Table 1.
Description of studies evaluating multicomponent interventions for survivors of abuse.
| Authors | Name of the intervention; location | Description of the intervention/program | Eligibility regarding violence/trauma & substance misuse | Description of the control group | Follow up and assessment of outcomes | Results | Limitations |
|---|---|---|---|---|---|---|---|
| Barrett et al., 2015 | Seeking Safety; Australia |
Objective: To reduce trauma-
and substance-related problems Program Components:
Provider: Clinical psychologist (masters level) |
Eligibility: Violence not
mentioned as an eligibility criterion, but more than 80% participants
reported violence histories PTSD checklist screen positive Substance misuse - history of problematic substance use Sample size Intervention group N=15 Control group N =15 Recruited from correctional facilities |
Usual care - included opioid substitution treatment, SMART Recovery, Narcotics Anonymous, non-pharmacological substance use treatment, mental health treatment |
Follow-up: 2- and
6-months Outcomes assessed: intervention feasibility/acceptability; ability to resist substance use; PTSD |
Demographics - Adult male
prisoners; 23% Aboriginal Mental Health - Preliminary evidence suggesting reductions in PTSD symptoms in both groups Substance Use - Preliminary evidence suggesting increased confidence in ability to resist substances in intervention group |
Statistical power/sample size; Attrition; Contamination; Shortened treatment protocol (25 to 8 modules); No statistical inferences on treatment outcomes |
| Choo et al., 2016 | BSAFER; United States |
Objective: Reduce drug use
and IPV Program Components:
|
Eligibility: Intimate partner
violence in past 3months Substance misuse - drug use in past 3 months Sample size Intervention group N= 21 Control group N =19 Recruited from adult EDs from a level I trauma center |
Time-matched web—based program on home
fire safety and included interactive components; Telephone booster with a brief conversation about fire safety |
Follow-up: 1- and
3-months Outcomes assessed: Past-month drug use; physical, psychological and sexual violence |
Demographics - Adult females
in the emergency department; 50% White Substance Use - Preliminary evidence for modest decreases in drug use days in both groups at 3 months. The intervention group had a mean decrease of 0.7days per week compared to a mean decrease of 1.5days per week in the control group. Among those using drugs other than marijuana, the intervention group had a mean decrease of 2.5 using days per week compared with a decrease of 1.3 using days per week in the control group. Violence - Preliminary evidence for modest decreases in IPV in both groups. The IIPV scores decreased by a mean of 4.1 points in the intervention group compared with a mean decrease of 3.3 points among controls |
Statistical power/sample size; Attrition; Implementation challenges; Selection bias; Generalizability |
| Garland et al., 2016 | Mindfulness-Oriented Recovery Enhancement (MORE); United States |
Objective: Reduce craving,
PTSD symptoms and psychological distress Program Components:
Provider: Social worker (masters level) |
Eligibility Trauma histories
including violence More than 80% of participants reported violence experience Substance use and co-occurring psychiatric issues Sample size Intervention group N= 64 Control group N = 64 CBT, N= 52 TAU Recruited from a therapeutic community |
Two control conditions: 10-session cognitive-behavioral therapy based on Seeking Safety; treatment as usual: psychoeducation, therapy, coping skills in therapeutic community | Follow-up: 10-weeks Outcomes assessed: Substance use craving, PTSD, Depression, Anxiety, Positive/Negative Affect | Demographics - Adult male; 42% White, 44%
Black Mental Health - Greater reductions in PTSD symptoms relative to Seeking Safety; Marginally significant reductions in PTSD symptoms relative to treatment as usual (p = 0.05) Substance Use - Great reductions in craving relative to Seeking Safety; No differences between mindfulness and treatment as usual |
Short follow-up precluding evaluation of sustained treatment effects; may not be generalizable to patients without co-occurring substance use and mental disorder |
| Ghee et al., 2009 | Condensed Seeking Safety Intervention |
Program Components: Coping
skills training for both trauma and substance abuse with six
topics: Introduction to safety, PTSD, detaching from emotional pain, setting boundaries in relationships, asking for help & commitment |
Eligibility Histories of
physical and/or sexual abuse Enrolled in residential treatment of
substance use in a community-based alcohol and drug treatment
center Sample size Intervention group N = 52 Control group N= 52 |
Standard treatment of substance use for participants in residential chemical dependence program |
Follow-up: 30 days
postcompletion of residential treatment Outcomes assessed: Sexual abuse trauma, PTSD, drug-screen and self-report of drug abstinence/relapse Overall trauma |
Demographics: Adult women, Caucasian (51%),
and African American (47%). Lower sexual abuse related trauma symptoms—not more advantageous in reducing overall trauma symptoms or relapse 30 days after treatment ended |
