Sudbury, ON, Canada.,Markham, ON, Canada.,Batchewana First Nation, ON, Canada
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15
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Bedard-Gilligan MA, Dworkin ER, Kaysen D, Ojalehto HJ, Stappenbeck CA, Lindgren KP. A pilot study on the feasibility, acceptability, and preliminary efficacy of a brief text message intervention for co-occurring alcohol misuse and PTSD symptoms in a community sample. J Anxiety Disord 2022; 91:102615. [PMID: 35988440 DOI: 10.1016/j.janxdis.2022.102615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
Accessible, brief, and self-directed intervention are needed to improve treatment access for individuals with co-occuring PTSD and alcohol misuse. This pilot study tests the feasibility, acceptability, and preliminary efficacy of a brief text message intervention based on cognitive behavioral therapy plus message framing (CBT + Framing) compared to active control providing kind support and attention (KAM), to reduce PTSD symptoms and alcohol use. Two waves of community-based data collection (Wave 1 n = 50; Wave 2 n = 59) were completed. Participants self-reported symptoms at baseline, post-intervention, and 8-week follow-up. Engagement and retention were high, suggesting messages were feasible and acceptable. Across waves and conditions, from baseline to follow-up primary outcomes of PTSD symptoms (medium to large effects), weekly drinks (medium effects), and heavy episodic drinking (small to medium effects) decreased. Consistent with hypotheses, CBT + Framing outperformed KAM for PTSD at post in Wave 2 and for number of heavy drinking episodes at both post and follow-up in Wave 1. Contrary to hypotheses, KAM outperformed CBT + Framing for PTSD at post in Wave 1, and minimal differences were observed between conditions for weekly drinks in both waves. Future studies should continue to develop and test brief, accessible interventions.
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Affiliation(s)
| | - Emily R Dworkin
- University of Washington, Department of Psychiatry, Box 356560, Seattle, WA 98195, USA
| | - Debra Kaysen
- University of Washington, Department of Psychiatry, Box 356560, Seattle, WA 98195, USA
| | - Heidi J Ojalehto
- University of Washington, Department of Psychiatry, Box 356560, Seattle, WA 98195, USA
| | - Cynthia A Stappenbeck
- University of Washington, Department of Psychiatry, Box 356560, Seattle, WA 98195, USA
| | - Kristen P Lindgren
- University of Washington, Department of Psychiatry, Box 356560, Seattle, WA 98195, USA
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16
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Morgan-López AA, Hien DA, Saraiya TC, Saavedra LM, Norman SB, Killeen TK, Simpson TL, Fitzpatrick S, Mills KL, Ruglass LM, Back SE, López-Castro T. Estimating posttraumatic stress disorder severity in the presence of differential item functioning across populations, comorbidities, and interview measures: Introduction to Project Harmony. J Trauma Stress 2022; 35:926-940. [PMID: 35124864 PMCID: PMC9844237 DOI: 10.1002/jts.22800] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 01/19/2023]
Abstract
Multiple factor analytic and item response theory studies have shown that items/symptoms vary in their relative clinical weights in structured interview measures for posttraumatic stress disorder (PTSD). Despite these findings, the use of total scores, which treat symptoms as though they are equally weighted, predominates in practice, with the consequence of undermining the precision of clinical decision-making. We conducted an integrative data analysis (IDA) study to harmonize PTSD structured interview data (i.e., recoding of items to a common symptom metric) from 25 studies (total N = 2,568). We aimed to identify (a) measurement noninvariance/differential item functioning (MNI/DIF) across multiple populations, psychiatric comorbidities, and interview measures simultaneously and (b) differences in inferences regarding underlying PTSD severity between scale scores estimated using moderated nonlinear factor analysis (MNLFA) and a total score analog model (TSA). Several predictors of MNI/DIF impacted effect size differences in underlying severity across scale scoring methods. Notably, we observed MNI/DIF substantial enough to bias inferences on underlying PTSD severity for two groups: African Americans and incarcerated women. The findings highlight two issues raised elsewhere in the PTSD psychometrics literature: (a) bias in characterizing underlying PTSD severity and individual-level treatment outcomes when the psychometric model underlying total scores fails to fit the data and (b) higher latent severity scores, on average, when using DSM-5 (net of MNI/DIF) criteria, by which multiple factors (e.g., Criterion A discordance across DSM editions, changes to the number/type of symptom clusters, changes to the symptoms themselves) may have impacted severity scoring for some patients.
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Affiliation(s)
| | - Denise A. Hien
- Center for Alcohol Studies, Rutgers University–Piscataway, Piscataway, New Jersey, USA
| | - Tanya C. Saraiya
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Sonya B. Norman
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California–San Diego, San Diego, California, USA
| | - Therese K. Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Tracy L. Simpson
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | | | | | - Lesia M. Ruglass
- Department of Psychology, City College of New York, New York, New York, USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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17
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Messina NP, Esparza P. Poking the bear: The inapplicability of the RNR principles for justice-involved women. J Subst Abuse Treat 2022; 140:108798. [DOI: 10.1016/j.jsat.2022.108798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
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18
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Dueweke AR, Higuera DE, Zielinski MJ, Karlsson ME, Bridges AJ. Does Group Size Matter? Group Size and Symptom Reduction Among Incarcerated Women Receiving Psychotherapy Following Sexual Violence Victimization. Int J Group Psychother 2022; 72:1-33. [PMID: 36249160 PMCID: PMC9555233 DOI: 10.1080/00207284.2021.2015601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Survivors Healing from Abuse: Recovery through Exposure (SHARE) is an eight-week therapy group for incarcerated women who have experienced sexual violence victimization. SHARE requires each member to complete an imaginal exposure and to listen when others share their experiences of victimization. While trauma-focused group interventions including SHARE are associated with reductions in internalizing symptoms, little work has examined how group characteristics predict symptom decreases. The purpose of this study was to examine whether group size was associated with symptom changes pre- to post-treatment. Participants (n=140 across 29 groups) completed self-report measures of posttraumatic stress symptoms before and after completing SHARE. Multilevel modeling revealed the majority of the variance in post-treatment symptoms was attributed to individual factors rather than group factors. Symptom change was comparable for groups of two to eight women; declines in symptom improvement were observed at a group size of ten participants.
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Affiliation(s)
- Aubrey R. Dueweke
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA
| | - Danielle E. Higuera
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA
| | - Melissa J. Zielinski
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA.,Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Marie E. Karlsson
- Department of Psychology, Murray State University, 212 Wells Hall, Murray, KY 42071, USA
| | - Ana J. Bridges
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA
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19
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Roberts NP, Lotzin A, Schäfer I. A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder. Eur J Psychotraumatol 2022; 13:2041831. [PMID: 35558682 PMCID: PMC9090345 DOI: 10.1080/20008198.2022.2041831] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The psychological treatment of comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) is clinically challenging, and outcomes are often poor. OBJECTIVE This paper describes a systematic review and meta-analysis which sought to establish the current efficacy for a number of established psychological approaches for adults and adolescents, in comparison to interventions for SUD alone, or other active approaches, following a pre-registered protocol. METHOD This review followed PRISMA and Cochrane Collaboration guidelines. Data extraction and risk of bias judgements using Cochrane criteria were undertaken by all authors. Primary outcomes were PTSD severity and substance use post-treatment. The quality of findings was assessed using GRADE. Following a comprehensive search, conducted to 13 September 2021, 27 studies were included. RESULTS We found a relatively high level of dropout across studies. In our main comparisons, we found no benefits for present-focused treatment approaches aimed at improving coping skills beyond those for SUD-only interventions. We found modest benefits for trauma-focused intervention plus SUD intervention post-treatment for PTSD (standardized mean difference (SMD) = -0.36, 95% confidence interval (CI) -0.64, -0.08), and at 6-13 months for PTSD (SMD = -0.48, 95% CI -0.81, -0.15) and alcohol use (SMD = -0.23, 95% CI -0.44, -0.02). There were no benefits for cognitive restructuring interventions as a group, but we found a modest effect for integrated cognitive behavioural therapy (ICBT) for PTSD post-treatment (SMD = -0.33, 95% CI -0.62, -0.04). There was evidence of some benefit for trauma-focused intervention over present-focused intervention for PTSD from a single study and for reduction in dropout for incentivized attendance for trauma-focused intervention from another single study. Most findings were of very low quality. CONCLUSION There is evidence that trauma-focused therapy and ICBT can improve PTSD for some individuals, but many patients do not fully engage with treatment and average treatment effects are modest. HIGHLIGHTS For PTSD, evidence was strongest for trauma-focused CBT-based approaches, but effects were modest.There was little evidence of any added benefit on substance use, beyond that of standard addiction treatments, for any included intervention.Dropout from treatment was high.
