Up to 80 percent of women seeking substance abuse treatment report lifetime histories of sexual and/or physical assault, and a substantial subset have symptoms of PTSD, the researchers report.
One-hundred seven urban, low-income women between 18 and 55 years of age diagnosed with comorbid substance abuse and PTSD participated in the study. Seventy-five were randomly assigned to receive one of twocognitive-behavioral treatments ("Seeking Safety" or "Relapse Prevention Treatment"), and 32 were assigned to a community care group that received other therapies.
All treatments were administered during a three-month period. The women were assessed at the end of treatment, and at six months and nine months post-treatment.
In the Seeking Safety model, the clinician simultaneously addresses substance abuse and trauma issues. Relapse Prevention Treatment, considered to be the "gold standard" for addiction treatment, focuses on identifying triggers for substance cravings and relapse and coping strategies for managing them.
Women in the community care group received such local care as outpatient psychological treatment that did not conform to Seeking Safety or Relapse Prevention protocols, but may have included psychiatric medication, inpatient psychiatric treatment, other drug or alcohol treatment, or attended self-help meetings.
Significantly Reduced Symptoms
At the end of three months of treatment, participants who received both forms of cognitive-behavioral treatment had significant reductions in substance abuse and PTSD symptom severity compared to women in the community care group. In addition, women who received either of these treatments showed sustained improvement in both areas at six and nine months post-treatment. Women in the comparison group showed no significant changes and their PTSD symptoms worsened over time.These findings illustrate that carefully conducted cognitive-behavioral treatments can substantially decrease symptoms of substance abuse and concurrent PTSD in a relatively brief period in a hard-to-reach and often underserved population. The study also generated strong support for the Seeking Safety model by showing it to be as effective as Relapse Prevention.
Dr. Denise Hien and her colleagues at the Women's Health Project Treatment and Research Center at St. Luke's/Roosevelt Hospital Center in New York City published the study in the August 2004 issue of the American Journal of Psychiatry.
