A Scoping Review of the Trauma Recovery and Empowerment Model (TREM).

The link between interpersonal trauma and negative biopsychosocial outcomes has been well-documented. Integrated treatments that address trauma, mental health, and substance use among women with trauma histories have been found to be more effective than treatments that focus separately on these concerns. Since the early 2000s, the Trauma Recovery and Empowerment Model (TREM) has been described as a "promising" integrated trauma group therapy for women. Despite widespread recognition and implementation of TREM, its effectiveness has not been clearly established. The present scoping review is the first systematic effort to describe the extant literature on TREM and aims to provide an understanding of TREM's effectiveness by organizing and synthesizing the available empirical data. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, a systematic search was conducted using PubMed, PsycINFO, SW Abstracts, Scopus, Embase, and Web of Science. Quantitative dissertation findings not published elsewhere and peer-reviewed journal articles published in English that reported outcomes from TREM intervention research with adult women were included. Twelve of the initial 385 publications identified met the inclusion criteria and reported data from nine studies. TREM demonstrated statistically significant effects on posttraumatic stress disorder, anxiety, psychological/psychosomatic distress, and substance use. A more limited set of findings suggests that TREM may also be associated with additional gains, including self-esteem, relationship power, social support, attachment, and spiritual well-being. Future research should replicate findings, use random assignment to groups, involve larger sample sizes and more representative samples, examine optimal duration, and identify components that facilitate change.

A Comparative Effectiveness Study of a Shortened Trauma Recovery Empowerment Model and an Attachment-Informed Adaptation.

Relational challenges often associated with interpersonal trauma may hinder survivors' abilities to fully benefit from group therapy. This quasi-experimental study compared clinical outcomes of a 16-week version of the Trauma Recovery and Empowerment Model (TREM) for women and an attachment-informed adaptation (ATREM). Prior findings of TREM are extended by demonstrating that both group conditions can facilitate comparable clinical outcomes, creating options for group facilitators. Only ATREM resulted in statistically significant improvement in individual attachment avoidance, and it trended toward a slightly higher completion rate. This study provides insight into the emerging concept of group attachment.

A randomized trial of yoga for stress and substance use among people living with HIV in reentry.

BACKGROUND: People in reentry from prison or jail (returning citizens) living with HIV and substance use problems often experience numerous stressors and are at high risk for resumed substance use. Interventions are needed to manage stress as a pathway to reduced substance use. OBJECTIVE: This study explored the effect of a hatha yoga intervention as compared to treatment as usual on stress and substance use among returning citizens living with HIV and substance use problems. METHODS: Participants were randomized to either a 12-session, 90-minute weekly yoga intervention or treatment as usual. All participants were clients of a service provider for returning citizens that offered case management, health care, and educational classes. Outcomes included stress as measured by the Perceived Stress Scale at the completion of the yoga intervention (three-months) and substance use as measured by the Timeline Followback at one-month, two-months, and three-months. RESULTS: Seventy-five people were enrolled, two of whom were withdrawn from the study because they did not have HIV. Of the 73 remaining participants, 85% participated in the three-month assessment. At three-months, yoga participants reported less stress than participants in treatment as usual [F (1,59) = 9.24, p < .05]. Yoga participants reported less substance use than participants in treatment as usual at one-month, two-months, and three-months [X2 (1) = 11.13, p < .001]. CONCLUSION: Yoga interventions for returning citizens living with HIV and substance use problems may reduce stress and substance use. This finding is tentative because the control group did not receive an intervention of equal time and intensity.

Woman to Woman (W2W): Adapting an HIV risk reduction intervention for older women.

Woman to Woman (W2W) is a novel adaptation of the Sisters Informing Sisters about Topics on AIDS (SISTA) HIV prevention program. This article describes the process of adapting and piloting W2W based on recommendations from existing HIV prevention research. Six older women, all of whom had histories of homelessness and the majority of whom identified as African American, enrolled in the study, which piloted the adapted intervention and materials, evaluated the acceptability of the program, and assessed the measures related to the intervention. Participants described satisfaction with the program and had high rates of attendance; observations regarding the measures suggest the need to further develop assessments of HIV knowledge, condom use self-efficacy, and risk behaviors in this context.

