title: Attendance and substance use outcomes for the Seeking Safety program: sometimes less is more.
abstract: OBJECTIVE
  This study uses data from the largest effectiveness trial to date on treatment of co-occurring posttraumatic stress and substance use disorders, using advances in statistical methodology for modeling treatment attendance and membership turnover in rolling groups.
  
  
  METHODS
  Women receiving outpatient substance abuse treatment (N = 353) were randomized to 12 sessions of Seeking Safety or a health education control condition. Assessments were completed at baseline and at 1 week, 3, 6, and 12 months posttreatment. Outcome measures were alcohol and cocaine use in the prior 30 days captured using the Addiction Severity Index. Latent class pattern mixture modeling (LCPMM) was used to estimate attendance patterns and to test for treatment effects within and across latent attendance patterns and group membership turnover.
  
  
  RESULTS
  Across LCPMM analyses for alcohol and cocaine use, similar treatment attendance patterns emerged: Completers never decreased below an 80% probability of attendance, droppers never exceeded a 41% probability of attendance, and titrators demonstrated a 50% to 80% probability of attendance. Among completers, there were significant decreases in alcohol use from baseline to 1-week posttreatment, followed by nonsignificant increases in alcohol during follow-up. No differences between treatment conditions were detected. Titrators in Seeking Safety had lower rates of alcohol use from 1-week through 12-month follow-up compared with control participants. Droppers had nonsignificant increases in alcohol during both study phases. Cocaine use findings were similar but did not reach significance levels.
  
  
  CONCLUSIONS
  The impact of client self-modulation of treatment dosage and group membership composition may influence behavioral treatment outcomes among this population.
authors.affiliation: Department of Clinical Psychology, Graduate Center, City College of the City University of New York, 160 Convent Avenue, New York, NY 10030, USA. dah26@columbia.edu
authors.forename: Denise A
authors.initials: DA
authors.lastname: Hien
authors.forename: Antonio A
authors.initials: AA
authors.lastname: Morgan-Lopez
authors.forename: Aimee N C
authors.initials: AN
authors.lastname: Campbell
authors.forename: Lissette M
authors.initials: LM
authors.lastname: Saavedra
authors.forename: Elwin
authors.initials: E
authors.lastname: Wu
authors.forename: Lisa
authors.initials: L
authors.lastname: Cohen
authors.forename: Lesia
authors.initials: L
authors.lastname: Ruglass
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods* / Q000706:statistics & numerical data; D011615:Psychotherapy, Group / Q000379:methods*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome