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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] [Track Full Text] [Subscribe] [Scholar Register] [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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Yalch MM, Moreland ML, Burkman KM. Integrating process and structure in group therapy for survivors of trauma. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schäfer I, Lotzin A, Hiller P, Sehner S, Driessen M, Hillemacher T, Schäfer M, Scherbaum N, Schneider B, Grundmann J. A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders. Eur J Psychotraumatol 2019; 10:1577092. [PMID: 30815234 PMCID: PMC6383607 DOI: 10.1080/20008198.2019.1577092] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/18/2018] [Accepted: 01/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are associated with a more severe course and worse outcome than either disorder alone. In Europe, few treatments have been evaluated for PTSD and SUD. Seeking Safety, a manualized, integrated, cognitive-behavioural treatment, has been shown to be effective in studies in the USA. Objective: To test the efficacy of Seeking Safety plus treatment as usual (TAU) in female outpatients with PTSD and SUD compared to Relapse Prevention Training (RPT) plus TAU and TAU alone. Method: In five German study centres a total of N = 343 women were randomized into one of the three study conditions. PTSD severity (primary outcome), substance use, depression and emotion dysregulation (secondary outcomes) were assessed at baseline, post-treatment, as well as at three months and six months post-treatment. Results: Treatment participants attended M = 6.6 sessions (Seeking Safety) and M = 6.1 sessions (RPT). In an intent-to-treat analysis, Seeking Safety plus TAU, RPT plus TAU and TAU alone showed comparable decreases in PTSD severity over the course of the study. Seeking Safety plus TAU showed superior efficacy to TAU alone on depression and emotion regulation and RPT plus TAU was more effective than TAU alone on number of substance-free days and alcohol severity. Minimum-dose analyses suggest additional effects of both programmes among participants who attended at least eight group sessions. Conclusions: With respect to PTSD symptoms, a brief dose of Seeking Safety and RPT in addition to TAU was not superior to TAU alone in women with PTSD and SUD. However, Seeking Safety and RPT showed greater reductions than TAU alone in other domains of psychopathology and substance use outcomes respectively. Future studies should investigate further variables, such as what aspects of each treatment appeal to particular patients and how best to disseminate them.
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Affiliation(s)
- Ingo Schäfer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy Bethel, Ev. Klinikum Bielefeld, Bielefeld, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus University Nuremberg, Nürnberg, Germany.,Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martin Schäfer
- Department of Psychiatry, Psychotherapy and Addiction Medicine, Lehrkrankenhaus der Universität Duisburg-Essen, Essen, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR-Klinik Essen, University Duisburg-Essen, Essen, Germany
| | - Barbara Schneider
- Department of Addictive Disorders and Psychiatry, LVR-Klinik Cologne, Cologne, Germany
| | - Johanna Grundmann
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schäfer I, Pawils S, Driessen M, Härter M, Hillemacher T, Klein M, Muehlhan M, Ravens-Sieberer U, Schäfer M, Scherbaum N, Schneider B, Thomasius R, Wiedemann K, Wegscheider K, Barnow S. Understanding the role of childhood abuse and neglect as a cause and consequence of substance abuse: the German CANSAS network. Eur J Psychotraumatol 2017; 8:1304114. [PMID: 28451071 PMCID: PMC5399994 DOI: 10.1080/20008198.2017.1304114] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/01/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Substance use disorders (SUD) belong to the most frequent behavioural consequences of childhood abuse and neglect (CAN). If parents are concerned, SUD are also an important risk factor for CAN. The relationship between CAN and SUD remains poorly understood. There is a need of adequate treatments for SUD patients suffering from the consequences of CAN, as well as for approaches to prevent CAN by parents with SUD. Objective: To describe the aims and the structure of a German research network on relationships between CAN and SUD (CANSAS network). Method: Descriptive overview of the aims, and the different project clusters of the network. Results: The aims of the CANSAS network are: (1) to examine relationships between SUD and CAN; (2) to examine the effects of an evidence-based treatment for SUD patients with posttraumatic disorders; and (3) to provide SUD services with tools to diagnose CAN, and to assess the risk of maltreatment among parents with SUD. The aims of the network are addressed by six projects in three different project clusters (mediators and risk factors, evidence-based treatment, and improvement of services). Conclusions: It is expected that the CANSAS network will advance the understanding of relationships between early adversity and substance use disorders. It will bring forward the discussion about promising treatments for SUD patients with experiences of CAN. Finally it will provide services with measures to identify patients with CAN, and with tools to break the trans-generational cycle of adversity.
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Affiliation(s)
- Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Silke Pawils
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Ev. Hospital Bielefeld, Bethel, Bielefeld, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Thomas Hillemacher
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Michael Klein
- Center of Excellence on Applied Addiction Research, Catholic University of Applied Sciences, Cologne, Germany
| | - Markus Muehlhan
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Ulrike Ravens-Sieberer
- Department of Psychology, Faculty of Human Science, Medical School Hamburg, Hamburg, Germany
| | - Martin Schäfer
- Department of Psychiatry, Hospital Essen-Mitte, Essen, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Barbara Schneider
- Department of Addiction Medicine, LVR-Clinic Cologne, CologneGermany
| | - Rainer Thomasius
- German Center for Addiction Research in Childhood and Adolescence, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry, University Medical Center Hamburg-Eppendorf, Germany
| | - Sven Barnow
- Department of Clinical Psychology and Psychotherapy, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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