The goal of this R21 proposal is to implement and further evaluate a promising new behavioral approach for the treatment of post-traumatic stress disorder, """"""""Seeking Safety"""""""" (Najavits, in press) in substance-using women entering treatment in a therapeutic community. As such, this proposal responds to the RFA-DA-01-015 """"""""Therapeutic Community Research."""""""" In addition, this proposal addresses two Healthy People 2010 objectives: 18-9: Increase the proportion of adults with mental disorders who receive treatment and 18-10: lncrease the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders. (USDHHS, 2000). Few therapeutic communities utilize empirically tested behavioral treatments for Posttraumatic Stress Disorder (PTSD) in substance using women. The clinical usefulness of most PTSD treatments are limited by several factors: 1) patient compliance, 2) treatments not specifically designed for PTSD in substance using women, 3) lack of formal standardized treatment in a therapeutic community setting, 4) specific counselor training in the area of PTSD and 5) cultural sensitivity in a TC setting. The proposed research examines 'the potential benefits of empirically supported behavioral treatments when combined with standard TC treatment (RFA: DA-01-015; Therapeutic Community Research) for substance using women with PTSD. Patients who volunteer and meet eligibility criteria for the study will be randomly assigned to an enhanced TC treatment consisting of the TC and individualized treatment sessions structured by a manual driven cognitive-behavioral therapy """"""""Seeking Safety,"""""""" (Najavits, in press) or the standard TC. Baseline and ongoing psychiatric assessments will monitor patents for any behavioral change potentially related to an improvement or alleviation of PTSD symptoms.
Specific aims over the three-year proposal are: 1. To implement a standardized manual-driven cognitive behavioral treatment offered in 24 individual sessions offered twice weekly for 12 weeks to randomly selected substance using women entering treatment in a therapeutic community setting who suffer from moderate to severe PTSD. 2. To explore the effectiveness and overall resident acceptability of an """"""""Individualized approach to behavioral treatment of PTSD"""""""" using a randomized pilot trial. Based on the outcome of this trial, the therapy and manual will be refined and readied for larger-scale triads. The present study may significantly add to the body of research in this area and raise treatment standards of PTSD in substance using women in therapeutic community treatment programs.