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Affiliation(s)
- Neil P Roberts
- Cardiff & Vale University Health Board, Cardiff, UK.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Simpson TL, Goldberg SB, Louden DKN, Blakey SM, Hawn SE, Lott A, Browne KC, Lehavot K, Kaysen D. Efficacy and acceptability of interventions for co-occurring PTSD and SUD: A meta-analysis. J Anxiety Disord 2021; 84:102490. [PMID: 34763220 PMCID: PMC8819868 DOI: 10.1016/j.janxdis.2021.102490] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 12/17/2022]
Abstract
Over the past 20 years, numerous treatments addressing comorbid Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) have been developed and tested. The current meta-analysis examined the efficacy and acceptability of the two central treatment types- trauma-focused and non-trauma-focused - compared with all comparators and with cognitive-behavioral manualized SUD treatments immediately post-treatment and at longest follow-up. Twenty-eight randomized clinical trials (N = 3247) were included. There were small to large within-group effects for all forms of active treatment (gs = 0.30-1.11). Trauma-focused but not non-trauma-focused treatments outperformed all comparators on PTSD outcomes at post-treatment. Neither trauma-focused nor non-trauma-focused treatment outperformed all comparators on SUD outcomes at post-treatment. Neither trauma- nor non-trauma-focused treatment outperformed manualized SUD treatments on PTSD outcomes at either time point. Manualized SUD treatments outperformed trauma-focused treatments on SUD outcomes at post-treatment and non-trauma-focused treatments on PTSD outcomes at follow-up. Regarding treatment retention, neither trauma-focused nor non-trauma-focused treatments significantly differed from all comparators or from manualized SUD treatments. Between-group results were largely unchanged in trim-and-fill analyses, but were not robust to fail-safe N. Few moderators were detected. Taken together, results suggest that trauma-focused, non-trauma-focused, and manualized SUD interventions are sound options for individuals with comorbid PTSD/SUD.
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Affiliation(s)
- Tracy L Simpson
- VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education, 1660 South Columbian Way, Seattle, WA 98108, USA; University of Washington, Department of Psychiatry, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin - Madison, 1000 Bascom Mall, Madison, WI 53706, USA.
| | - Diana K N Louden
- University of Washington, Health Sciences Libraries, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Shannon M Blakey
- Durham VA Medical Center, 508 Fulton St, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr, Durham, NC 27705, USA.
| | - Sage E Hawn
- Boston VA Medical Center, 150S Huntington Ave, Boston, MA 02130, USA.
| | - Aline Lott
- VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education, 1660 South Columbian Way, Seattle, WA 98108, USA.
| | - Kendall C Browne
- VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education, 1660 South Columbian Way, Seattle, WA 98108, USA; University of Washington, Department of Psychiatry, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Keren Lehavot
- University of Washington, Department of Psychiatry, 1959 NE Pacific St, Seattle, WA 98195, USA; VA Puget Sound Seattle/Denver HSR&D COIN, 1660 South Columbian Way, Seattle, WA 98108, USA.
| | - Debra Kaysen
- Stanford University, Department of Psychiatry, 401 Quarry Road, Stanford, CA 94305, USA.
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21
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Beaudry G, Yu R, Perry AE, Fazel S. Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials. Lancet Psychiatry 2021; 8:759-773. [PMID: 34419185 PMCID: PMC8376657 DOI: 10.1016/s2215-0366(21)00170-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/03/2021] [Accepted: 04/23/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Repeat offending, also known as criminal recidivism, in people released from prison has remained high over many decades. To address this, psychological treatments have been increasingly used in criminal justice settings; however, there is little evidence about their effectiveness. We aimed to evaluate the effectiveness of interventions in prison to reduce recidivism after release. METHODS For this systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, Embase, Global Health, MEDLINE, PsycINFO, and Google Scholar for articles published from database inception to Feb 17, 2021, without any language restrictions. We searched for randomised controlled trials (RCTs) that evaluated the effect of psychological interventions, delivered to adolescents and adults during incarceration, on recidivism outcomes after release. We excluded studies of solely pharmacological interventions and of participants in secure psychiatric hospitals or special residential units, or attending therapies mainly delivered outside of the prison setting. We extracted summary estimates from eligible RCTs. Data were extracted and appraised according to a prespecified protocol, with effect sizes converted to odds ratios. We used a standardised form to extract the effects of interventions on recidivism and estimated risk of bias for each RCT. Planned sensitivity analyses were done by removing studies with fewer than 50 participants. Our primary outcome was recidivism. Data from individual RCTs were combined in a random-effects meta-analysis as pooled odds ratios (ORs) and we explored sources of heterogeneity by comparing effect sizes by study size, control group, and intervention type. The protocol was pre-registered with PROSPERO, CRD42020167228. FINDINGS Of 6345 articles retrieved, 29 RCTs (9443 participants, 1104 [11·7%] females, 8111 [85·9%] males, and 228 [2·4%] unknown) met the inclusion criteria for the primary outcome. Mean ages were 31·4 years (SD 4·9, range 24·5-41·5) for adult participants and 17·5 years (SD 1·9; range 14·6-20·2) for adolescent participants. Race or ethnicity data were not sufficiently reported to be aggregated. If including all 29 RCTs, psychological interventions were associated with reduced reoffending outcomes (OR 0·72, 95% CI 0·56-0·92). However, after excluding smaller studies (<50 participants in the intervention group), there was no significant reduction in recidivism (OR 0.87, 95% CI 0·68-1·11). Based on two studies, therapeutic communities were associated with decreased rates of recidivism (OR 0·64, 95% CI 0·46-0·91). These risk estimates did not significantly differ by type of control group and other study characteristics. INTERPRETATION Widely implemented psychological interventions for people in prison to reduce offending after release need improvement. Publication bias and small-study effects appear to have overestimated the reported modest effects of such interventions, which were no longer present when only larger studies were included in analyses. Findings suggest that therapeutic communities and interventions that ensure continuity of care in community settings should be prioritised for future research. Developing new treatments should focus on addressing modifiable risk factors for reoffending. FUNDING Wellcome Trust, Fonds de recherche du Québec - Santé.
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Affiliation(s)
| | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amanda E Perry
- Department of Health Sciences, University of York, York, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
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22
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Mennicke A, Daniels K, Rizo CF. Suicide Completion Among Incarcerated Women. JOURNAL OF CORRECTIONAL HEALTH CARE 2021; 27:14-22. [PMID: 34232762 DOI: 10.1089/jchc.18.12.0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little is known about factors that contribute to suicide completion among women who are incarcerated. The current study used data from the National Violent Death Reporting System to examine contributing factors for 176 suicide deaths from 2003 to 2015 in 21 states among women who were incarcerated. Common circumstances for suicide completion included mental health and substance use challenges. Women experienced these problems at rates higher than men who were incarcerated and completed suicide. In addition, women were more often the victim of violence and abuse. Qualitative narratives were coded, revealing that isolation and health concerns may also contribute to suicide risk for women who are incarcerated.
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Affiliation(s)
- Annelise Mennicke
- School of Social Work, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Kaylyn Daniels
- School of Social Work, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Cynthia Fraga Rizo
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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23
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López G, Orchowski LM, Reddy MK, Nargiso J, Johnson JE. A review of research-supported group treatments for drug use disorders. Subst Abuse Treat Prev Policy 2021; 16:51. [PMID: 34154619 PMCID: PMC8215831 DOI: 10.1186/s13011-021-00371-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 11/10/2022] Open
Abstract
This paper reviews methodologically rigorous studies examining group treatments for interview-diagnosed drug use disorders. A total of 50 studies reporting on the efficacy of group drug use disorder treatments for adults met inclusion criteria. Studies examining group treatment for cocaine, methamphetamine, marijuana, opioid, mixed substance, and substance use disorder with co-occurring psychiatric conditions are discussed. The current review showed that cognitive behavioral therapy (CBT) group therapy and contingency management (CM) groups appear to be more effective at reducing cocaine use than treatment as usual (TAU) groups. CM also appeared to be effective at reducing methamphetamine use relative to standard group treatment. Relapse prevention support groups, motivational interviewing, and social support groups were all effective at reducing marijuana use relative to a delayed treatment control. Group therapy or group CBT plus pharmacotherapy are more effective at decreasing opioid use than pharmacotherapy alone. An HIV harm reduction program has also been shown to be effective for reducing illicit opioid use. Effective treatments for mixed substance use disorder include group CBT, CM, and women's recovery group. Behavioral skills group, group behavioral therapy plus CM, Seeking Safety, Dialectical behavior therapy groups, and CM were more effective at decreasing substance use and psychiatric symptoms relative to TAU, but group psychoeducation and group CBT were not. Given how often group formats are utilized to treat drug use disorders, the present review underscores the need to understand the extent to which evidence-based group therapies for drug use disorders are applied in treatment settings.
