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Women Seeking Safety in Community Treatment Programs. Gregory S. Brigham, Ph.D. Maryhaven, Columbus, Ohio NIDA CTN Ohio Valley Node National Conference on Women, Addiction and Recovery: News You Can Use Orange County, California (July 2006)

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women seeking safety in community treatment programs

Women Seeking Safety inCommunity Treatment Programs

Gregory S. Brigham, Ph.D.

Maryhaven, Columbus, Ohio

NIDA CTN Ohio Valley Node

National Conference on Women, Addiction and Recovery: News You Can Use

Orange County, California (July 2006)

Support from: The Ohio Valley Node of the NIDA CTN, NIDA 5 U10 DA13732-04

topics
Topics
  • Who are we?
  • Who do we serve?
  • What motivates us?
  • What does our community need?
  • What we want to know?
  • Who delivered the treatments?
  • They sure look different!
  • Ambivalence, patient’s & staff!
  • Now what?
who are we
Who are we?
  • Maryhaven is a private free standing comprehensive integrated addiction and mental healthcare treatment program founded in 1953 and located in Columbus, Ohio.
  • Started out as a substance abuse treatment facility later added certification for mental health treatment
  • Funding is primarily public
  • 7,332 admissions in July 1, 2003 to June 30, 2004.
  • Programs offered include: adult and adolescent residential & outpatient services, ambulatory & sub-acute medical detoxification programs, agonist therapy and homeless shelter/engagement center.
who do we serve
Who do we serve?
  • Race & Gender
    • 12% Female African American
    • 17% Female Caucasian
    • 26% Male African American
    • 43% Male Caucasian
    • 2% Male Latino
  • Medically Indigent and working poor
  • All patients have a substance use disorder
what motivates us
What motivates us?
  • The majority of women admitted present a history of trauma
  • Common wisdom/bias has been to treat substance abuse first then trauma when substance abuse is stable
  • Catch 22: Women with untreated trauma often drop from treatment and relapse at a high rate
  • Shift to co-occurring treatment for co-occurring disorders but how much and what kind?
  • We now have specialized women’s programs with a 100% rate of trauma history
what does our community need
What does our community need?
  • We received over 300 calls in response to our first advertisement for women with substance abuse and trauma,
  • Many of the women wanted trauma treatment but were ambivalent about substance abuse treatment.
what do we want to know
What do we want to know?
  • Should we treat PTSD in the early engagement stage of substance abuse treatment?
  • Will our patients look better or worse at one year if we treat PTSD at the onset of substance abuse treatment?
    • Is it harmful to treat PTSD in early substance abuse treatment?
    • Is it harmful to not treat PTSD in early substance abuse treatment.
  • Can our substance abuse counselors treat PTSD effectively?
  • Will treating or not treating PTSD affect patient retention in substance abuse treatment?
  • When should treatments for substance abuse and trauma be initiated: sequence and timing
who delivered the treatment
Who delivered the treatment?
  • The clinician was a non-degree certified chemical dependency professional with no formal training in psychotherapy
  • The supervisor was a Masters Degree counselor with certification.
  • The Blinded Assessor is a doctoral student in Social Work
  • The RA’s were either BA or MA with no experience in substance abuse treatment
they sure do look different
They sure do look different!
  • Crisis:
    • Relationship
    • Suicide ideation
    • Confrontations with abusers
    • Confrontations with friends and family regarding past traumatic events
  • Presentation of higher than typical levels of emotional arousal and behavioral instability
patient ambivalence
Patient Ambivalence
  • Presenting for trauma treatment not substance abuse or vise versa
  • Reluctance to give up substance use as a means for coping with symptoms of trauma
  • Minimal participation in substance abuse treatment
  • Initial high motivation for trauma treatment followed by drop out of treatment and avoidance of treatment and study staff for several months “I know I need it but this is just too much for me right now!”
  • No trauma treatment I’m out of here!
staff ambivalence
Staff Ambivalence
  • Substance abuse counselors were ambivalent about the focus on trauma in patient’s initial substance abuse treatment
    • Patients complained about the conflict between treatment philosophies
  • Substance abuse counselors were intimidated by the excessive levels of emotionality and frequent presentation of suicide lethality
  • Less confident in dealing with crisis and lethality
  • Conflict with harm reduction components of treatment
  • Moving out of comfort zone (from confident to anxious)
now what
Now what?
  • We definitely might adopt it!
    • They look worse, no they look better now, what is happening here?
    • We will wait for the results.
  • This treatment has been an important catalyst for increased awareness of the needs of this population.
  • Both patients and clinical staff are very enthusiastic about the adoption of Seeking safety.
supported by
Supported by:
  • Maryhaven’s participation was made possible by:
    • NIDA CTN Ohio Valley Node
    • NIDA/NIH Grant U10 DA13732
  • Maryhaven Acknowledgements: Cathy McPherson, Denise Lewis, Vicki Johnson, Felisha Lyons, Becky Krebs, Ann Whetzel, Alvin Pelt, Stella Resko, Maryhaven Outpatient Department.