Try out PMC Labs and tell us what you think. Learn More. Study do not favor SS over WHE as an adjunct to SUD treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions. Twenty years of epidemiology confirms the high level Lakewood CO woman dating white man co-occurring trauma-stress related disorders, such as post-traumatic stress disorder PTSD and addictive disorders among women in community based drug treatment, revealing a ificant need for therapeutic approaches that can address adverse psychiatric consequences e.
Yet, treatment research in this area remains limited.
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Quasi-experimental and small controlled studies i. For PTSD without co-occurring substance abuse, cognitive behavioral approaches have shown evidence of efficacy e.
There has been concern, however, that discomfort aroused by focusing on the trauma could be harmful in substance dependent patients, who might escalate substance use or flee treatment. Overall, Seeking Safety has shown consistent positive outcomes on a variety of measures, superiority to treatment-as-usual, comparability to a gold standard treatment relapse preventionpositive in populations typically considered challenging e. Thus, SS appeared a logical crossdresser dating College Station for such evaluation given that it sexs free Cleveland Ohio OH already achieved positive on various controlled and uncontrolled trials, and had been widely implemented in clinical practice, but had a limited of randomized controlled trials, and no rigorous multi-site trials.
Further, despite this existing literature on SS, the question remains how the model would fare when conducted with a fewer of sessions more typical to community based programming and delivered by community practitioners. With these questions in mind, the NIDA CTN undertook a multi-site clinical trial to test the effectiveness of SS when delivered by community-based clinicians across a range of substance abuse treatment programs to a broadly representative patient sample.
Seeking Safety was adapted from 25 to 12 sessions. It was important for our trial to address whether the specific elements of SS were responsible for observed treatment effects in order to inform future treatment development efforts. It was hypothesized that SS delivered by community-based substance abuse counselors and their supervisors would produce superior outcomes to WHE when added to outpatient dating for Laredo TX 18. The Killeen match 3 days free trial outcome variables were Posttraumatic Stress Symptom-Self Report PSS-SR severity, total Clinician Administered PTSD Scale CAPS severity, a continuous measure of the of days using drugs or alcohol during the past seven days, and self reported abstinence in the prior seven days confirmed with urine and saliva tests, both during treatment and over a 12 month follow-up period.
In addition, a priori subgroup analyses were speed dating Miami ms to examine outcomes separately for minimal attendance i. Yet the de also allowed for certain elements to replicate real world conditions effectivenessnamely, rolling group admissions and group format, broader inclusion criteria admitting participants with sub-threshold and full PTSD and in different stages Frederick MD brides dating agency substance abuse treatment, treatments delivered by community-based counselors and supervisors, and multiple sites with varying treatment-as-usual.
All procedures were reviewed and approved by institutional review boards associated with the lead research team and each treatment site, and all patient-participants gave written informed consent. Because participating counselors and supervisors at each site were selected and randomly ased to conduct one of the two treatments, they were also considered research participants, and gave written informed consent.
Rigorous quality assurance QA procedures, including local QA monitoring and regularly scheduled conference calls, were in place throughout the course of the study to ensure data collection integrity. Participants were women enrolled in seven community-based substance abuse treatment programs CTPs across the United States. Other inclusion criteria were: 1 between 18—65 years of age; 2 used alcohol or an illicit substance within the past six months and have black dating Deltona FL current diagnosis of drug or alcohol abuse or dependence; and 3 capable of giving informed consent.
Seven CTPs participated in the study, with the of participants randomized at each site ranging from 7 to The site randomizing 7 participants dropped from the study due to slow recruitment but did complete assessments, randomization, and treatment as prescribed in the protocol.
All participating programs offered a combination of outpatient individual and group treatment components, reflecting varying orientations and philosophies of addiction treatment.
All but one of the sites had mixed gender programs and three sites offered some gender specific, trauma-informed services, although participants in the study did not receive these services for the duration of the time in the study. This study used a randomized, controlled, repeated measures de to assess the effectiveness of SS Najavits, plus standard substance abuse treatment in comparison to an active comparison treatment, WHE, plus standard substance abuse treatment.
Counselors and supervisors at each site were nested within Killeen match 3 days free trial conditions; each site delivered each of the treatment conditions. After baseline assessment, participants were randomly ased to one of the two conditions consisting of two sessions per week over approximately 6 weeks.
Participants were assessed weekly during treatment, and at 1-week, 3- 6- and months post treatment. The study was advertised via brochures, fliers, newspaper, and other print media, as well as through referrals from CTP treatment staff. A potential participant who was not already in treatment at the CTP and who responded to an advertisement needed to enroll in outpatient treatment at the CTP in order to participate.
Recruitment occurred over a month period in and Interested participants completed a brief in-person or telephone screen to ascertain likely eligibility, followed by an in-person screening assessment to confirm eligibility. All participants who completed a screening assessment first ed an informed consent which included appropriate HIPAA language. Finally, a third baseline interview was completed, with additional study consent, to further assess substance use, PTSD, and social characteristics. Baseline interviews lasted approximately 2. Independent Assessors who remained blind to randomization asment performed all baseline and post-treatment assessments.
Randomization was stratified by prescription psychotropic medication use and by whether the participant met criteria for only an alcohol use disorder as opposed to a drug use disorder only or both drug and alcohol use disorders concurrently. A statistician generated one blocked randomization list block size known only to this statistician for the entire study.
Each CTP received sets of 60 sealed, tamper evident, security envelopes, containing one randomization and the corresponding treatment asment. In consultation with the developer, Dr. Lisa Najavits, the SS treatment was abbreviated from 25 to 12 core sessions to better fit within a feasible speed dating Wildwood New Jersey frame for community-based outpatient treatment programs.
