Treatment of Incarcerated Women with Substance Use Disorder and Post-traumatic Stress Disorder in Providence, Rhode Island, 1999-2001

The goal of this study was to evaluate the initial
efficacy, feasibility, and acceptability of Seeking Safety (SS)
treatment in a sample of incarcerated women with comorbid substance
use disorder (SUD) and comorbid post-traumatic stress disorder
(PTSD). Seeking Safety, a cognitive-behavioral psychotherapy
treatment, is a psychosocial treatment for women with comorbid PTSD
and SUD and, at the time this study was conducted, it was the
treatment with the most efficacy data for this population. SS
treatment appears to be a promising intervention for incarcerated
women with PTSD and SUD because (1) the treatment targets many of the
deficits found in this population that may interfere with their
recovery and place these women at risk for reoffending (such as
impulsiveness, anger dyscontrol, and maladaptive lifestyle
activities), and (2) it teaches skills to manage these problematic
behaviors. This study aimed to conduct an open feasibility trial of
Seeking Safety treatment in a sample of six incarcerated women with
SUD and PTSD and to conduct a randomized controlled pilot study to
evaluate the initial efficacy, feasibility, and acceptability of the
proposed treatment as an adjunct to treatment as usual (TAU), compared
to a TAU control group in a sample of 22 incarcerated women with
comorbid PTSD and SUD. The primary hypothesis was that, compared to
the TAU condition, women in the SS treatment condition would have less
severe drug and alcohol use as well as fewer PTSD symptoms and legal
problems after intervention, and at six weeks and three months after
release. The first six participants recruited for the study received
SS group treatment as an adjunct to the treatment provided by the
Discovery Program, the substance abuse treatment program in the
minimum security arm of the Women's Facility of the Adult Correctional
Institution in Providence, Rhode Island. The remaining participants
were randomly assigned to either the control group (TAU) or to a group
that received SS treatment as an adjunct to TAU. The treatment groups
were conducted by clinicians who worked as substance abuse therapists
in the Discovery Program and a clinical psychologist from Brown
University. All SS therapists received training in delivering SS
therapy from Dr. Lisa Najavits, who developed SS
treatment. Assessments were conducted at pretreatment, post-treatment
during incarceration, and three and six months postrelease for
PTSD-related measures. Measures of severity of substance abuse and
legal problems were taken at pretreatment, as well as at the six- and
12-week postrelease intervals. Measures were taken with a variety of
clinical instruments, including the Addiction Severity Index (ASI),
the Structured Clinical Interview for DSM-IV (SCID) module on
substance use, the Clinician Administered Post-Traumatic Stress
Disorder Scale-I (CAPS-I), the Trauma History Questionnaire (THQ), the
Helping Alliance Questionnaire-II (HAQ-II), the Client Satisfaction
Questionnaire, and the End-of-Treatment Questionnaire. Basic
demographic data were also collected from administrative
records. Variables include alcohol, drug, and legal composite scores
at pretreatment and post-treatment, number of relapses, whether the
woman returned to prison, whether the woman lied about substance
abuse, use of particular substances one month prior to prison and
during lifetime, PTSD indicators of frequency and intensity, total
client satisfaction scores, patients' ratings of therapists and
treatment, and trauma scales for crime, sexual abuse, and physical
abuse. Demographic variables include age, ethnic background,
education, first time in prison, the nature of the current conviction,
and number of arrests with convictions.