COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

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HIEN, COHEN, MIELE, ET AL. for the efficacy of integrated models that address traumarelated issues in substance-abusing populations. Method Design All subjects were recruited through advertisements requesting participants for a study about trauma and addiction. Eligible patients were randomly assigned to one of two active treatment conditions: seeking safety or relapse prevention. Treatments were conducted in twice-weekly 1-hour individual sessions for 12 consecutive weeks. A nonrandomized community care comparison group served as a nonspecific comparison condition. This design follows the criteria of stage IB behavioral therapies research (17), which allows for a preliminary stage efficacy trial with a nonrandomized, quasi-experimental comparison group. The community care comparison condition strengthened our design by allowing us to examine whether seeking safety and relapse prevention were more effective than other routinely sought out substance abuse treatments. The 32 women in the community care group met the same diagnostic criteria and were recruited in the same manner as those in the two cognitive therapy groups but were not offered either of the two manualized therapies. If interested, they were given the same list of treatment referrals as those in the manualized therapy groups. They were followed longitudinally for the same pretest-posttest assessment periods. Over the 3-month active treatment phase, seven (22%) of the subjects in the community care group received outpatient psychological treatment, seven were prescribed psychiatric medication, and two (6%) were hospitalized for psychiatric reasons. Nine (28%) reported receiving any drug or alcohol treatment, and five (16%) reported attending selfhelp meetings. The patients in the two manualized study treatments (seeking safety and relapse prevention) received standard care in the community similar to the care received by the community care group. Over the 3-month study period, 22 (29%) received outpatient psychological treatment, 14 (19%) received prescription medications, four (5%) were hospitalized for psychiatric reasons, 15 (20%) received any drug or alcohol treatment, and 18 (24%) reported attending self-help meetings. Neither active treatment group statistically differed from the community care group in this comparison. Participants Participants were treatment-seeking women who responded to an advertisement or were referred from substance use treatment programs in a major metropolitan area. Women met screening criteria for the presence of a lifetime traumatic event (defined as positive response to items from the Lifetime Trauma Events Scale adapted from Fullilove et al. [5]). Screening inclusion criteria were as follows: 1) age 18 through 55 years, 2) female, 3) diagnosis of substance use disorder, 4) a history of at least one DSM-IV-defined trauma event, and 5) English-speaking. Patients who met these initial eligibility criteria received further diagnostic screening. Exclusion criteria were as follows: 1) advanced-stage medical disease (e.g., AIDS, tuberculosis) as indicated by global physical deterioration and incapacitation, 2) organic mental syndrome (associated with chronic drug abuse), and 3) psychiatric exclusions, defined below. All women who met screening eligibility criteria (N=207) were asked to participate in a diagnostic interview. Interviewers obtained written informed consent before the interview. Each participant received $10. Patients met criteria for final eligibility (and received an additional $20 voucher for their additional interview time) if they were diagnosed with current or subthreshold PTSD (defined as DSM-IV criteria A, B, and E and the presence of either C or D) and current DSM-IV substance dependence; if they reported using substances at least three times a week on the Substance Use Inventory (18); and if their Mini-Mental State Examination score was greater than 21. Psychiatric exclusion criteria included 1) current active suicidality, 2) current axis I diagnoses other than atypical bipolar, depressive, or anxiety disorders, and 3) history of psychosis. Of the 128 women who met full study eligibility criteria, 115 (90%) agreed to participate, and 96 of these women were randomly assigned to active treatment. Thirty-two of the 128 women became the community care comparison group. Baseline data were available for 115 of the women entered into the study. Of the 96 women randomly assigned to active treatments, 75 (78%) attended at least one psychotherapy session and were included in the intent-to-treat group. Thus, the total number of subjects was 107 (75 in active treatment and 32 in community care). There were no significant differences in demographics, treatment history, or baseline symptom severity between those who entered treatment and those who did not, suggesting that dropouts were random rather than attributable to any systematic bias. Ninety-four (88%) of the 107 subjects met full criteria for current PTSD; 13 (12%) met “subthreshold” criteria. Comparative analyses of those with full and subthreshold PTSD yielded no differences in substance use, PTSD, and psychiatric symptom severity. There were no differences in distribution of subthreshold PTSD across the three study groups. Table 1 presents the subjects’ demographic characteristics. The groups differed significantly only in age: the seeking safety group was significantly older than the relapse prevention group (Table 1). Therefore, age was entered as a covariate in all analyses. Study participants in all three conditions received repeatedmeasures assessments at baseline, end of treatment (3 months after baseline), 6 months after baseline, and 9 months after baseline. The primary outcomes assessed were substance use and PTSD symptoms. The secondary outcomes were global psychiatric symptoms. Additionally, for patients in the two active treatment groups, feasibility and acceptability were examined through adherence and dropout rates. Measures To reduce the possibility of Type I error, standardized composite scores were created for the two primary outcome domains of substance use