For the majority of inner-city women with crack/cocaine dependence, chronic traumatic victimizations and their far-reaching psychological consequences are ongoing obstacles to achieving abstinence in early recovery from drug addiction. One psychiatric consequence of chronic victimization is developing a posttraumatic stress disorder (PTSD). Studies have demonstrated that comorbid psychopathology such as PTSD in female substance abusers is associated with poorer outcomes, which may include any or all of the following: (1) poor substance abuse treatment compliance manifested by ongoing substance abuse, especially cocaine abuse, and high treatment drop-out rates; (2) chronic psychiatric symptoms including feelings of terror, and hopelessness, intrusive recollections, hyperarousal, affective numbing, depression and anxiety, and numerous nonspecific somatic symptoms; and (3) high-risk sexual behaviors which may lead to HIV infection. While the need for treatment approaches to address such problems has been demonstrated empirically, and the clinical literature attests to the potential of such approaches, to date there are not known controlled studies which examine the efficacy of manualized treatments with crack/cocaine-dependent women who are suffering from PTSD. The proposed study aims to examine the efficacy of an enhanced cocaine treatment based on relapse prevention (RPT) which includes a specific manualized component geared towards coping with and reducing PTSD symptomatology for women with cocaine dependence. This randomized two-armed clinical trial will assess the relative efficacy of PTSDRPT versus RPT alone in treating inner- city women with cocaine dependence and comorbid PTSD over a three month period with repeated measures at baseline, completion of treatment (3 months), 3-month post-treatment follow-up and 6 month post-treatment follow-up. Concurrently, it will also evaluate a non-randomized, non-specific """"""""treatment-as-usual"""""""" TAU) comparison condition. The specific outcomes to be examined in the present study are efficacy in: 1a) reducing crack/cocaine use; (1b) maintaining retention rates in cocaine abuse 2) The research aims to assess the impact of potential predictors (including baseline severity of cocaine use, PTSD, depression and intensity of other services received) on cocaine use and PTSD symptomatology over follow-up. 3) The research will also assess the impact of potential mediators, representing acquisition of intervention components, on cocaine use and PTSD symptomatology over the three assessment periods, especially examining concurrent level of PTSDRPT and RPT alone skill and concurrent level of perceived self-efficacy to use these skills. The proposed study has the particular advantages of (1) adding the rigorous assessment of DSM-IV PTSD to the study of inner-city cocaine-dependent women; and (2) adding a manualized PTSD component to cocaine abuse treatment for these women, which builds directly on the empirical findings of the researchers' prior work.
| Cohen, Lisa R; Hien, Denise A (2006) Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatr Serv 57:100-6 |
| Hien, Denise A; Cohen, Lisa R; Miele, Gloria M et al. (2004) Promising treatments for women with comorbid PTSD and substance use disorders. Am J Psychiatry 161:1426-32 |
