The proposed study will examine the combined effects of trauma exposure and posttraumatic stress disorder (PTSD) on primary treatment outcomes among individuals with comorbid substance use disorders (SUDs) and severe mental illness (SMI) with attention to gender differences. Further analyses of a longitudinal sample of 400 individuals receiving services at 11 residential treatment programs will be conducted.
The specific aims of this study include: 1a) to determine whether trauma exposure is associated with primary treatment outcomes at the 6- and 12-month follow-ups; 1b) to examine whether the association between trauma exposure and treatment outcomes is mediated by the presence of PTSD; to determine if the association between PTSD and treatment outcomes is mediated by changes in trauma related symptoms and psychological distress; 2) examine whether the participation in specific treatment services mediate and/or moderate the relationship between trauma exposure/PTSD and treatment outcomes; and 3) to examine whether the patterns of association identified for each of these aims differ by gender. Regression models based on the generalized estimating equations approach will be employed to examine the longitudinal relationship between the variables of interest. Several methodological strengths of the proposed study provide a unique opportunity to address gaps in the literature. Specifically: 1) the use of structured clinical interviews to diagnose SUDs, SMI, and PTSD according to DSM-IV criteria; 2) repeated assessment of the variables of interest; 3) a sample of individuals receiving concurrent substance abuse and mental health services; and 4) the inclusion of sufficient males and females to allow for simultaneous gender comparisons. In sum, the findings of the present study can aid in the development of treatment interventions that better address the needs of individuals with multiple comorbid disorders. ? ? ?
| Gil-Rivas, Virginia; Prause, JoAnn; Grella, Christine E (2009) Substance use after residential treatment among individuals with co-occurring disorders: the role of anxiety/depressive symptoms and trauma exposure. Psychol Addict Behav 23:303-14 |