and PTSD severity, as well as for the secondary outcome domain of global psychiatric symptoms. Intercorrelation matrices of all standardized measure total scores relevant to a specific outcome were created to determine which had reliability coefficients (alpha) of at least 0.85. Composite scores for each construct (substance use, PTSD, and global psychiatric symptoms) were then created by using a mean of all standardized scores meeting reliability criteria. Standardized scores range from –1 to 1. A score approaching –1 can be interpreted as low severity relative to a score approaching 1, whereas a score close to 0 falls at the midpoint. Individual measures that were used to create the respective outcome composites are described below. Substance use severity composite individual measures. The Substance Use Inventory (18), which consists of self-report questions, was used to determine quantity (i.e., dollars spent per day) and frequency (i.e., days) of substance use over the past week. Substances included opiates, cocaine, alcohol, marijuana, amphetamines, sedatives, phencyclidine, and prescription medications. Outcomes were based on the mean rating of use over the previous 4 weeks. The Clinical Global Impression (CGI) (19), a series of 7-point, interviewer-rated scales, was used to measure substance abuse. Am J Psychiatry 161:8, August 2004 http://ajp.psychiatryonline.org 1427
PTSD AND SUBSTANCE USE DISORDERS TABLE 1. Characteristics of 107 Women With Comorbid PTSD and Substance Use Disorder Assigned to Two Types of Cognitive Behavior Therapy or Receiving Standard Community Care Active Treatment With Cognitive Behavior Therapy Characteristic Seeking Safety a (N=41) Relapse Prevention (N=34) Community Care (N=32) Mean SD Mean SD Mean SD Age (years) b 38.2 9.1 33.8 8.3 39.7 0.7 Education (years) 13.6 2.5 13.5 3.1 13.5 2.3 N % N % N % Ethnicity African American 20 48.8 12 35.3 13 40.6 Hispanic 10 24.4 5 14.7 6 18.8 Caucasian 10 24.4 17 50.0 13 40.6 Other 1 2.4 0 0.0 0 0.0 Drug of choice Alcohol 13 31.7 13 38.2 13 40.6 Crack 6 14.6 6 17.6 3 9.4 Cocaine 8 19.5 6 17.6 8 25.0 Heroin 3 7.3 3 8.8 3 9.4 Cannabis 11 26.8 6 17.6 5 15.6 Affective disorders Major depressive disorder Lifetime 37 90.2 24 70.6 27 84.4 Current 21 51.2 17 50.0 23 71.9 Dysthymia 14 34.1 11 32.4 10 31.3 a Addresses both trauma and substance abuse. b The seeking safety group was significantly older than the relapse prevention group (F=5.17, df=2, 104, p
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Program Description: The Commonweal
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Conference Information: The Pennsyl
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MONDAY May 15 th , 2006
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Monday Morning Plenary Session “S
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COSIG Co-Occurring Disorders Confer
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M01: The Addiction Psychiatry Couns
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5. Criminal Logic: This is a 3- to
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12 Roadblocks of Communication 1 Or
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3 G.R.A.C.E. G- For Gap. Often our
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5 _________________________________
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7 Overall, what do you gain by drug
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9 2. What time of day would be best
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11 10. What good things would happe
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13 Decisional Balance for Drug Use
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15 ________________________________
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17 Drug use: Antecedents, Consequen
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Certificate of Achievement Temple U
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M06: An Overview: Co-Occurring Diso
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Requirements for CCDP Employment CC
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ecertification cycle (PCB approved
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Work Experience Verification Applic
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Code of Ethical Conduct UNLAWFUL CO
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psychoactive substance impairs the
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Easy Pass for PCB credentialed prof
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CCDP Checklist for applicants with
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TABLE OF CONTENTS Purpose of the Ca
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confidentiality in substance abuse
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Task 4 - Recognize signs and sympto
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individual’s needs and circumstan
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and community resources and service
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3. Social supports and networks for
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COUNSELING Task 1 - Provide a safe,
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CASE MANAGEMENT information. Task 1
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ensure continuity of care whenever
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disciplinary codes of ethics and st
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2. Effective public relations techn
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2. Eliciting accurate evaluation da
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2. There are seven elements in the
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elationship is established with the
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In taking the test, you may find it
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REFERENCES The following resources
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Other Drug Abuse Counselors. Columb
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Stern, T., Herman, J., & Slavin, P.