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Affiliation(s)
- Gabriela López
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912, USA
| | - Lindsay M Orchowski
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, 02904, USA.
| | - Madhavi K Reddy
- Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Jessica Nargiso
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jennifer E Johnson
- Division of Public Health, Michigan State University, Flint, MI, 48502, USA
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24
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Saavedra LM, Morgan-López AA, Hien DA, López-Castro T, Ruglass LM, Back SE, Fitzpatrick S, Norman SB, Killeen TK, Ebrahimi CT, Hamblen J. Evaluating treatments for posttraumatic stress disorder, alcohol and other drug use disorders using meta-analysis of individual patient data: Design and methodology of a virtual clinical trial. Contemp Clin Trials 2021; 107:106479. [PMID: 34157418 DOI: 10.1016/j.cct.2021.106479] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
This paper describes Project Harmony, a Virtual Clinical Trial (VCT) funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to harmonize and analyze data from over 40 independent psychological, pharmacologic and/or combined pharmacological treatment studies for posttraumatic stress disorder and comorbid alcohol and other drug use disorders (PTSD/AOD). The study attends to three distinct analysis challenges: (1) variation in measurement of PTSD/AOD across studies, time, populations and reporters, (2) cross-study variation in treatment effect sizes and (3) non-randomized, cross-study variation in the classification of treatments (despite within-study randomization of treatment arms). To address these challenges, the study combines meta-analysis of individual patient data (MIPD), integrative data analysis (IDA) and propensity score weighting (PSW) to integrate raw data from these clinical trials. This protocol shows how this VCT analytic framework was used to (1) develop commensurate scale scores of PTSD and AOD severity when measures vary across studies, (2) compare the efficacy of evidence-based treatment models for PTSD/AOD, (3) test for potential mediators of treatment effects on AOD and PTSD across treatment models, and (4) explore individual- and study-level moderators to inform for whom each of the treatment models works best. The advantages of the general VCT approach are juxtaposed against the limitations of single randomized controlled trials and conventional meta-analysis.
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Affiliation(s)
| | | | - Denise A Hien
- Center of Alcohol Studies, Rutgers University-New Brunswick, USA
| | | | | | | | | | - Sonya B Norman
- National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, USA
| | | | | | - Jessica Hamblen
- National Center for PTSD, White River Junction, VT, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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25
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Najavits LM, Clark HW, DiClemente CC, Potenza MN, Shaffer HJ, Sorensen JL, Tull MT, Zweben A, Zweben JE. PTSD / substance use disorder comorbidity: Treatment options and public health needs. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2020; 7:544-558. [PMID: 35444925 PMCID: PMC9017717 DOI: 10.1007/s40501-020-00234-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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.
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Affiliation(s)
| | | | | | - Marc N Potenza
- Departments of Psychiatry, Child Study and Neuroscience, Yale University School of Medicine
| | | | - James L Sorensen
- Department of Psychiatry and Behavioral Sciences, University of California at San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center
| | | | | | - Joan E Zweben
- University of California, San Francisco, Veterans Affairs Medical Center, San Francisco
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26
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LeBel TP, Rose SJ. The Persistent Impact of Childhood Trauma: Current Mental Health Challenges Faced by Women in Jail. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23774657.2020.1848483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas P. LeBel
- Department of Criminal Justice & Criminology, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Susan J. Rose
- Department of Social Work, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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27
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Aryan N, Banafshe HR, Farnia V, Shakeri J, Alikhani M, Rahimi H, Sehat M, Mamsharifi P, Ghaderi A, Omidi A. The therapeutic effects of methylphenidate and matrix-methylphenidate on addiction severity, craving, relapse and mental health in the methamphetamine use disorder. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:72. [PMID: 32977820 PMCID: PMC7519552 DOI: 10.1186/s13011-020-00317-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022]
Abstract
Background Little evidence has examined the therapeutic effects of methylphenidate (MPH) and Matrix Model treatment on addiction severity, craving, relapse and mental health in people who use methamphetamine (PWUM). This study was conducted to determine the effects of MPH, Matrix Model treatment, and Matrix-MPH on addiction severity, craving, relapse and mental health in PWUM. Methods This clinical trial was conducted among 100 patients with METH users. Participants were randomly divided into four groups who received: 1) 22 sessions of 45-min, twice a week for Matrix Model treatment (n = 25); 2) MPH 10 mg/day in the first month, 7.5 mg/day in the second month and 5 mg/day in the third month (n = 25); 3) Matrix Model treatment combined with MPH (n = 25); 4) control group (n = 25) for 12 weeks. Addiction severity, craving, relapse and mental status were evaluated at baseline and end-of-trial. Results Matrix Model treatment combined with MPH significantly reduced MA craving (P < 0.001) and addiction severity (P < 0.001). In addition, Matrix Model treatment combined with MPH resulted in a significant increase of mental health (P = 0.001), compared with Matrix Model treatment, MPH, and control group. Also, negative METH urine test significantly increased in the Matrix Model treatment combined with MPH group compared with the other groups (P < 0.001). Conclusions In conclusion, Matrix Model treatment combined with MPH for 12 weeks had beneficial effects on addiction severity, craving, relapse, and mental health in PWUM, compared with Matrix Model treatment, MPH, and control group. Trial registration This study was retrospectively registered in the Iranian website (www.irct.ir) for clinical trials registration (http://www.irct.ir: IRCT20171105037245N1). Registration date: 9 December 2017.
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Affiliation(s)
- Nazanin Aryan
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Banafshe
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran.,Department of Pharmacology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jalal Shakeri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Alikhani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibollah Rahimi
- Department of Biostatistics and Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojtaba Sehat
- Department of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Peyman Mamsharifi
- Department of Psychology, Allameh Tabataba'i University, Tehran, Iran
| | - Amir Ghaderi
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran.,Clinical Research development unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Abdollah Omidi
- Department of clinical psychology, School of Medicine, Kashan University of Medical Science, Kashan, Iran.
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28
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Peer navigation for individuals with serious mental illness leaving jail: a pilot randomized trial study protocol. Pilot Feasibility Stud 2020; 6:114. [PMID: 32821420 PMCID: PMC7429745 DOI: 10.1186/s40814-020-00659-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Serious mental illness (SMI) is a prevalent public health problem affecting 25% of individuals in jail. Re-entry to the community following incarceration is a vulnerable time for justice-involved individuals with SMI. SMI requires prompt and ongoing access to mental health and other healthcare services. Methods The study will (1) develop a Mentoring And Peer Support (MAPS) intervention for post-release mental health and other service connection among jailed individuals with SMI and (2) pilot test the MAPS intervention to determine its feasibility and acceptability. The primary outcomes will be to evaluate the feasibility and acceptability of the proposed recruitment methods and research design, of the intervention training methods, and of delivering the enhanced peer-navigator and control interventions. Study samples include focus groups (n=36), open trial (n=15), and a randomized pilot trial in a sample of 40 individuals with SMI re-entering the community after jail release. Secondary outcomes will include post-release enrollment in mental health, medical care, and substance use services. We will also evaluate reduction in psychiatric symptoms, improvements in functioning, adherence to psychiatric medications, fewer substance using days, fewer hospitalizations and suicide attempts, nights unstably housed, and time until rearrest. Discussion This pilot study will evaluate the feasibility and acceptability of a peer navigation intervention for individuals with serious mental illness leaving jails. The study will serve as a formative work for a larger randomized controlled trial assessing the effectiveness of peer navigator intervention for (include the primary outcome) in this population.