Small sample; One treatment facility limits
the generalizability of our findings-the small number of participants
returned for the 30 days posttreatment assessment may have affected the
power to show results; Longer time frame for assessing violence |
| Gilbert et al., 2006 | Relapse Prevention and Relationship Safety (RPRS); United States |
Objective: Reducing drug use
and IPV Program Components:
Provider: Trained facilitator |
Eligibility: Past 90-day
intimate partner violence experience Substance use-past 90-day drug use
Sample size Intervention group N=
16 Control group N= 18 Recruited from methadone maintenance treatment programs |
Informational control condition: 1-hour didactic session presenting a variety of community services | Follow-up: 3-months Outcomes assessed: drug use, IPV, depression, PTSD, sexual HIV risk behaviors | Demographics - Adult female; 59% Latina, 21%
White HIV-risk - Less likely to have sex while high on drugs, but no difference in number of unprotected sexual occasions or number of sexual partners Mental health - The RPRS group was significantly more likely than control to report decrease in depression. Although, the RPRS group showed a decrease in PTSD avoidance symptoms than control, the difference was not significant at 0.05 level (p = 0.06) Substance use - No difference between the groups in use of heroin or marijuana, However, women in RPRS were more likely than control group to report decrease in any illicit drug use, binge drinking or crack cocaine, although the effects were not significant Violence - RPRS participants were more likely than controls to show decrease in minor physical, sexual or injurious IPV and any severe physical IPV as well as minor or severe psychological IPV. |
Statistical power/sample size |
| Gilbert et al., 2015 | Project WINGS (Women Initiating New Goals of Safety); United States |
Objective: Disclose IPV and
receive IPV services; improve IPV-related selfefficacy, social support
and drug abstinence Program Components:
|
Eligibility: Being in an
intimate relationship (~77% sample reported intimate partner
violence) Substance use - past 6-month illicit drug use, drinking or substance use treatment Sample size Intervention group N= 94 Control group N= 97 Recruited from probation or community court-administered alternative-to-incarceration programs |
SBIRT provided by a case manager (1 session) |
Follow-up: 3-month
follow-up Outcomes assessed: IPV, drug use |
Demographics - Adult female;
67% Black, 30% Latina Substance Use - Decrease in drug use days in both groups, but no significant between-group differences Violence - Increase in IPV services utilization, but no between-group differences |
No inactive control group; Measurement issues for IPV |
| Hien et al., 2009, 2010* (*Both tested the same intervention) | Seeking Safety; United States |
Objective: Reduce PTSD
symptoms and substance use Program Components:
|
Eligibility: Trauma histories
including violence; More than 80% experienced violence in their lifetime
(adulthood & childhood) Substance use - current substance misuse Sample size: Intervention group N =176 Control group N= 177 Recruited from community-based substance use treatment programs |
Women’s Health Education Group (psychoeducation; 12 sessions) - Attention Matched Control Group |
Follow-up: weekly during
treatment, 1-week, 3-, 6- and 12-months
posttreatment Outcomes assessed: PTSD, substance use, unprotected sexual occasions |
Demographics - Adult female;
46% Caucasian, 34% Black HIV-Risk - Seeking safety associated with reduction of HIV sexual risk among women with higher levels of unprotected sex (Hien et al., 2010) Mental Health - PTSD symptoms reduced in both groups, but not significant between-group differences; PTSD improvement associated with subsequent substance use improvement; Substance Use - No changes in abstinence rates |
No inactive control group; generalizability; attrition; statistical limitations |
| McGovern et al., 2011 | Integrated Cognitive Behavioral Therapy; United States |
Objective: Reduce PTSD
symptoms and substance use Program Components:
|
Eligibility: PTSD screen
positive; More than 80% experienced violence in their lifetime
(adulthood & childhood) Substance use - enrolled in outpatient substance abuse treatment Sample size: Intervention group N = 32 Control group N= 21 Recruited from community-based intensive outpatient or methadone maintenance programs |
10–12 weekly individual addiction counseling sessions with the following modules: treatment initiation, early abstinence, maintaining abstinence, recovery, termination |
Follow-up: Baseline, 3- and
6-months postbaseline Outcomes assessed: Substance use days, substance use severity, PTSD, depression |
Demographics - 43% female;
Adult; 91% Caucasian Mental Health - Reductions in depressive symptoms over follow-up, but no differences between groups. Significantly greater reduction in PTSD re-experiencing symptoms and PTSD diagnosis in the intervention group. Substance Use - Reductions in substance use severity, alcohol and drug use days over time in both groups; significantly greater reduction in drug use days in integrated CBT group |
