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PTSD-SUD Treatment Questions

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PTSD-SUD Treatment Questions

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  1. Synthesizing Outcomes In Evidence-based Practices For Women With Trauma and AddictionsDenise Hien, Ph.D., ABPPCity University of New York, Subprogram in Clinical Psychology &Columbia University College of Physicians & SurgeonsGloria Miele, Ph.D.Columbia University College of Physicians and SurgeonsAimee Campbell, Ph.D., MSWNew York State Psychiatric Institute, Columbia University College of Physicians and Surgeons; St. Luke’s Roosevelt Hospital CenterCollege on Problems of Drug Dependence Annual MeetingJune 20, 2013This work was supported by the National Institute on Drug Abuse: U10DA13035 (PI: Nunes), DA01025198 (PI: Morgan-Lopez), and City College Interdisciplinary Research Program (PI: Hien)

  2. PTSD-SUD Treatment Questions Can we reduce PTSD symptoms without increasing substance use? Can we safely deliver trauma-focused group therapy in community based drug treatment?

  3. Study Team Lead Investigative Team Denise Hien, Lead Investigator Edward Nunes, Node PI Gloria Miele, Training Director Lisa Cohen, Protocol Manager Aimee Campbell, Proj Director Jennifer Lima, Node Coord Huiping Jiang, Statistician Mei-Chen Hu, Statistician David Liu, NIDA Liaison

  4. Study Aims • Primary Analyses: • To assess the effectiveness of adding a trauma focused therapy to ongoing substance abuse treatment • To evaluate the transportability of a 12- session group version of Seeking Safety in community drug/alcohol treatment settings. • Secondary Analyses: • To identify for whom and how the trauma focused therapy worked best.

  5. Treatment Groups • Seeking Safety (SS) • Short term, manualized treatment • Cognitive Behavioral • Focused on addiction and trauma • Women’s Health Education (WHE) • Short term, manualized treatment • Psychoeducational • Focused on women’s health issues

  6. Pre-Post Control Group Design Screening, Baseline,Randomization,Individual Session w/ Counselor Pre-Treatment 1 - 4 Weeks Treatment 6 Weeks 12 Twice Weekly Group Sessions (rolling admission) Post Treatment Follow-up 46 Weeks 1 Week 3 Month 6 Month 12 Month

  7. PSS-SR Trauma Symptom Severity for ITT Sample (N=353) Hien, Wells, et al. (2009). Multi-site randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. Journal of Consulting and Clinical Psychology.

  8. Abstinence Rates for ITT Sample (N=353) Hien et al. (2009). Multi-site randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. Journal of Consulting and Clinical Psychology.

  9. Snapshot of Secondary Analyses: For Whom, In What Ways and In What Context? SubgroupsOther OutcomesMediators and Moderators

  10. Alcohol Misuse SS had stronger treatment effects on PTSD hyperarousal symptoms (PSS-SR) compared with WHE over time for women with alcohol misuse at baseline. Hien, Campbell et al. (2010). The role of alcohol misuse on PTSD outcomes for women in community treatment? A secondary analysis of NIDA’s Women and Trauma study. Drug and Alcohol Dependence.

  11. Cocaine/Stimulant UseDays of cocaine/stimulant use in the last 30 days (N=141)Ruglass, Hien, Hu, & Campbell, AN. (In press). Secondary analysis of outcomes for stimulant users with PTSD in the NIDA “Women and Trauma” study. American Journal on Addictions

  12. Snapshot of Secondary Analyses: In What Ways?SubgroupsOther OutcomesMediators and Moderators

  13. Sexual Risk Participants receiving SS who were at higher risk significantly reduced unprotected sexual occasions over 12-month follow-up. Hien et al. (2009). The impact of trauma-focused group therapy upon HIV risk behaviors among women with PTSD in the NIDA Clinical Trials Network “Women and Trauma.”AIDS and Behavior.

  14. Presence of eating disorders at baseline led to significantly less improvement in PTSD symptoms and abstinence over time. Eating Disorders Cohen et al. (2010). Eating disorders and trauma among female substance use disorders: Is there a real association? A secondary analysis of NIDA’s CTN “Women and Trauma” multi-site trial. American Journal on Addictions.

  15. Other Positive Outcomes

  16. Snapshot of Secondary Analyses: In What Context?SubgroupsOther OutcomesMediators and Moderators

  17. Racial/Ethnic Matching White clients with more severe PTSD at baseline improved on PTSD outcomes when receiving SS from a ethnically-matched White therapist African-American and Latino clients with less SUD severity at baseline improved on SUD outcomes with SS if they had an ethnically-matched non-White therapist

  18. Temporality of Treatment Response Hien et. al, (2010). Do Treatment Improvements in PTSD Severity Affect Substance Use Outcomes? A Secondary Analysis from “Women and Trauma” Multi-Site Randomized Study. American Journal of Psychiatry.

  19. A Conceptual Model for How PTSD Affects Alcohol Use

  20. A Mediational Model of PTSD Severity and Alcohol Use PTSD Severity b = -.03, p<.05 b = 16.27, p<.01 Mediated effect-.66 (CI: -1.59,-.125) Seeking Safety Alcohol Use Morgan-Lopez, Saavedra, Hien, et al. (In press). Indirect Effects of Seeking Safety on Substance Use Outcomes: Overall and Attendance Class-Specific Effects. American Journal on Addictions

  21. Attendance Matters • Three distinct attendance patterns emerged: Completers, Droppers, and Titrators. • Titrators in Seeking Safety had lower rates of alcohol use across the study period compared to the health education control; cocaine results were similar but not statistically significant. Hien, Morgan-Lopez, et al. (2012) Can Less be More?: A secondary analysis of CTN “Women and Trauma” study. Journal of Consulting and Clinical Psychology.

  22. Alcohol Use Over Time For AA Attenders Morgan-Lopez, Hien, et al. (in press). Synergistic effects of recovery management: A secondary analysis of the NIDA Clinical Trials Network “Women and Trauma” study. Journal of Substance Abuse Treatment.

  23. Alcohol Use Over Time For Non-AA Attenders Morgan-Lopez, Hien, et al. (in press). Synergistic effects of recovery management: A secondary analysis of the NIDA Clinical Trials Network “Women and Trauma” study. Journal of Substance Abuse Treatment.

  24. Considerations Regarding Secondary Analyses • Large enough sample size to examine nuanced clinical questions yielding promising avenues for future inquiry • Cautions regarding over interpretation of findings

  25. Hands on guide for clinicians and providers seeking to treat women who suffer from trauma and the effects of substance abuse Available from APA Press and on Amazon.com

  26. THANK YOU • Participants & Staff from NIDA CTN “Women & Trauma” • 353 Participants; 28 RAs, Assessors, & Coordinators; 39 Therapists & Supervisors; 11 Project Directors and Protocol Principal Investigators; 27 QA Monitors and Data Managers • Colleagues & Students • Violet Amata; Raquel Bibi; Ruthie Bornstein; Nathilee Caldeira PhD; Aimee Campbell PhD; Lisa Cohen PhD; Eric Fertuck PhD; Eva Garcia; Miriam Hafez; Grace Kiriakos; Peter Lemons; Lisa Litt PhD; Jed McGiffin; Robert Melara PhD; Antonio Morgan-Lopez PhD; Gloria Miele PhD; Edward Nunes MD; Lesia Ruglass PhD; Lissette Saavedra PhD; Rafal Skiba; & Patricia Yoon • Funding Support • U10DA13035 (PI: Nunes); DA01025198 (PI: Morgan-Lopez); & City College City Seeds Interdisciplinary Grant (PI: Hien)

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