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29
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Mahoney A, Karatzias T, Halliday K, Dougal N. How important are Phase 1 interventions for complex interpersonal trauma? A pilot randomized control trial of a group psychoeducational intervention. Clin Psychol Psychother 2020; 27:597-610. [DOI: 10.1002/cpp.2447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Adam Mahoney
- Psychology Department Glasgow Caledonian University Glasglow UK
- Psychology Department HMP & YOI Cornton Vale Stirling UK
| | - Thanos Karatzias
- School of Health & Social Science Edinburgh Napier University Edinburgh UK
| | | | - Nadine Dougal
- School of Health & Social Science Edinburgh Napier University Edinburgh UK
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30
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Karlsson ME, Zielinski MJ. Sexual Victimization and Mental Illness Prevalence Rates Among Incarcerated Women: A Literature Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:326-349. [PMID: 29661117 PMCID: PMC6761034 DOI: 10.1177/1524838018767933] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Incarcerated women evidence high rates of both interpersonal trauma and mental illness. In particular, the rates of sexual violence victimization are so high that some researchers have suggested that sexual abuse may be a pathway to prison for women, likely through the development of mental illness, including substance abuse. This review article summarizes the literature on sexual victimization (n = 32 articles; 28 independent studies) and mental illness (n = 11 articles; 8 independent studies) prevalence among samples of incarcerated women (Ns ≥ 100) in context of methodological choices within included articles. Best estimates for sexual victimization from studies using established survey methods were as follows: 50-66% for child sexual abuse, 28-68% for adult sexual abuse, and 56-82% for lifetime sexual assault. Although data directly comparing prevalence of sexual victimization among incarcerated women to prevalence for other groups are limited, the existing data indicate that incarcerated women have significantly greater exposure than incarcerated men and community samples of women. Moreover, compared to findings from the National Comorbidity Survey-Replication, incarcerated women evidence greater prevalence of most lifetime and current mental illnesses, especially depressive disorders, post-traumatic stress disorder, and substance use disorders. Surprisingly, only two independent studies have investigated the overlap between sexual victimization and mental illness in samples of incarcerated women. Both studies found disproportionally high rates of mental illness among victims of sexual violence. Suggestions and implications for research, policy, and practice are discussed.
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Affiliation(s)
| | - Melissa J. Zielinski
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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31
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Perry AE, Martyn‐St James M, Burns L, Hewitt C, Glanville JM, Aboaja A, Thakkar P, Santosh Kumar KM, Pearson C, Wright K. Interventions for female drug-using offenders. Cochrane Database Syst Rev 2019; 12:CD010910. [PMID: 31834635 PMCID: PMC6910124 DOI: 10.1002/14651858.cd010910.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This review represents one in a family of three reviews focusing on the effectiveness of interventions in reducing drug use and criminal activity for offenders. OBJECTIVES To assess the effectiveness of interventions for female drug-using offenders in reducing criminal activity, or drug use, or both. SEARCH METHODS We searched 12 electronic bibliographic databases up to February 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 13 trials with 2560 participants. Interventions were delivered in prison (7/13 studies, 53%) and community (6/13 studies, 47%) settings. The rating of bias was affected by the lack of clear reporting by authors, and we rated many items as 'unclear'. In two studies (190 participants) collaborative case management in comparison to treatment as usual did not reduce drug use (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.20 to 2.12; 1 study, 77 participants; low-certainty evidence), reincarceration at nine months (RR 0.71, 95% CI 0.32 to 1.57; 1 study, 77 participants; low-certainty evidence), and number of subsequent arrests at 12 months (RR 1.11, 95% CI 0.83 to 1.49; 1 study, 113 participants; low-certainty evidence). One study (36 participants) comparing buprenorphine to placebo showed no significant reduction in self-reported drug use at end of treatment (RR 0.57, 95% CI 0.27 to 1.20) and three months (RR 0.58, 95% CI 0.25 to 1.35); very low-certainty evidence. No adverse events were reported. One study (38 participants) comparing interpersonal psychotherapy to a psychoeducational intervention did not find reduction in drug use at three months (RR 0.67, 95% CI 0.30 to 1.50; low-certainty evidence). One study (31 participants) comparing acceptance and commitment therapy (ACT) to a waiting list showed no significant reduction in self-reported drug use using the Addiction Severity Index (mean difference (MD) -0.04, 95% CI -0.37 to 0.29) and abstinence from drug use at six months (RR 2.89, 95% CI 0.73 to 11.43); low-certainty evidence. One study (314 participants) comparing cognitive behavioural skills to a therapeutic community programme and aftercare showed no significant reduction in self-reported drug use (RR 0.86, 95% CI 0.58 to 1.27), re-arrest for any type of crime (RR 0.73, 95% CI 0.52 to 1.03); criminal activity (RR 0.80, 95% CI 0.63 to 1.03), or drug-related crime (RR 0.95, 95% CI 0.68 to 1.32). A significant reduction for arrested (not for parole) violations at six months follow-up was significantly in favour of cognitive behavioural skills (RR 0.43, 95% CI 0.25 to 0.77; very low-certainty evidence). A second study with 115 participants comparing cognitive behavioural skills to an alternative substance abuse treatment showed no significant reduction in reincarceration at 12 months (RR 0.70, 95% CI 0.43 to 1.12; low certainty-evidence. One study (44 participants) comparing cognitive behavioural skills and standard therapy versus treatment as usual showed no significant reduction in Addiction Severity Index (ASI) drug score at three months (MD 0.02, 95% CI -0.05 to 0.09) and six months (MD -0.02, 95% CI -0.09 to 0.05), and incarceration at three months (RR 0.46, 95% CI 0.04 to 4.68) and six months (RR 0.51, 95% CI 0.20 to 1.27); very low-certainty evidence. One study (171 participants) comparing a single computerised intervention versus case management showed no significant reduction in the number of days not using drugs at three months (MD -0.89, 95% CI -4.83 to 3.05; low certainty-evidence). One study (116 participants) comparing dialectic behavioural therapy and case management (DBT-CM) versus a health promotion intervention showed no significant reduction at six months follow-up in positive drug testing (RR 0.67, 95% CI 0.43 to 1.03), number of people not using marijuana (RR 1.23, 95% CI 0.95 to 1.59), crack (RR 1.00, 95% CI 0.87 to 1.14), cocaine (RR 1.02, 95% CI 0.93 to 1.12), heroin (RR 1.05, 95% CI 0.98 to 1.13), methamphetamine (RR 1.02, 95% CI 0.87 to 1.20), and self-reported drug use for any drug (RR 1.20, 95% CI 0.92 to 1.56); very low-certainty evidence. One study (211 participants) comparing a therapeutic community programme versus work release showed no significant reduction in marijuana use at six months (RR 1.03, 95% CI 0.19 to 5.65), nor 18 months (RR 1.00, 95% CI 0.07 to 14.45), heroin use at six months (RR 1.59, 95% CI 0.49 to 5.14), nor 18 months (RR 1.92, 95% CI 0.24 to 15.37), crack use at six months (RR 2.07, 95% CI 0.41 to 10.41), nor 18 months (RR 1.64, 95% CI 0.19 to 14.06), cocaine use at six months (RR 1.09, 95% CI 0.79 to 1.50), nor 18 months (RR 0.93, 95% CI 0.64 to 1.35). It also showed no significant reduction in incarceration for drug offences at 18 months (RR 1.45, 95% CI 0.87 to 2.42); with overall very low- to low-certainty evidence. One study (511 participants) comparing intensive discharge planning and case management versus prison only showed no significant reduction in use of marijuana (RR 0.79, 95% CI 0.53 to 1.16), hard drugs (RR 1.12, 95% CI 0.88 to 1.43), crack cocaine (RR 1.08, 95% CI 0.75 to 1.54), nor positive hair testing for marijuana (RR 0.75, 95% CI 0.55 to 1.03); it found a significant reduction in arrests (RR 0.19, 95% CI 0.04 to 0.87), but no significant reduction in drug charges (RR 1.07, 95% CI 0.75 to 1.53) nor incarceration (RR 1.09, 95% CI 0.86 to 1.39); moderate-certainty evidence. One narrative study summary (211 participants) comparing buprenorphine pre- and post-release from prison showed no significant reduction in drug use at 12 months post-release; low certainty-evidence. No adverse effects were reported. AUTHORS' CONCLUSIONS The studies showed a high degree of heterogeneity for types of comparisons, outcome measures and small samples. Descriptions of treatment modalities are required. On one outcome of arrest (no parole violations), we identified a significant reduction when cognitive behavioural therapy (CBT) was compared to a therapeutic community programme. But for all other outcomes, none of the interventions were effective. Larger trials are required to increase the precision of confidence about the certainty of evidence.