Stress, Substance Use, and Yoga in the Context of Community Reentry Following Incarceration.

This field report provides a rationale for the potential of yoga to support reductions in stress and substance use among people returning to the community from jail or prison and describes an agency-based example of yoga classes offered in this context. People who have recently experienced incarceration face a multitude of stressors, which can heighten the risk of substance use and support the need to address stress reduction as a pathway to reduced substance use. One promising intervention is yoga, which has demonstrated significant stress-reduction effects among several populations. Feedback from participants in this field report's practice example reinforces the potential for yoga to decrease stress and complement substance use treatment in supporting health during the transition from incarceration to community return. Further scholarship is needed to explore the benefits and limitations of yoga in this context.

Correlates of HIV Risks Among Women on Probation and Parole.

This article examines HIV risks among a sample of 406 women on probation and parole with lifetime histories of victimization who were recruited from an urban community in the southern U.S. Guided by the Comprehensive Health Seeking and Coping Paradigm, we analyze the significance of sociodemographic characteristics, substance use, posttraumatic stress disorder, and social support in relationship to three sexual risks and one drug use risk using multivariable regression. Findings indicate that substance use is a significant correlate of nearly all HIV risks examined, including lifetime sexual partners and sexual partners during the past 12 months. Age, race/ethnicity, homelessness, lifetime traumatic event exposure, regular use of alcohol to intoxication and other drugs, functional social support, and substance use treatment in the past 12 months are associated with specific HIV risks. The findings identify potential targets to address in HIV prevention with women on probation and parole who have experienced victimization.

Types and Characteristics of Childhood Sexual Abuse: How Do They Matter in HIV Sexual Risk Behaviors Among Women in Methadone Treatment in New York City?

BACKGROUND: Childhood sexual abuse (CSA) is often considered an important distal factor in HIV sexual risk behaviors; however, there are limited and mixed findings regarding this relationship among women experiencing substance use problems. In addition, research with this population of women has yet to examine differences in observed CSA-HIV sexual risk behaviors relationships by CSA type and characteristics. OBJECTIVES: This study examines relationships between CSA coding, type, and characteristics and HIV sexual risk behaviors with main intimate partners among a random sample of 390 women in methadone treatment in New York City who completed individual interviews with trained female interviewers. RESULTS: Findings from logistic regression analyses indicate that CSA predicts substance use with sexual activity, with variations by CSA coding, type, and characteristics; however, the role of CSA is more limited than expected. Having a main partner with HIV risk mediates some relationships between CSA and drinking four or more drinks prior to sex. Intimate partner violence is the most consistent predictor of sexual risk behaviors. Other salient factors include polysubstance use, depression, social support, recent incarceration, relationship characteristics, and HIV status. CONCLUSIONS/IMPORTANCE: This study contributes to understanding of relationships between CSA and HIV sexual risk behaviors and key correlates associated with HIV sexual risk behaviors among women in methadone treatment. It also highlights the complexity of measuring CSA and its association with sexual risk behaviors and the importance of comprehensive approaches to HIV prevention that address psychological, relational, situational, and substance use experiences associated with sexual risk behaviors among this population.

Psychological distress among victimized women on probation and parole: A latent class analysis.

Latent class analysis was used to identify subgroups of victimized women (N = 406) on probation and parole differentiated by levels of general psychological distress. The 9 primary symptom dimensions from the Brief Symptom Inventory (BSI) were used individually as latent class indicators (Derogatis, 1993). Results identified 3 classes of women characterized by increasing levels of psychological distress; classes were further differentiated by posttraumatic stress disorder symptoms, cumulative victimization, substance use and other domains of psychosocial functioning (i.e., sociodemographic characteristics; informal social support and formal service utilization; perceived life stress; and resource loss). The present research was effective in uncovering important heterogeneity in psychological distress using a highly reliable and easily accessible measure of general psychological distress. Differentiating levels of psychological distress and associated patterns of psychosocial risk can be used to develop intervention strategies targeting the needs of different subgroups of women. Implications for treatment and future research are presented.

