Trauma and post traumatic stress disorder (PTSD) are highly prevalent among people with substance use disorders. There is consensus in the literature that AOD treatment services need to incorporate trauma-specific interventions to improve the outcomes of their clients suffering from symptoms of PTSD. A small number of protocols have been developed to treat this client group, however they tend to be lengthy, have relatively low retention rates and require extensive training and clinical supervision. For these reasons, many AOD clinicians are not able, or willing, to implement these interventions in clinical practice. A brief intervention (BI) for PTSD symptoms may be more attractive, feasible and sustainable to both clients and AOD workers. The present study is the first study to examine the feasibility of a BI for traumatised clients of AOD treatment services.
Professor Amanda Baker (University of Newcastle)
Dr Glenys Dore (Royal North Shore Hospital)
To assess the feasibility of a BI for traumatised clients of AOD treatment services as measured by:
- improvements in PTSD symptoms, post traumatic cognitions, substance use and severity of dependence
- clients’ willingness to participate in the study, the attendance rate, and client satisfaction
An uncontrolled pilot study was conducted to address the research aims. Twenty nine participants were recruited from an inpatient detoxification service in Northern Sydney. Baseline data was collected from all participants, who then attended the brief intervention. The intervention consisted of a single one-hour session with a therapist involving: i) psychoeducation regarding the symptoms people commonly experience following trauma and how these may relate to a person’s substance use; ii) brief discussion of symptom management; and iii) the provision of a self-help booklet. Participants were followed up at 1-week, 1-month and 3-months post-baseline, with follow-up rates of 86%, 86%, and 69%, respectively. Information pertaining to substance use and PTSD symptomology was collated at each interview.
Severity of PTSD symptoms significantly decreased from baseline to 1-week follow up and these reductions were retained through to the 3 month follow up. Despite these reductions, the majority of participants continued to meet criteria for a diagnosis of PTSD (74%). There was also no change in participants’ negative post-traumatic cognitions. In terms of substance use, reductions in the number of drug types used and severity of dependence were observed initially at 1-week, however, these improvements were not retained. The intervention appears to be acceptable to clients, as measured by a moderate participation rate (55%), 100% attendance at the intervention, and high levels of client satisfaction. In conclusion, these findings provide preliminary evidence that brief psychoeducation for traumatised clients of AOD services is safe and appears to have some benefit in relation to PTSD symptoms. However, while PTSD symptoms decreased, patients were still experiencing symptoms at severe levels. There was also no change in relation to post traumatic cognitions, and initial improvements in substance use were not maintained. Thus, the brief intervention may best be conceptualised as a “stepping stone” to further trauma treatment. Further research examining the brief intervention in the context of stepped-care approaches to treatment may be beneficial.
The preliminary results of this study were presented at the APSAD 2011 conference, EABCT 2011 conference and as an invited keynote at the NADA 2011 trauma forum. The findings are currently being written up for publication.