Pathways to change: Use trajectories following trauma-informed treatment of women with co-occurring post-traumatic stress disorder and substance use disorders.
OBJECTIVE
Despite advances towards integration of care for women with co-occurring substance use disorder (SUD) and post-traumatic stress disorder (PTSD), low abstinence rates following SUD/PTSD treatment remain the norm. The utility of investigating distinct substance use trajectories is a critical innovation in the detection and refining of effective interventions for this clinical population.


METHODS
The present study reanalysed data from the largest randomised clinical trial to date for co-occurring SUD and PTSD in women (National Drug Abuse Treatment Clinical Trials Network; Women and Trauma Study). Randomised participants (n = 353) received one of two interventions in addition to treatment as usual for SUD: (i) trauma-informed integrative treatment for PTSD/SUD; or (ii) an active control psychoeducation course on women's health. The present study utilised latent growth mixture models (LGMM) with multiple groups to estimate women's substance use patterns during the 12-month follow-up period.


RESULTS
Findings provided support for three different trajectories of substance use in the post-treatment year: (i) consistently low likelihood and use frequency; (ii) consistently high likelihood and use frequency; and (iii) high likelihood and moderate use frequency. Covariate analyses revealed improvement in PTSD severity was associated with membership in a specific substance use trajectory, although receiving trauma-informed treatment was not. Additionally, SUD severity, age and after-care efforts were shown to be related to trajectory membership.


CONCLUSIONS
Findings highlight the necessity of accounting for heterogeneity in post-treatment substance use, relevance of trauma-informed care in SUD recovery and benefits of incorporating methodologies like LGMM when evaluating SUD treatment outcomes.
Department of Psychology, The City College of New York-CUNY, New York City, USA.
Teresa
T
López-Castro
Mei-Chen
MC
Hu
Santiago
S
Papini
Lesia M
LM
Ruglass
Denise A
DA
Hien
D000328:Adult; D005260:Female; D006266:Health Education; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D016387:Women's Health
latent growth mixture modelling; post-traumatic stress disorder; relapse; substance abuse; substance use trajectory