Integrated Treatment of Substance Use Disorders and Trauma Experiences: The Women of Worth Program
Background: Up to 60% of women who enter substance use disorder (SUD) treatment also have been diagnosed with posttraumatic stress disorder (PTSD), which is higher than the U.S. general population of women. Traditionally, SUD and mental health treatment have occurred in separate systems, and providers in each system tend to not be dually trained. Yet, current research has found that clients with PTSD in standard SUD treatment programs experience poorer outcomes compared to their counterparts without PTSD. Given the high prevalence of PTSD among women in SUD treatment, treating both disorders at the same time and by the same clinical team may improve outcomes.
Purpose: To examine the effectiveness of the Women of Worth program, an integrated SUD and PTSD treatment program.
Methods: The study design was single-group, and measures were administered at baseline, at treatment midpoint (12 weeks), and at treatment end (24 weeks). Adult women with a SUD in need of intensive outpatient services were eligible for enrollment. The primary measures were substance use in the past 30 days as measured by the Addiction Severity Index and psychological trauma symptom severity in the past 30 days as measured by the PTSD Checklist – Civilian Version for DSM-IV (scoring range: 17–85). Sociodemographic measures also were collected. Descriptive statistics were used to analyze data along with the Friedman test, a nonparametric statistic similar to repeated measures ANOVA, to examine client outcomes.
Results: Of the 86 women (average age: 39 years [standard deviation: 10.5]) in the Women of Worth program, most were white (70.4%), unemployed (84.6%), and had minor children (61.7%). Reduction over time in the number of days of substance use (median: 2, interquartile range [IQR]: 15; χ2 = 10.67; P < 0.01) and psychological trauma symptom severity (median: 51.5, IQR: 35; χ2 = 6.65; P < 0.05) was statistically significant. Median substance use at the end of treatment was 0 (IQR: 2), and the median psychological trauma symptom severity score was 28 (IQR: 30).
Conclusion: Study findings show statistical and clinical significance, with the median substance use being abstinence and the median psychological trauma symptom severity score registering below one recommended clinical cut-point of 38 at study end. When looking at the ranges of scores, and the IQR of 30 for trauma at the end of treatment, it suggests the Women of Worth program may need additional program resources to address psychological trauma among the women.