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Affiliation(s)
- Amanda E Perry
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Marrissa Martyn‐St James
- University of SheffieldSchool of Health and Related Research (ScHARR)Regent Court, 30 Regent StreetSheffieldSouth YorkshireUKS1 4DA
| | - Lucy Burns
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Catherine Hewitt
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Julie M Glanville
- York Health Economics ConsortiumMarket SquareUniversity of York, HeslingtonYorkUKYO10 5NH
| | - Anne Aboaja
- Tees, Esk and Wear Valleys NHS Foundation TrustMiddlesbroughUKTS4 3AF
| | | | | | - Caroline Pearson
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
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Perry AE, Martyn‐St James M, Burns L, Hewitt C, Glanville JM, Aboaja A, Thakkar P, Santosh Kumar KM, Pearson C, Wright K, Swami S. Interventions for drug-using offenders with co-occurring mental health problems. Cochrane Database Syst Rev 2019; 10:CD010901. [PMID: 31588993 PMCID: PMC6778977 DOI: 10.1002/14651858.cd010901.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND This review represents one from a family of three reviews focusing on interventions for drug-using offenders. Many people under the care of the criminal justice system have co-occurring mental health problems and drug misuse problems; it is important to identify the most effective treatments for this vulnerable population. OBJECTIVES To assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems in reducing criminal activity or drug use, or both.This review addresses the following questions.• Does any treatment for drug-using offenders with co-occurring mental health problems reduce drug use?• Does any treatment for drug-using offenders with co-occurring mental health problems reduce criminal activity?• Does the treatment setting (court, community, prison/secure establishment) affect intervention outcome(s)?• Does the type of treatment affect treatment outcome(s)? SEARCH METHODS We searched 12 databases up to February 2019 and checked the reference lists of included studies. We contacted experts in the field for further information. SELECTION CRITERIA We included randomised controlled trials designed to prevent relapse of drug use and/or criminal activity among drug-using offenders with co-occurring mental health problems. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane . MAIN RESULTS We included 13 studies with a total of 2606 participants. Interventions were delivered in prison (eight studies; 61%), in court (two studies; 15%), in the community (two studies; 15%), or at a medium secure hospital (one study; 8%). Main sources of bias were unclear risk of selection bias and high risk of detection bias.Four studies compared a therapeutic community intervention versus (1) treatment as usual (two studies; 266 participants), providing moderate-certainty evidence that participants who received the intervention were less likely to be involved in subsequent criminal activity (risk ratio (RR) 0.67, 95% confidence interval (CI) 0.53 to 0.84) or returned to prison (RR 0.40, 95% CI 0.24 to 0.67); (2) a cognitive-behavioural therapy (one study; 314 participants), reporting no significant reduction in self-reported drug use (RR 0.78, 95% CI 0.46 to 1.32), re-arrest for any type of crime (RR 0.69, 95% CI 0.44 to 1.09), criminal activity (RR 0.74, 95% CI 0.52 to 1.05), or drug-related crime (RR 0.87, 95% CI 0.56 to 1.36), yielding low-certainty evidence; and (3) a waiting list control (one study; 478 participants), showing a significant reduction in return to prison for those people engaging in the therapeutic community (RR 0.60, 95% CI 0.46 to 0.79), providing moderate-certainty evidence.One study (235 participants) compared a mental health treatment court with an assertive case management model versus treatment as usual, showing no significant reduction at 12 months' follow-up on an Addictive Severity Index (ASI) self-report of drug use (mean difference (MD) 0.00, 95% CI -0.03 to 0.03), conviction for a new crime (RR 1.05, 95% CI 0.90 to 1.22), or re-incarceration to jail (RR 0.79, 95% CI 0.62 to 1.01), providing low-certainty evidence.Four studies compared motivational interviewing/mindfulness and cognitive skills with relaxation therapy (one study), a waiting list control (one study), or treatment as usual (two studies). In comparison to relaxation training, one study reported narrative information on marijuana use at three-month follow-up assessment. Researchers reported a main effect < .007 with participants in the motivational interviewing group, showing fewer problems than participants in the relaxation training group, with moderate-certainty evidence. In comparison to a waiting list control, one study reported no significant reduction in self-reported drug use based on the ASI (MD -0.04, 95% CI -0.37 to 0.29) and on abstinence from drug use (RR 2.89, 95% CI 0.73 to 11.43), presenting low-certainty evidence at six months (31 participants). In comparison to treatment as usual, two studies (with 40 participants) found no significant reduction in frequency of marijuana use at three months post release (MD -1.05, 95% CI -2.39 to 0.29) nor time to first arrest (MD 0.87, 95% CI -0.12 to 1.86), along with a small reduction in frequency of re-arrest (MD -0.66, 95% CI -1.31 to -0.01) up to 36 months, yielding low-certainty evidence; the other study with 80 participants found no significant reduction in positive drug screens at 12 months (MD -0.7, 95% CI -3.5 to 2.1), providing very low-certainty evidence.Two studies reported on the use of multi-systemic therapy involving juveniles and families versus treatment as usual and adolescent substance abuse therapy. In comparing treatment as usual, researchers found no significant reduction up to seven months in drug dependence on the Drug Use Disorders Identification Test (DUDIT) score (MD -0.22, 95% CI -2.51 to 2.07) nor in arrests (RR 0.97, 95% CI 0.70 to 1.36), providing low-certainty evidence (156 participants). In comparison to an adolescent substance abuse therapy, one study (112 participants) found significant reduction in re-arrests up to 24 months (MD 0.24, 95% CI 0.76 to 0.28), based on low-certainty evidence.One study (38 participants) reported on the use of interpersonal psychotherapy in comparison to a psychoeducational intervention. Investigators found no significant reduction in self-reported drug use at three months (RR 0.67, 95% CI 0.30 to 1.50), providing very low-certainty evidence. The final study (29 participants) compared legal defence service and wrap-around social work services versus legal defence service only and found no significant reductions in the number of new offences committed at 12 months (RR 0.64, 95% CI 0.07 to 6.01), yielding very low-certainty evidence. AUTHORS' CONCLUSIONS Therapeutic community interventions and mental health treatment courts may help people to reduce subsequent drug use and/or criminal activity. For other interventions such as interpersonal psychotherapy, multi-systemic therapy, legal defence wrap-around services, and motivational interviewing, the evidence is more uncertain. Studies showed a high degree of variation, warranting a degree of caution in interpreting the magnitude of effect and the direction of benefit for treatment outcomes.
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Affiliation(s)
- Amanda E Perry
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Marrissa Martyn‐St James
- University of SheffieldSchool of Health and Related Research (ScHARR)Regent Court, 30 Regent StreetSheffieldSouth YorkshireUKS1 4DA
| | - Lucy Burns
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Catherine Hewitt
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | - Julie M Glanville
- York Health Economics ConsortiumMarket SquareUniversity of York, HeslingtonYorkUKYO10 5NH
| | - Anne Aboaja
- Tees, Esk and Wear Valleys NHS Foundation TrustMiddlesbroughUKTS4 3AF
| | | | | | - Caroline Pearson
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
| | | | - Shilpi Swami
- University of YorkDepartment of Health SciencesHeslingtonYorkUKYO105DD
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Sabri B, Greene C, Lucas GM. A systematic review of comprehensive interventions for substance abuse: Focus on victimization. AGGRESSION AND VIOLENT BEHAVIOR 2019; 48:46-59. [PMID: 33312052 PMCID: PMC7732018 DOI: 10.1016/j.avb.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Violence victimization is common among men and women who use substances and is associated with co-occurring health issues such as PTSD, depression and HIV. Substance use interventions, therefore, should include integrated components that are designed to address co-occurring health issues among victimized substance-using individuals. This systematic review synthesized the evidence on efficacy of comprehensive, integrated, multicomponent interventions for victimized substance-using individuals. The efficacy of integrated multicomponent intervention strategies was assessed for the following syndemic conditions: mental health, substance misuse, violence, and HIV risk. Seventeen studies were identified. Examples of effective components were empowerment strategies for violence, mindfulness-based stress reduction for mental health, social cognitive skill building for addressing HIV risk and psychoeducation for substance misuse. Although in this review, some components were found to be effective, we identified methodological limitations of included studies which calls for more rigorous research in this area. Further, there is lack of evidence base for multicomponent interventions for victimized substance-using individuals in developing countries. Additional studies are needed to establish rigorous evidence base for multicomponent interventions for victimized substance using individuals that help them cope effectively with their trauma of violence and address their needs.