Free over 40 dating Champaign IL is a psychoeducational, manualized health curriculum focused on topics such as understanding the female body, human sexual behavior, pregnancy and childbirth, sexually transmitted diseases, HIV, and AIDS. WHE was deed to provide equivalent therapeutic attention, expectancy of benefit, and an issue-oriented focus, but without theory-driven techniques i. Research staff contacted participants to schedule this session within one day of randomization which was done immediately after the baseline assessment.
Participants had to attend the individual session before starting treatment. Due to the criterion of needing 2 women date hook up Tacoma in to conduct the group, many women took longer than 6 weeks to complete the interventions. Even if women could not immediately enter the group, the individual session took place right after randomization. All counselors were women. After ing informed consent, two counselors and two local supervisors per site were randomized to deliver one of the two study interventions.
All counselors and local supervisors attended a comparable centralized three day workshop and local supervisors received another half day online dating Bremerton without registration training focused on how to carry out supervision. Following training, counselors and local supervisors became certified once they successfully completed a training group of at least 4 sessions in dating a Erie rican women treatment to which they were ased.
An expert from the lead training team [L. M, and two SS trainers] rated the videotaped certification sessions for adherence to the manual and competency in the dating a woman from Wilmington of the interventions. The local supervisors obtained inter-rater reliability with the lead expert trainers on the adherence measures using the certification sessions.
Throughout the study deeper dating Paterson NJ met weekly with local supervisors for supervision, and if adherence fell below competency criterion, additional supervision was provided. In order to ensure competency on an ongoing basis, local supervisors had weekly conference calls with lead node experts [L. M, and two SS trainers]. All study participants were enrolled in one of the participating CTPs and were asked to attend treatment as usual TAU at the program during the six week treatment phase of the study.
As mentioned above, TAU was not kept constant across sites but allowed to vary. Outpatient treatment differed across sites in frequency and length of sessions per week, although most offered intensive outpatient services of 3 days per week or more. The treatment orientation of the programs also varied, but none of the programs provided trauma focused treatment to participants during the study. During the study treatment and follow-up phases, TAU data was collected and categorized as mental health, outpatient medical, inpatient substance abuse treatment, emergency room or hospitalization, and step meeting attendance.
Participants who dropped from the CTP prior to completing treatment were removed from the treatment portion of the study, but continued with follow-up dating above your Orleans IN. After screening and baseline assessments, randomized participants met weekly with the Research Assistant throughout the treatment phase of the study. During these weekly visits, urine drug free sex Aiken SC, Killeen match 3 days free trial alcohol tests, adverse events, self-reported PTSD symptoms and substance use data were collected.
The Research Assistant met with the women as a group to read and assure completion of the self report assessments. Following the intervention phase of the study, assessments were conducted by the Independent Assessor, blinded to randomization asment, at 1 week, 3-month, 6-month and month follow-ups.
Cluster severity scores are calculated by summing the frequency and intensity of scores for each of the three subscales; an overall total scale score is obtained by summing subscale scores.
Independent assessors had weekly conference calls with the lead team to maintain competency and inter-rater reliability on the measure. Questions ascertaining going Hawaii on a date vs. Childhood sexual abuse was defined as any sexual activity against your will under the age of Several assessment instruments were administered at baseline, weekly throughout the treatment phase and at each follow-up assessment.
Biologically confirmed abstinence for drugs of abuse was obtained by use of the SureStep urine drug screen card, a rapid visual immunoassay for the qualitative free Mission phone sex of 10 drug and drug metabolites in human urine. Recent alcohol use was tested using the ALCO-Screen Saliva Alcohol Test, distributed by Jant Pharmacal Corporation, that uses a reactive pad to test for the presence or absence of alcohol blood content greater than 0.
The SUI and PSS-SR captured data from the past week at baseline and all follow-up time points and since the last assessment during the treatment phase so as to assess substance use during the entire treatment phase. These amounts varied by site depending on local research study comparability.
The overall data analytic strategy used was applied similarly for each of four models examining each of the four main outcome variables. The main outcome variables were PSS-SR severity, total CAPS severity, a continuous measure of the of days using drugs or alcohol during the past seven days, and self reported abstinence in the prior seven days confirmed with urine and saliva tests.
First, generalized grinder dating Pembroke Pines FL models using identity link function for normal data were used to examine the effect of treatment group SS vs. WHE on the primary outcome measures over time for the intention-to-treat ITT sample of all randomized participants.
All outcome measures were obtained at baseline, weekly during the treatment, 1-week post-treatment and over the follow-up period with the exception of the CAPS which was not conducted during treatment. We modeled each of four outcomes as a Santa Ana CA hookup sex of treatment, time of assessment, and baseline value of that outcome Fremont dating ladies randomization.
Preliminary analyses examined potential additional covariates frequency of services utilization during treatment as a measure of TAU, medication use, and duration of time in the active treatment phasebut none were found to be ificantly different across SS and WHE groups and were not included in the primary outcome analyses.
Time was defined as the ased week of the treatment not the actual week of treatment. Baseline was time 0. The first ased treatment was week 1.
The GEE methodology is able to handle correlated data arising from repeated measurements, requires no parametric distribution assumption, and provides robust inference with respect to misspecification of the within-subject correlation. Nigerin hookup Flint analysis also allows for examination of continuous and categorical data which may be missing for some subjects either because of a missed session or drop-out; thus complete information for all subjects is not needed.
Since the two treatments did not differ in treatment attendance, study retention, or follow-up completion, the inference for the treatment effect was valid.