Childhood victimization, attachment, psychological distress, and substance use among women on probation and parole.

The present analysis was guided by a gendered pathways-based theoretical model and examined relationships between childhood victimization and current attachment, psychological distress, and substance use among 406 women with histories of victimization who were on probation and parole in an urban Kentucky county. Structural equation modeling examined relationships among childhood victimization, attachment, psychological distress, and substance use. Additionally, we examined the mediational role that attachment plays in relationships between childhood victimization and both psychological distress and substance use. The data fit the models properly. Psychological distress was significantly predicted by childhood victimization, and adult attachment partially mediated this relationship. Childhood victimization did not significantly predict substance use; however, attachment did. The findings suggest that attachment may be an important factor to further understand and address in relation to psychological distress and substance use among women with histories of victimization who are involved in the criminal justice system.

Correlates of recent drug use among victimized women on probation and parole.

Guided by the Comprehensive Health Seeking and Coping Paradigm (CHSCP; Nyamathi, 1989), the present research sought to examine associations between victimization, psychological distress, lawbreaking and recent drug use (past 12 months) among 406 victimized women on probation and parole. Bivariate differences between women who reported recent drug use and those who did not report recent use were compared across the 4 domains of the CHSCP (sociodemographic characteristics, personal resources, lifetime victimization, dynamic crime and drug factors). Variables significantly related to recent drug use at the bivariate level were retained in the multivariate analysis. The final multivariate model, using stepwise logistic regression via backward elimination, retained five candidate variables indicating women who recently used drugs, were younger, were not sexually victimized as children, began using drugs before they were 13 years of age, were on probation, and had engaged in more recent lawbreaking. The final model accounted for approximately 30% of the variance in drug use over the past 12 months. Implications for intervention and future research are discussed.

Psychosocial and reincarceration risks among older adults in mental health courts.

OBJECTIVE: Older adults are increasingly involved in the criminal justice system, yet there is limited research regarding their needs and experiences. This study examined differences in psychosocial experiences and reincarceration between older and younger adults with psychiatric disorders involved in the criminal justice system. METHODS: Participants (N = 80) were recruited from two mental health courts in the midwestern United States. Bivariate analyses examined age-related differences in psychosocial experiences and reincarceration between younger and older participants. RESULTS: Older adults, on average, experienced more treatment adherence and fewer probation violations than younger adults during the 6-month follow-up; however, they experienced comparable risk for reincarceration. Older adults' substance use, service use, housing instability, and program retention were similar to their younger counterparts. CONCLUSION: Despite older mental health court participants' treatment adherence and reduced probation violations, they are at risk for incarceration, substance use, and housing instability.

Childhood sexual abuse characteristics, intimate partner violence exposure, and psychological distress among women in methadone treatment.

Traumatic experiences and their biopsychosocial sequelae present complex challenges in substance use treatment. For women with substance use problems, childhood sexual abuse (CSA), intimate partner violence exposure (IPV), posttraumatic stress disorder (PTSD), and overall psychological distress are often co-occurring concerns. To address gaps in knowledge and to strengthen practice regarding these critical issues in substance use treatment, we drew upon cross-sectional and longitudinal data from baseline and 12-month interviews with a random sample of 416 women in methadone treatment to examine relationships between CSA characteristics, particularly the presence of force and involvement of family, IPV, and mental health concerns. Although CSA involving force and family was not associated with IPV as hypothesized, it was associated with increased risk of PTSD and overall psychological distress. The multivariate findings underscore the psychological vulnerabilities associated with CSA involving force and family and suggest that drug use and financial circumstances may be important targets to reduce IPV risk.

Harm reduction and 12 steps: complementary, oppositional, or something in-between?

BACKGROUND: Initially born of the desire to prevent the transmission of HIV among injection drug users, harm reduction presents a relatively new option for assisting individuals who struggle with drug and alcohol use. Twelve-step programs such as Alcoholics Anonymous (AA) are widely recognized as being a representative example of abstinence-based treatment and are often seen as oppositional to harm reduction. METHODS: The purpose of this study is to examine the ways in which harm reduction workers interpret the relationship between harm reduction and 12-step approaches to treatment. The study draws upon qualitative interviews with 18 staff members from two harm reduction-based substance use treatment programs. (1) RESULTS: Two central themes emerge from the qualitative data: (1) harm reduction and 12-step approaches can be complementary; and (2) 12-step approaches in high-threshold treatment settings may differ significantly from their original philosophy and intent. A third, much less prominent theme reflects some respondents' skepticism about the capacity of the two approaches to work together given the resistance to harm reduction by some in the 12-step community. CONCLUSION: Complementary conceptualizations of harm reduction and 12-step approaches have the potential to broaden the range of options available to people experiencing substance use problems.

Age and HIV sexual risk among women in methadone treatment.

This study examines the relationship between age and HIV sexual risk behaviors among a random sample of 372 women in methadone treatment in New York City. Logistic regression results indicate that women of all ages are at risk for HIV through inconsistent condom use. Exposure to intimate partner violence (IPV), alcohol use, and HIV-negative status are associated with inconsistent condom use during vaginal sex. Age (35-44), having a main sexual partner with an HIV risk factor, IPV, and alcohol use are associated with using crack or cocaine during sex. Similarly, age (35-44), having a main sexual partner with an HIV risk factor, IPV, and drug use are associated with consuming four or more drinks prior to sex. The findings highlight the importance of age-appropriate HIV prevention and intervention strategies, as well as the need to address intimate partner violence, mental health, polysubstance use, and relational factors associated with HIV sexual risk behaviors among women in methadone treatment.

Involving caregiving grandmothers in family interventions when mothers with substance use problems are incarcerated.

The alarming rate of incarceration of women disproportionately affects women of color, frequently intersects with the women's substance use problems, and often results in grandmothers providing care for their grandchildren during their daughters' incarceration. Numerous factors complicate the grandmothers' caregiving experiences and contribute to strains that exceed those typically associated with grandparent caregiving. Such complicating factors include the stresses associated with their daughters' substance use problems and incarceration; the complex biopsychosocial needs of many of their grandchildren; the challenging relational issues they must address; and often, the long-term, multifaceted effects of poverty. Despite the critical roles they play, the multiple vulnerabilities they face, and the potential for multigenerational, culturally relevant family interventions to yield gains for all three generations, grandmothers have received little attention in intervention research with this group of families. This paper provides a theoretical and empirical rationale for the inclusion of caregiving grandmothers in interventions and research with families affected by maternal incarceration and substance use problems, in general, and for the promise of multifamily groups, in particular. Strategies for tailoring multifamily groups with this population of families are also included.

Childhood Sexual Abuse and Intimate Partner Violence among Women in Methadone Treatment: A Direct or Mediated Relationship?

Women in substance use treatment report rates of childhood sexual abuse and intimate partner violence that far exceed those reported by women in the general population. Previous research with nonrandom samples of women in substance use treatment suggests that there is a statistically significant relationship between childhood sexual abuse and intimate partner violence; however, little is known about the mechanisms of risk between these two public health concerns among this population of women. To address this gap in knowledge and to inform intervention strategies, this study examined direct and mediated relationships between childhood sexual abuse and intimate partner violence risk among a random sample of 416 women in methadone treatment. In addition to high rates of childhood sexual abuse (57.9%), intimate partner violence (lifetime prevalence, 89.7%; 6-month prevalence, 78.4%), posttraumatic stress disorder (PTSD, 28.6%), and global psychological distress (19.5%), findings suggest that the relationship between childhood sexual abuse and intimate partner violence is mediated by mental health problems and that women experiencing PTSD or global psychological distress are 2.7 and 2.4 times more likely to experience intimate partner violence than women without such experiences, respectively. Although not a mediator in this relationship, financial independence reduced women's risk of partner violence by two-thirds. The paper includes discussion of social learning and stress and coping theories to explicate the findings and to inform intervention strategies.