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Affiliation(s)
- Bushra Sabri
- School of Nursing, 525 North Wolfe Street, Johns Hopkins
University, Baltimore, MD 21205, United States of America
| | - Claire Greene
- Johns Hopkins Bloomberg School of Public Health, 624 North
Broadway, Baltimore, MD 21205, United States of America
| | - Gregory M. Lucas
- Johns Hopkins University School of Medicine, 1830 E.
Monument St, Baltimore, MD 21205, United States of America
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Moore KE, Stein MD, Kurth ME, Stevens L, Hailemariam M, Schonbrun YC, Johnson JE. Risk Factors for Self-stigma among Incarcerated Women with Alcohol Use Disorder. STIGMA AND HEALTH 2019; 5:158-167. [PMID: 33102697 DOI: 10.1037/sah0000182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Alcohol use disorder (AUD) is a highly stigmatized condition, often associated with negative stereotypes such as being morally weak, incompetent, unpredictable, and aggressive. People with AUD are at risk of experiencing self-stigma, a social-cognitive experience in which people think others hold negative stereotypes about them, expect to be treated unfairly, and/or believe that negative stereotypes are personally accurate. Women in the criminal justice system with AUD in particular are at risk of experiencing self-stigma due to intersecting sources of disadvantage. Given that self-stigma can lead to treatment avoidance and dropout, it is important to understand risk factors for self-stigma to inform prevention and intervention efforts in the justice system. Incarcerated women with AUD (n=185) completed measures of alcohol self-stigma as well as a variety of theoretically relevant risk factors including sociodemographics, baseline levels of stress and depression, and alcohol-related factors (i.e., length of drinking history, frequency/amount of use, consequences of use, physician advice to stop, belief that legal involvement is related to alcohol use, alcohol-related charges, self-efficacy to quit, readiness for treatment, pressures to enter treatment, factors that influence treatment) and other stigmatized conditions (drug use, exchanging sex, and homelessness). Results showed that experiencing more consequences of alcohol use, pressures to enter treatment, and perceived stress were associated with internalized stigma and anticipated/enacted stigma. This study begins to identify which incarcerated women with AUD are most at risk of experiencing self-stigma that may interfere with alcohol treatment.
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Affiliation(s)
- Kelly E Moore
- East Tennessee State University, Department of Psychology, 420 Rogers-Stout Hall P.O. 70649, Johnson City, TN 37614
| | - Michael D Stein
- Butler Hospital, Behavioral Medicine and Addictions Research, 345 Blackstone Blvd. Providence, RI 02906
- Boston University School of Public Health, Department of Health Law, Policy & Management, 715 Albany Street, Boston, MA 02118
| | - Megan E Kurth
- Butler Hospital, Behavioral Medicine and Addictions Research, 345 Blackstone Blvd. Providence, RI 02906
| | - Lindsey Stevens
- Brown University Medical School, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906
| | - Maji Hailemariam
- Michigan State University, Division of Public Health, College of Human Medicine, 200 East 1st St., Flint, MI 48502
| | - Yael C Schonbrun
- Butler Hospital, Behavioral Medicine and Addictions Research, 345 Blackstone Blvd. Providence, RI 02906
- Brown University Medical School, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906
| | - Jennifer E Johnson
- Michigan State University, Division of Public Health, College of Human Medicine, 200 East 1st St., Flint, MI 48502
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Johnson-Lawrence V, Bailey S, Sanders PE, Sneed R, Angel-Vincent A, Brewer A, Key K, Lewis EY, Johnson JE. The Church Challenge: A community-based multilevel cluster randomized controlled trial to improve blood pressure and wellness in African American churches in Flint, Michigan. Contemp Clin Trials Commun 2019; 14:100329. [PMID: 30886933 PMCID: PMC6402374 DOI: 10.1016/j.conctc.2019.100329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/09/2019] [Accepted: 01/18/2019] [Indexed: 01/07/2023] Open
Abstract
Chronic disease carries high morbidity and mortality in the United States, with large racial and ethnic disparities observed in chronic disease. Physical activity and healthy food are vital for chronic disease prevention yet challenging to access in economically distressed areas. Public health prevention efforts have become particularly prominent within faith-based organizations over the last three decades. This manuscript describes the protocol of the Church Challenge, a multilevel cluster-randomized controlled nutrition and physical activity trial across 24 churches to reduce blood pressure by 6 mmHg among 576 residents in Flint, MI. The Church Challenge was developed using community-based participatory approaches and is rooted in a church-based program developed by and for primarily African-American Flint church congregations. This three-level intervention addresses health at the community (level 3), church (level 2), and individual (level 1) to reduce blood pressure, reduce chronic disease risk, and promote health equity and wellbeing in Flint. Churches are randomized in a 1:1 ratio to a 16-week physical activity and nutrition program or a 4-session health and wellness workshop. Flint is not a unique community but has a history of traumatic community wide events; even now, the public health infrastructure continues to be a challenge and distract residents from focusing on their health. This trial is highly significant and innovative because it uses a combination of evidence-based practices simultaneously supporting health behavior change for individuals and their faith organizations, and evaluates multilevel efforts to sustain long-term health promotion activities in vulnerable communities like Flint.
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Affiliation(s)
- Vicki Johnson-Lawrence
- Division of Public Health, College of Human Medicine, Michigan State University, 200 E 1st St, Flint, MI, 48502, USA
| | | | - Patrick E. Sanders
- Community Outreach for Families and Youth, 1015 Carpenter Rd, Flint, MI, 48505, USA
| | - Rodlescia Sneed
- Division of Public Health, College of Human Medicine, Michigan State University, 200 E 1st St, Flint, MI, 48502, USA
| | - Ariel Angel-Vincent
- Division of Public Health, College of Human Medicine, Michigan State University, 200 E 1st St, Flint, MI, 48502, USA
| | - Allysoon Brewer
- Division of Public Health, College of Human Medicine, Michigan State University, 200 E 1st St, Flint, MI, 48502, USA
| | - Kent Key
- Division of Public Health, College of Human Medicine, Michigan State University, 200 E 1st St, Flint, MI, 48502, USA
| | | | - Jennifer E. Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, 200 E 1st St, Flint, MI, 48502, USA
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Bailey K, Trevillion K, Gilchrist G. What works for whom and why: A narrative systematic review of interventions for reducing post-traumatic stress disorder and problematic substance use among women with experiences of interpersonal violence. J Subst Abuse Treat 2019; 99:88-103. [DOI: 10.1016/j.jsat.2018.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/13/2022]
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Mahoney A, Karatzias T, Hutton P. A systematic review and meta-analysis of group treatments for adults with symptoms associated with complex post-traumatic stress disorder. J Affect Disord 2019; 243:305-321. [PMID: 30261446 DOI: 10.1016/j.jad.2018.09.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/23/2018] [Accepted: 09/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND No previous meta-analyses have specifically investigated the effectiveness of psychological group therapy for symptoms associated with complex interpersonal trauma, including whether trauma memory processing (TMP) therapies are superior to psychoeducational approaches alone. METHODS A systematic review identified 36 randomised control trials (RCTs) which were included in the meta-analysis. RESULTS Large significant effect sizes were evident for TMP interventions when compared to usual care for three outcome domains including: PTSD (k = 6, g = -0.98, 95% CI -1.53, -0.43), Depression (k = 7, g = -1.12, 95% CI -2.01, -0.23) and Psychological Distress (k = 6, g = -0.98, 95% CI 1.66, -0.40). When TMP and psychoeducation interventions were directly compared, results indicated a small non-significant effect in favour of the former for PTSD symptoms, (k = 4, g = -0.34, 95% CI -1.05, 0.36) and small non-significant effect sizes in favour of the latter for Depression (k = 3, g = 0.29, 95% CI -0.83, 1.4) and Psychological Distress (k = 6, g = 0.19, 95% CI -0.34, 0.71). LIMITATIONS Heterogeneity and a limited number of high quality RCTs, particularly in the Substance Misuse and Dissociation domains, resulted in uncertainty regarding meta-analytical estimates and subsequent conclusions. CONCLUSIONS Results suggest that TMP interventions are useful for traumatic stress whereas non-TMP interventions can be useful for symptoms of general distress (e.g. anxiety and depression). Thus, both TMP and psychoeducation can be useful for the treatment of complex interpersonal trauma symptoms and further research should unravel appropriate sequencing and dose of these interventions.
