The high prevalence of victimization and its sequelae among cocaine-dependent individuals is an issue of much current concern. Recent studies have suggested meaningful relationships between substance use disorders, victimization and psychiatric disorders most notably Post-traumatic Stress Disorder (PTSD). While it has been estimated that as many as 30% of individuals with substance use disorders suffer from PTSD, the appropriate treatment of these individuals remains to be elucidated. The proposed project is a Stage I project designed to develop and pilot test a treatment manual which specifically targets cocaine-dependent individuals who have current crime-related PTSD (CR-PTSD). The manual will be an integration of a cognitive behavioral therapy manual which has been developed for the treatment of PTSD with a cognitive behavioral therapy manual which has been developed for the treatment of cocaine dependence. A unique feature of the manual developed will be the addition of specific training in HIV-risk reduction strategies. The three year project is divided into 4 phases: manual development and the development of specific integrity, competence and adherence measures for the manuals; therapist training and pilot therapy (10 subjects) deliveries; manual revision; and pilot testing of the manual in 25 subjects. Process evaluation will guide the refinement of the manual during the course of the project. Treatment outcome will be evaluated along multiple dimensions.
The specific aims of this proposal are: 1) To develop and refine a treatment manual for CBT targeting issues specific to cocaine-dependent individuals with CR-PTSD which also addresses HIV-risk behaviors. 2) To develop measures of therapist competence, adherence and integrity specific to the integrated treatment manual. 3) To develop and imp1ement a training program for therapists to use the integrated treatment manual. 4) To pilot test the manual in 25 individuals with concurrent CR-PTSD and cocaine-dependence. In summary, this project targets the treatment of cocaine-dependent individuals who have been victims of violence and have current CR-PTSD. If the data gathered in this project is promising, a proposal to support the implementation of the manual developed in a larger, Stage II, controlled clinical trial will be developed. All participants will be assessed initially and at 6 and 12 months by two structured interviews, the Individual Assessment Profile (IAP) and the Risk for AIDS Behaviors Questionnaire (RAB). Outcome measures of interest for each six month period are: number of positive urinalysis, self reported drug use days, days in treatment, number of people with whom drug injection equipment was shared, number of arrests, days employed or in school. To study intensively immediate precipitants of first events of drug use fol-lowing a period of abstinence. Such study is to include the context of background, person, treatment, and environmental determinants of lapses. To evaluate the adequacy of the proposed model in explaining lapses and empir-ical definitions of relapse. The breadth of these analyses will also reflect on and sharpen existing theories of relapse. The methodology for pursuing these goals entails a multivariate correlational design that incorporates an initial classification of clients according to gender. A detailed assessment of clients will occur at treatment entry. Subjects and their collaterals will be interviewed at months 1 through 6, 9., and 12 after treatment entry to collect detailed information on their substance use and on lapses/relapses that have occurred since their last assessment. Taken together, this research will provide important information needed to expand knowledge regarding the myriad of factors and processes associated with lapse/relapse and their interplay.
| Back, Sudie E; Sonne, Susan C; Killeen, Therese et al. (2003) Comparative profiles of women with PTSD and comorbid cocaine or alcohol dependence. Am J Drug Alcohol Abuse 29:169-89 |
