title: Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men.
abstract: A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n=230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n=142) or by preference (n=88) to receive SS or M-TREM, with a waitlist group of (n=93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co-morbid PTSD and addiction problems.
authors.affiliation: Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, 176 Ryders Lane, New Brunswick, NJ 08901, United States. Electronic address: nwolff@cbhs.rutgers.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Wolff
authors.affiliation: Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, 176 Ryders Lane, New Brunswick, NJ 08901, United States.
authors.forename: Jessica
authors.initials: J
authors.lastname: Huening
authors.affiliation: Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, 176 Ryders Lane, New Brunswick, NJ 08901, United States.
authors.forename: Jing
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Psychology, University of Hawaii, 200 W. Kawili St., Hilo, HI 96720, United States; The Menninger Clinic, Houston, TX 12303, United States.
authors.forename: B Christopher
authors.initials: BC
authors.lastname: Frueh
authors.affiliation: Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, 176 Ryders Lane, New Brunswick, NJ 08901, United States.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.affiliation: Dartmouth Psychiatric Research Center, The Geisel School of Medicine at Dartmouth, United States.
authors.forename: Gregory
authors.initials: G
authors.lastname: McHugo
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010349:Patient Compliance; D011329:Prisoners / Q000523:psychology*; D011615:Psychotherapy, Group / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014754:Violence / Q000523:psychology
keywords: Incarcerated men; Integrated treatment; PTSD; Seeking Safety; Trauma Recovery and Empowerment Model (MTREM)