Women with co-occurring disorders (COD): treatment settings and service needs.

Over the past two decades, substance abuse and mental health treatment systems have continued to define and refine interventions for co-occurring disorders (COD) for women. However, there is still a need for improvement of treatment and referral services for women with co-occurring disorders. This article presents data from studies of four types of interventions across a continuum of substance abuse treatment settings for women with co-occurring substance abuse and mental health issues. The studies include: (1) local data from the National Women with Co-Occurring Disorders and Violence Study (WCDVS); (2) a study of process improvement changes made to improve treatment access and retention implemented under the Network for the Improvement of Addiction Treatment (NIATx) and SAMHSA/CSAT's Strengthening Treatment Access and Retention (STAR) Program; (3) an examination of selected data collected in a large publicly-funded assessment center for substance abuse and mental health disorders; and (4) a study of postpartum depression within a larger evaluation of a comprehensive treatment model for pregnant/postpartum women with substance abuse disorders. The results from these studies provide information that allows both mental health and substance abuse systems and providers to move toward more effective interventions tailored to specific groups of women with COD. The interventions tested include: centralized screening and assessment centers; trauma-informed, integrated treatment; process improvement strategies to improve retention; and screening for postpartum depression in substance abuse and mental health programs.

Implementing an evidence-based practice: Seeking Safety Group.

This article presents findings from a multisite study on adopting and implementing an evidence-based practice, Seeking Safety, for women with co-occurring disorders and experiences of physical and sexual abuse. It focuses on what implementation decisions different sites made to optimize the compatibility of Seeking Safety with the site's needs and experiences and on issues posed by Rogers (1995) as relevant to successful diffusion of an innovative practice. A total of 157 clients and 32 clinicians reported on satisfaction with various aspects of the model. Cross-site differences are also examined. Results show that Seeking Safety appears to be an intervention that clinicians perceive as highly relevant to their practice, and one that adds value. Clients perceive the treatment as uniquely touching on their needs in a way that previous treatments had not.

Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders.

OBJECTIVE: Women with co-occurring mental health and substance use disorders frequently have a history of interpersonal violence, and past research has suggested that they are not served effectively by the current service system. The goal of the Women, Co-occurring Disorders, and Violence Study was to develop and test the effectiveness of new service approaches specifically designed for these women. METHODS: A quasi-experimental treatment outcome study was conducted from 2001 to 2003 at nine sites. Although intervention specifics such as treatment length and modality varied across sites, each site used a comprehensive, integrated, trauma-informed, and consumer-involved approach to treatment. Substance use problem severity, mental health symptoms, and trauma symptoms were measured at baseline, and follow-up data were analyzed with prospective meta-analysis and hierarchical linear modeling. RESULTS: A total of 2,026 women had data at the 12-month follow-up: 1,018 in the intervention group and 1,008 in the usual-care group. For substance use outcomes, no effect was found. The meta-analysis demonstrated small but statistically significant overall improvement in women's trauma and mental health symptoms in the intervention relative to the usual-care comparison condition. Analysis of key program elements demonstrated that integrating substance abuse, mental health, and trauma-related issues into counseling yielded greater improvement, whereas the delivery of numerous core services yielded less improvement relative to the comparison group. A few person-level characteristics were associated with increases or decreases in the intervention effect. These neither moderated nor supplanted the effects of integrated counseling. CONCLUSIONS: Outcomes for women with co-occurring disorders and a history of violence and trauma may improve with integrated treatment.

Effects of women-sensitive, long-term residential treatment on psychological functioning of diverse populations of women.

A number of studies have found that women who abuse substances enter treatment with greater psychological problems and more vulnerabilities than men. This article reports on a 5-year study of clients in a comprehensive, residential drug treatment program for women and their children. Psychological assessments on 362 women included the Basic Personality Inventory (BPI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Luria-Nebraska Neuropsychological Battery, Screening Test (LNNB-ST). Early in the course of treatment, the typical client tends to experience a great deal of distress, as evidenced by scores on the CES-D. Other assessments indicate she is relatively alienated, mistrustful of others, and resentful of rules imposed on her by others. Repeated assessments show that these psychological indicators improve significantly as the client progresses through the treatment program. Additional studies are needed to focus on long-term treatment outcomes of women in programs designed specifically for them.