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2004 PA Certification Board (PCB).
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Prochaska, J.O. & DiClemente, C.C.,
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M12: An Overview of Adolescents and
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G. Benson, 2004 G. Benson 2004 COSI
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M13: Tri-Recovery Process: Improvin
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M15: TIP 42 Treatment for Persons w
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M16: Housing Implications for the O
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DRAFT - Community Based and Recover
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are perceived as necessary for stat
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esponsibility shared with consumers
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or provided at other rehab programs
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Supportive housing is a successful,
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Living on the Edge: Substance Use a
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M26: Dual Recovery: 12-Step Program
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Using Dialectical Behavior Therapy
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Using Dialectical Behavior Therapy
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TUESDAY May 16 th , 2006
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Article by Kenneth Minkoff, MD and
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RESOURCE BIBLIOGRAPHY (2005) 1. Ame
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38. Foundation Associates, Making M
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71. Minkoff K & Cline C, Developing
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co-occurring psychiatric and substa
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T31: Implementing Evidence-Based Pr
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T32: Berks County Adolescent Pilot
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T35: CCISC Implementation in Pennsy
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Volume 1, Issue 5 The Trainers meet
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Volume 1, Issue 1 BLAIR COUNTY’S
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Volume 1, Issue 1 Vision/Mission CO
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Volume 1, Issue 1 3. The population
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Volume 1, Issue 1 Complete
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Volume 1, Issue 1 The forgoing Cons
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Volume 1, Issue 1 Language for Inte
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Volume 1, Issue 1 Language for Inte
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T36: The Co-Occurring Distinction:
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Integration or Occupation? •QUEST
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Coming to a Balance “Rather shall
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T41: Offering Positive Incentives t
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Motivational Incentives for Enhance
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T43: Prison to Community: Reducing
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T45: Workforce Issues and Co-occurr
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T46: Creation of Local Housing Opti
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Fetal alcohol spectrum disorders fo
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MY 9-YR-OLD SON’S HISTORY OF MEDI
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Don’t Ask My Child to Fly Bruce R
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1 Multisystemic Therapy MST Model H
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3 NCFAS RESULTS: Adolescents & Pare
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Adelphoi Village Multisystemic Ther
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DISCHARGES PER AGENCY TOTAL DISCHAR
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T53: Using Change Theory to Assess
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The following questionnaire is desi
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THE STAGES OF CHANGE APPLIED TO COU
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T55: Creating Co-Occurring Centers
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12. What is the diagnosis: |___| 1
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Fact Sheet A Project to Establish A
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Planning and Implementing a Welcomi
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All organizations signing this memo
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3. Region I organizations will assi
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e) Link organizations with websites
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Planning and Implementing a Welcomi
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Welcome to the Johnson Institute ht
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johnsoninstitute.com - History http
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johnsoninstitute.com - President's
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MISA PILOT TAKES FLIGHT: A PILOT AP
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In Flight Changes for COD in Washin
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Crisis & Counseling Centers Co-occu
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Fact Sheet A Project to Establish A
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Mental Health Network Co-Occurring
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Improving Assessment and Treatment
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W86: Fairweather Lodge - An Evidenc
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Housing, Employment, Social and Aut
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Principle VI. Successful Lodges res
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Fidelity to Autonomy Principles 1.
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W87: Physical Disorders and Persons
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