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Affiliation(s)
- Adam Mahoney
- Psychology Department, HMP & YOI Cornton Vale, Stirling, UK; School of Health & Social Science, Edinburgh Napier University, UK.
| | - Thanos Karatzias
- School of Health & Social Science, Edinburgh Napier University, UK; Rivers Centre for Traumatic Stress, NHS Lothian, UK
| | - Paul Hutton
- School of Health & Social Science, Edinburgh Napier University, UK
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The Effect of Matrix Model on Depression, Anxiety, and Quality of Life in Methamphetamine Users and Their Caregivers. ADDICTIVE DISORDERS & THEIR TREATMENT 2018. [DOI: 10.1097/adt.0000000000000136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bowen K, Jarrett M, Stahl D, Forrester A, Valmaggia L. The relationship between exposure to adverse life events in childhood and adolescent years and subsequent adult psychopathology in 49,163 adult prisoners: A systematic review. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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de Andrade D, Ritchie J, Rowlands M, Mann E, Hides L. Substance Use and Recidivism Outcomes for Prison-Based Drug and Alcohol Interventions. Epidemiol Rev 2018; 40:121-133. [DOI: 10.1093/epirev/mxy004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/19/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dominique de Andrade
- Centre for Youth Substance Abuse Research, Institute of Health and Biomedical Innovation, School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Australia
| | - Jessica Ritchie
- TC Beirne School of Law, Faculty of Business, Economics and Law, University of Queensland, Brisbane, Australia
| | - Michael Rowlands
- Centre for Accident Research and Road Safety- Queensland, Queensland University of Technology, Brisbane, Australia
| | - Emily Mann
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Leanne Hides
- Lives Lived Well Research Group, School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, Australia
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Moore KE, Santiago Rivera OJ, Anderson B, Johnson JE, Hahn JA, Kurth ME, Reddy MK, Schonbrun YC, Stein MD. Phosphatidylethanol Levels Among Incarcerated Women: The Influence of Pre-incarceration Alcohol Consumption and Length of Abstinence. Alcohol Clin Exp Res 2018; 42:500-507. [PMID: 29281858 DOI: 10.1111/acer.13587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Phosphatidylethanol (PEth) is a direct biomarker for alcohol that is formed shortly after alcohol use and may remain detectable in blood for weeks after alcohol consumption. There is little research on alcohol use factors that influence PEth elimination, especially among women. METHODS Data were collected from 116 alcohol use-disordered women who were recently incarcerated. We used a 2-part model with logistic and linear components to examine whether alcohol consumption in the 2 weeks prior to incarceration and days since last alcoholic drink (operationalized as abstinence days prior to incarceration + days incarcerated) were associated with PEth detectability (>8 ng/ml) and level (ng/ml) in blood. RESULTS Participants reported drinking an average of 10 drinks per day in the 2 weeks prior to incarceration. Days since last drink was negatively associated with PEth level (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.93; 0.99) and being PEth detectable (OR = 0.96, 95% CI = 0.91; 0.99). Quantity of alcohol consumed prior to jail admission was associated with PEth detection (OR = 1.08; 95% CI = 1.03; 1.16), but not PEth level. CONCLUSIONS Days since last alcoholic drink and drinks per day both influenced PEth detectability, but only days since last drink predicted PEth level among a large sample of women with alcohol use disorder in the criminal justice system.
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Affiliation(s)
- Kelly E Moore
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | | | - Bradley Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island
| | - Jennifer E Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Megan E Kurth
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island
| | - Madhavi K Reddy
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Yael C Schonbrun
- Department of Psychiatry and Human Behavior, Brown University Medical School and Butler Hospital, Providence, Rhode Island
| | - Michael D Stein
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
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Schwartze D, Barkowski S, Strauss B, Knaevelsrud C, Rosendahl J. Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials. Psychother Res 2017; 29:415-431. [DOI: 10.1080/10503307.2017.1405168] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- D. Schwartze
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - S. Barkowski
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - B. Strauss
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - C. Knaevelsrud
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - J. Rosendahl
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
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Ruglass LM, Shevorykin A, Brezing C, Hu MC, Hien DA. Demographic and clinical characteristics of treatment seeking women with full and subthreshold PTSD and concurrent cannabis and cocaine use disorders. J Subst Abuse Treat 2017; 80:45-51. [PMID: 28755772 PMCID: PMC5575989 DOI: 10.1016/j.jsat.2017.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/29/2017] [Accepted: 06/23/2017] [Indexed: 01/28/2023]
Abstract
While the detrimental effects of concurrent substance use disorders (SUDs) are now being well documented, very few studies have examined this comorbidity among women with posttraumatic stress disorder (PTSD). Data for these analyses were derived from the "Women and Trauma" study conducted within the National Drug Abuse Treatment Clinical Trials Network. Women with full or subthreshold PTSD and co-occurring cannabis use disorder (CUD) and cocaine use disorder (COD; N=99) were compared to their counterparts with co-occurring CUD only (N=26) and co-occurring COD only (N=161) on rates of trauma exposure, psychiatric disorders, psychosocial problems, and other substance use utilizing a set of multivariate logistic regressions. In models adjusted for age and race/ethnicity, women with PTSD and COD only were significantly older than their counterparts with CUD only and concurrent CUD+COD. Relative to those with CUD only, women with concurrent CUD+COD had higher odds of adult sexual assault. Relative to those with COD only, women with concurrent CUD+COD had higher odds of alcohol use disorder in the past 12months. Finally, relative to those with CUD only, women with COD only had higher odds of ever being arrested/convicted and adult sexual assault. The higher rates of adult sexual assault and alcohol use disorder among those with concurrent CUD+COD suggest the need for trauma-informed approaches that can respond to the needs of this dually-diagnosed population. Moreover, the causal link between repeated traumatic stress exposure and polysubstance use requires further examination.
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Affiliation(s)
- Lesia M Ruglass
- Department of Psychology, The City College of New York, CUNY, 160 Convent Avenue, NAC Building, Rm 7/120, New York, NY 10031, United States.
| | - Alina Shevorykin
- Department of Psychology, Pace University, 861 Bedford Road, Pleasantville, NY, United States.
| | - Christina Brezing
- Division on Substance Abuse, Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside, Drive, Unit 66, Room 3736, United States.
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, United States.
| | - Denise A Hien
- Gordon F. Derner Institute for Advanced Psychological Studies, Adelphi University & Department of Psychiatry, Columbia University College of Physicians and Surgeons, IAPS, Derner Institute, Hy Weinberg Center, Room 306, Garden City, NY 11530-0701, United States.
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44
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Zaccari B, Layne W, Loftis J, Penn P. The Participant’s Voice: A Mixed-Method Evaluation of a Mixed-Gender Seeking Safety Group. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1322416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Belle Zaccari
- Northwest Mental Illness Research, Education and Clinical Center, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Research & Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Wendy Layne
- Research and Evaluation, La Frontera Center, Inc., Tucson, Arizona, USA
| | - Jennifer Loftis
- Research & Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Patricia Penn
- Research and Evaluation, La Frontera Center, Inc., Tucson, Arizona, USA
- Biobehavioral and Social Sciences Research Program, University of Arizona Cancer Center, Tucson, Arizona, USA
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45
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Mulay AL, Kelly E, Cain NM. Psychodynamic Treatment of the Criminal Offender: Making the Case for Longer-Term Treatment in a Longer-Term Setting. Psychodyn Psychiatry 2017; 45:143-173. [PMID: 28590205 DOI: 10.1521/pdps.2017.45.2.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, prisons and jails have become de facto psychiatric hospitals, responsible for the care and treatment of individuals with serious mental illness. Historically, cognitive-behaviorally informed therapeutic approaches have been the treatment of choice among mental health practitioners in correctional settings. However, inmate-clients often present with complex diagnostic issues that are arguably better served by long-term treatment options, such as psychodynamic psychotherapy. We first review the nature of psychotherapy in the correctional setting, as well as treatment barriers and challenges faced by both mental health providers and inmate-clients. We then review treatment studies that examine the efficacy of various therapeutic techniques in correctional/forensic contexts. Finally, we argue that, due to the complex nature of psychopathology, average length of time incarcerated, and treatment issues that arise in this multifaceted and challenging setting, mental health treatment providers should consider providing psychodynamic treatment modalities when working with incarcerated individuals. We also argue that more research is needed to examine the efficacy of these treatment approaches with inmate-clients.
