Treatment of Incarcerated Women with Substance Use Disorder and Post-traumatic Stress Disorder in Providence, Rhode Island, 1999-2001

The goal of this study was to evaluate the initialefficacy, feasibility, and acceptability of Seeking Safety (SS)treatment in a sample of incarcerated women with comorbid substanceuse disorder (SUD) and comorbid post-traumatic stress disorder(PTSD). Seeking Safety, a cognitive-behavioral psychotherapytreatment, is a psychosocial treatment for women with comorbid PTSDand SUD and, at the time this study was conducted, it was thetreatment with the most efficacy data for this population. SStreatment appears to be a promising intervention for incarceratedwomen with PTSD and SUD because (1) the treatment targets many of thedeficits found in this population that may interfere with theirrecovery and place these women at risk for reoffending (such asimpulsiveness, anger dyscontrol, and maladaptive lifestyleactivities), and (2) it teaches skills to manage these problematicbehaviors. This study aimed to conduct an open feasibility trial ofSeeking Safety treatment in a sample of six incarcerated women withSUD and PTSD and to conduct a randomized controlled pilot study toevaluate the initial efficacy, feasibility, and acceptability of theproposed treatment as an adjunct to treatment as usual (TAU), comparedto a TAU control group in a sample of 22 incarcerated women withcomorbid PTSD and SUD. The primary hypothesis was that, compared tothe TAU condition, women in the SS treatment condition would have lesssevere drug and alcohol use as well as fewer PTSD symptoms and legalproblems after intervention, and at six weeks and three months afterrelease. The first six participants recruited for the study receivedSS group treatment as an adjunct to the treatment provided by theDiscovery Program, the substance abuse treatment program in theminimum security arm of the Women's Facility of the Adult CorrectionalInstitution in Providence, Rhode Island. The remaining participantswere randomly assigned to either the control group (TAU) or to a groupthat received SS treatment as an adjunct to TAU. The treatment groupswere conducted by clinicians who worked as substance abuse therapistsin the Discovery Program and a clinical psychologist from BrownUniversity. All SS therapists received training in delivering SStherapy from Dr. Lisa Najavits, who developed SStreatment. Assessments were conducted at pretreatment, post-treatmentduring incarceration, and three and six months postrelease forPTSD-related measures. Measures of severity of substance abuse andlegal problems were taken at pretreatment, as well as at the six- and12-week postrelease intervals. Measures were taken with a variety ofclinical instruments, including the Addiction Severity Index (ASI),the Structured Clinical Interview for DSM-IV (SCID) module onsubstance use, the Clinician Administered Post-Traumatic StressDisorder Scale-I (CAPS-I), the Trauma History Questionnaire (THQ), theHelping Alliance Questionnaire-II (HAQ-II), the Client SatisfactionQuestionnaire, and the End-of-Treatment Questionnaire. Basicdemographic data were also collected from administrativerecords. Variables include alcohol, drug, and legal composite scoresat pretreatment and post-treatment, number of relapses, whether thewoman returned to prison, whether the woman lied about substanceabuse, use of particular substances one month prior to prison andduring lifetime, PTSD indicators of frequency and intensity, totalclient satisfaction scores, patients' ratings of therapists andtreatment, and trauma scales for crime, sexual abuse, and physicalabuse. Demographic variables include age, ethnic background,education, first time in prison, the nature of the current conviction,and number of arrests with convictions.