1. Subject Area: Women’s Treatment Issues Article Title: “Seeking Safety”: Outcome of a New Cognitive-Behavioral Psychotherapy for Women with Posttraumatic Stress Disorder and Substance Dependence. Author/s Najavits, Weiss, Shaw and Muenz

Individualized or Group Intervention? Yes. Both modalities are part of the intervention system.

Outcome/s Measures Treatment attendance and alliance, substance use and reduction of PTSD symptoms.

Subjects Info N=17 completers. N=27 intent to treat Women with PTSD and substance dependency.

Randomized Controlled Trial? No. Randomized controlled trials are currently being implemented through NIDA’s Clinical Trials Network. Results are not yet available.

Generalizable to Iowa? Yes. Women with both PTSD and dependency comprise 30-50% of SA treatment samples.

Citation Najavits, L. M., Weiss, R. D., Shaw, S. R., & Muenz, L. R. (1998). Seeking Safety: outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. Journal of Traumatic Stress, 11(3), 437-456. Abstract/Results/Notes: Najavits has developed a 24-session cognitive-behavioral group therapy treatment in an effort to provide treatment protocols for women suffering from both posttraumatic stress disorder and chemical dependency. Results are preliminary and the sample is a small hospital-based treatment group. The article is a call for more empirical study. Early reports from this sample showed significant improvements for treatment completers in substance use, trauma-related symptoms, suicide risk, depression, and social adjustment. Decreases in substance use and PTSD symptoms held up through 3 month follow-up post treatment. Client satisfaction with the curriculum components was statistically significant. Clients reported a high alliance to the philosophy of abstinence from all substances. Treatment completers were assessed with more severe symptoms at intake, suggesting that the curriculum may be useful with a population that is difficult to treat.

2. Subject Area: Women’s Treatment Issues Article Title: A Cognitive-Behavioral Treatment for Incarcerated Women with Substance Use Disorders and Posttraumatic Stress Disorder. Author/s Zlotnick, Najavits, Rohsenow and Johnson

Individualized or Group Intervention? Group and individual interventions are used.

Outcome/s Measures Lowered PTSD symptoms.

Subjects Info N= 17 incarcerated women with substance abuse disorder and PTSD.

Randomized Controlled Trial? No. Preliminary study with no control group.

Generalizable to Iowa? Yes.

Citation Zlotnick, C., Najavits, L. M., Rohsenow, D. J., & Johnson, D. M. (2003). A cognitive-behavioral treatment for incarcerated women with substance abuse disorder and posttraumatic stress disorder: findings from a pilot study. Journal of Substance Abuse Treatment, 25(2), 99-105. Abstract/Results/Notes: Rates for comorbid substance abuse disorder and posttraumatic stress disorder diagnosis among incarcerated women is considerably higher than women in the general population. Tentative findings for the 17 women in the study reported that 53% no longer met criteria for PTSD at the end of treatment and 46% at the follow-up three months later. There was also a decrease in PTSD symptoms from intake to posttreatment and that decrease was maintained for the 3-month follow-up. 35% reported the use of illegal substances within three months from prison release. Recidivism (return to prison) was 33% at the follow-up. There was a strong alliance and satisfaction with the Seeking Safety treatment despite challenges and difficulty with return to using. Randomized controlled trials of the Seeking Safety treatment program are currently underway through NIDA’s Clinical Trials Network.

3. Subject Area: Women’s Treatment Issues Article Title: Seeking Safety Therapy for Adolescent Girls with PTSD and Substance Use Disorder. Author/s Najavits, Gallop

Individualized or Group Intervention? Both are used within the curriculum.

Outcome/s Measures Reduction in usage, reduction in PTSD symptoms.

Subjects Info 33 outpatient adolescent girls.

Randomized Controlled Trial? Yes. Seeking Safety compared to treatment-asusual.

Generalizable to Iowa? Promising.

Citation Najavits, L. M., & Gallop, R. J. ((Under review)). Seeking Safety therapy for adolescent girls with PTSD and substance use disorder: a randomized controlled trial. Abstract/Results/Notes: The Seeking Safety (SS) Therapy Program participants evidenced better outcomes than treatment-as-usual group at post-treatment regarding reduced substance use, trauma-related symptoms, psychiatric functioning and cognitions related to both substance use disorders and PTSD. Some gains were sustained at follow-up, but not of significance. Patient alliance to and satisfaction with SS were moderate. Seeking Safety appears promising for this treatment population but further study is needed.

4. Subject Area: Women’s Treatment Issues Article Title: Helping Women Recover: A Comprehensive Integrated Treatment Model Author/s Covington

Individualized or Group Intervention? Both modalities are encouraged.

Outcome/s Measures N/A

Subjects Info N/A

Randomized Controlled Trial? No.

Generalizable to Iowa? Yes.

Citation Covington, S. S. (2000). Helping women recover: a comprehensive integrated treatment model. Alcohol Treatment Quarterly, 18(3), 99-111. Abstract/Results/Notes: This article included an overview of the treatment history for women’s addictions and moved into a new model for treating women entitled, “Helping Women Recover” (HWR), a model that blends the field knowledge of addiction theory, trauma theory and the basic underpinnings of psychological development for women. Subject areas emphasized were relationships, self, spirituality and sexuality. The HWR program is designed for criminal justice- and community treatment-based programs for women. Covington’s work is promising, receiving high praise in the field, and in need of empirical study to support the initial findings.

5. Subject Area: Women’s Treatment Issues Article Title: Promising Empirically Supported Treatments for Women with Co morbid PTSD and Substance Use Disorders. Author/s Hien, Cohen, Litt, Miele, and Capstick

Individualized or Group Intervention? Individual interventions.

Outcome/s Measures Reduction of use (frequency and intensity).

Subjects Info 100 outpatient, low-income urban women.

Randomized Controlled Trial? Yes. Control was treatment as usual and study group participated in Seeking Safety treatment.

Generalizable to Iowa? Yes.

Citation Hien, D. A., Cohen, L., Litt, L. C., Miele, G. M., & Capstick, C. (In press ). Promising empirically supported treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry. Abstract/Results/Notes: Twenty-five sessions of the Seeking Safety treatment format were conducted for 100 outpatient, low-income, urban women as the individualized format to relapse prevention over a three-month period. Results reported that patients receiving both Seeking Safety (SS) and relapse prevention therapy (RPT) had significant reductions in usage frequency, intensity, PTSD symptoms and psychiatric symptoms. The treatment-as-usual comparison group did not show significant changes. Improvement in PTSD symptoms was sustained at the 6-month follow-up but not at 9-months for those receiving both SS and RPT, appears to show promise for a difficult-to-treatment population.