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46
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Yoon IA, Slade K, Fazel S. Outcomes of psychological therapies for prisoners with mental health problems: A systematic review and meta-analysis. J Consult Clin Psychol 2017; 85:783-802. [PMID: 28569518 PMCID: PMC5518650 DOI: 10.1037/ccp0000214] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Prisoners worldwide have substantial mental health needs, but the efficacy of psychological therapy in prisons is unknown. We aimed to systematically review psychological therapies with mental health outcomes in prisoners and qualitatively summarize difficulties in conducting randomized clinical trials (RCTs). METHOD We systematically identified RCTs of psychological therapies with mental health outcomes in prisoners (37 studies). Effect sizes were calculated and meta-analyzed. Eligible studies were assessed for quality. Subgroup and metaregression analyses were conducted to examine sources of between-study heterogeneity. Thematic analysis reviewed difficulties in conducting prison RCTs. RESULTS In 37 identified studies, psychological therapies showed a medium effect size (0.50, 95% CI [0.34, 0.66]) with high levels of heterogeneity with the most evidence for CBT and mindfulness-based trials. Studies that used no treatment (0.77, 95% CI [0.50, 1.03]) or waitlist controls (0.71, 95% CI [0.43, 1.00]) had larger effect sizes than those that had treatment-as-usual or other psychological therapies as controls (0.21, 95% CI [0.01, 0.41]). Effects were not sustained on follow-up at 3 and 6 months. No differences were found between group and individual therapy, or different treatment types. The use of a fidelity measure was associated with lower effect sizes. Qualitative analysis identified difficulties with follow-up and institutional constraints on scheduling and implementation of trials. CONCLUSIONS CBT and mindfulness-based therapies are modestly effective in prisoners for depression and anxiety outcomes. In prisons with existing psychological therapies, more evidence is required before additional therapies can be recommended. (PsycINFO Database Record
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Affiliation(s)
| | - Karen Slade
- Division of Psychology, Nottingham Trent University
| | - Seena Fazel
- Department of Psychiatry, University of Oxford
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47
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Empson S, Cuca YP, Cocohoba J, Dawson-Rose C, Davis K, Machtinger EL. Seeking Safety Group Therapy for Co-Occurring Substance Use Disorder and PTSD among Transgender Women Living with HIV: A Pilot Study. J Psychoactive Drugs 2017; 49:344-351. [PMID: 28524758 DOI: 10.1080/02791072.2017.1320733] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Transgender women living with HIV experience high rates of substance use, violence, and post-traumatic stress disorder (PTSD). Seeking Safety is a manualized, present-focused, cognitive-behavioral therapy program designed to address co-occurring substance use and PTSD. Seeking Safety has evidence of efficacy in a variety of populations but had not been evaluated specifically with people living with HIV or transgender women. We pilot-tested a 12-session Seeking Safety program with a group of transgender women living with HIV who reported substance use and a history of violence. Seven transgender women living with HIV were recruited from two HIV primary care clinics in San Francisco and completed pre- and post-intervention assessments. Participants attended an average of 8 of the 12 sessions. Mean scores for all three outcome measures improved: PTSD symptom scores declined 17.5%, alcoholism screening scores declined 23.9%, and drug abuse screening scores declined 68.8%, on average. Despite the small sample, this pilot study showed Seeking Safety to be a promising intervention among transgender women living with HIV. The findings are encouraging and justify larger studies of Seeking Safety among transgender women and other people living with HIV who experience high rates of substance use and PTSD.
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Affiliation(s)
- Susannah Empson
- a Emergency Medicine Resident Physician , Harbor-UCLA Medical Center , Los Angeles , CA , USA
| | - Yvette P Cuca
- b Research Specialist , UCSF School of Nursing , San Francisco , CA , USA
| | - Jennifer Cocohoba
- c Professor, UCSF School of Pharmacy , San Francisco , CA , USA.,d Pharmacist, UCSF Women's HIV Program , San Francisco , CA , USA
| | | | - Katy Davis
- f Director of Trauma Informed Care , UCSF Women's HIV Program , San Francisco , CA , USA
| | - Edward L Machtinger
- g Director, UCSF Women's HIV Program , San Francisco , CA , USA.,h Professor, UCSF School of Medicine , San Francisco , CA , USA
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48
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King EA. Outcomes of Trauma-Informed Interventions for Incarcerated Women. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2017; 61:667-688. [PMID: 26338529 DOI: 10.1177/0306624x15603082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The purpose of this article was to conduct a review of experimental, quasi-experimental, and pre-test/post-test studies using manualized, trauma-informed interventions with incarcerated women. A systematic search of electronic databases, reference harvesting, and communication with experts were used to identify relevant primary studies. Nine studies meeting the specified inclusion/exclusion criteria were identified. Three studies used random assignment and five used a comparison or waitlist group. Interventions identified included Seeking Safety, Helping Women Recover/Beyond Trauma, Esuba, and Beyond Violence. Results of the studies indicate a decrease in post-traumatic stress disorder (PTSD) symptomatology and an additive effect to treatment as usual. Initial evidence for trauma-informed interventions for incarcerated women appears positive; however, replication using more rigorous research designs and inclusion of effect sizes are recommended. Limitations of this review include exclusion of the gray literature and lack of meta-analysis.
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Affiliation(s)
- Erin A King
- 1 Florida State University, Tallahassee, USA
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49
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Grace S. Effective interventions for drug using women offenders: A narrative literature review. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1278624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sharon Grace
- Department of Social Policy and Social Work, University of York, York, North Yorkshire, UK
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50
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Johnson JE, Schonbrun YC, Anderson B, Kurth M, Timko C, Stein M. Study protocol: Community Links to Establish Alcohol Recovery (CLEAR) for women leaving jail. Contemp Clin Trials 2017; 55:39-46. [PMID: 28185995 DOI: 10.1016/j.cct.2017.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE This article describes the protocol for a randomized effectiveness trial of a method to link alcohol use disordered women who are in pretrial jail detention with post-release 12-step mutual help groups. BACKGROUND Jails serve 15 times more people per year than do prisons and have very short stays, posing few opportunities for treatment or treatment planning. Alcohol use is associated with poor post-jail psychosocial and health outcomes including sexually transmitted diseases and HIV, especially for women. At least weekly 12-step self-help group attendance in the months after release from jail has been associated with improvements in alcohol use and alcohol-related consequences. Linkage strategies improve 12-step attendance and alcohol outcomes among outpatients, but have not previously been tested in criminal justice populations. DESIGN In the intervention condition, a 12-step volunteer meets once individually with an incarcerated woman while she is in jail and arranges to be in contact after release to accompany her to 12-step meetings. The control condition provides schedules for local 12-step meetings. Outcomes include percent days abstinent from alcohol (primary), 12-step meeting involvement, and fewer unprotected sexual occasions (secondary) after release from jail. We hypothesize that (Minton, 2015) 12-step involvement will mediate the intervention's effect on alcohol use, and (O'Brien, 2001) percent days abstinent will mediate the intervention's effect on STI/HIV risk-taking outcomes. Research methods accommodate logistical and philosophical hurdles including rapid turnover of commitments and unpredictable release times at the jail, possible post-randomization ineligibility due to sentencing, 12-step principles such as Nonaffiliation, and use of volunteers as interventionists.
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Affiliation(s)
- Jennifer E Johnson
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1st St Room 367, Flint, MI 48503, United States.
| | - Yael Chatav Schonbrun
- Butler Hospital, Warren Alpert Medical School of Brown University, 345 Blackstone Blvd, Providence, RI 02906, United States.
| | - Bradley Anderson
- Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, United States.
| | - Megan Kurth
- Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, United States.
| | - Christine Timko
- Department of Veterans Affairs, Stanford University School of Medicine, 795 Willow Rd., Menlo Park, CA 94025, United States.
| | - Michael Stein
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States.
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