Power/small sample size; Attrition |
| Mills et al., 2012, 2017* (*Both tested the same intervention) | Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE); Australia |
Objective: Reduce PTSD
symptoms Program Components:
|
Eligibility: Past-month PTSD;
More than 80% experienced violence in their lifetime (adulthood &
childhood) Substance use-Past-month substance misuse Sample size: Intervention group N= 55 Control group N= 48 Recruited from substance use treatment services, provider referral and media advertisements |
Usual care: Access to community-based substance use treatment |
Follow-up: 6-weeks, 3-months
and 9-months post-baseline Outcomes assessed: PTSD symptom severity, severity of substance use disorder, depression, anxiety |
Demographics - 62% female;
Adult; 6% Aboriginal Mental Health - Reductions in anxiety, depressive and PTSD symptoms over follow-up, but no differences between groups for depression and anxiety. Significantly greater reduction in PTSD in the intervention/COPE group. Substance Use - No significant differences in number of drug classes used or abstinence rates between groups. |
Power/small sample size |
|
Reed et al.,
2015; Wechsberg et al., 2013* (*Both tested the same intervention) |
Women’s Health CoOp (WHC); South Africa |
Objective: Address alcohol
and other drug use risks, sexual risks for HIV, violence and gender
inequality Program Components:
|
Eligibility: Violence not a
criterion but participants had high prevalence of non-partner and
partner violence (84% reported in Reed et al.; 51% non-partner and 33%
partner) Substance use-Past 3-month drug use Sample size: Intervention group N= 360 Control group N= 181 Nutrition; N= 179 HCT Recruited by peer outreach workers |
Two control conditions:
|
Follow-up: 3-, 6-, 9- and
12-months Outcomes assessed: Substance use, IPV, non-partner violence |
Demographics - Adult female;
57% Coloured, 43% Black African HIV-Risk - No difference in unprotected sexual occasions, sex while high or casual sexual partners Substance Use - Increased abstinence at 12-months compared to combined control conditions (Among violence-affected participants at baseline, those no longer reporting violence at follow-up did not differ significantly in drug abstinence compared with those who reported violence at follow up (Reed et al., 2015)) Violence - No difference in physical partner violence |
Group imbalances; Statistical power for secondary analyses; attrition |
| Reif et al., 2002 | North Carolina CoOperative (NC CoOp); United States |
Objective: Reduce HIV-related
risk behaviors and cooccurring distress Program Components:
|
Eligibility: Violence not a
criterion but participants had high prevalence of violence victimization
(2/3rd reported experiences of violence) Substance use-past 30-day injection drug or crack use Sample size: Intervention group N =122 Control group N= 84 Recruited from a metropolitan area; restricted to women out of treatment |
2 risk reduction sessions including HIV education and counseling |
Follow-up: 3-months
post-treatment Outcomes assessed: Depression, anxiety, violence victimization, substance use |
Demographics - Adult female;
Predominantly Black Mental Health - Significantly greater reductions in anxiety and overall distress in intervention group. No significant differences in reductions in depression, traumatic stress. Among participants with high cooccurring distress, the intervention significantly reduced depressive symptoms. Violence - No significant differences in victimization between groups. |
Attrition and selection bias; Generalizability |
| Sacks et al., 2008 | Dual Assessment and Recovery Track (DART); United States |
Objective: Improve
functioning related to social and emotional functioning (psychiatric
severity, trauma, housing). Substance use intervention effects
hypothesized to be comparable in intervention and control
condition Program Components:
|
Eligibility: Violence not the
criterion but all participants had histories of community violence;
97.5% had histories of interpersonal violence Substance use - Substance misuse problems Sample size Intervention group N =126 Control group N= 114 Recruited from outpatient substance use programs |
Usual care - intensive outpatient substance use treatment |
Follow-up:
12-months Outcomes assessed: Psychiatric severity, trauma, housing, substance use, criminal activity |
Demographics - 43% male;
Adult; 79% Black Mental Health - Significant reductions in psychological symptoms and depressive symptoms over follow-up period; significant differences between groups in psychological symptoms, but no difference in depressive symptoms Substance Use - Significant reductions in substance use problems and days using drugs for entire sample over follow-up period, but no between-group differences Violence - Significant reductions in community and interpersonal violence over follow-up period, but no between-group differences |
Multiple comparisons; Inconsistent results across similar outcomes; attrition; no inactive control group |
| Tirado-Munoz et al., 2015 | Women’s Wellness Treatment; Spain |
Objective: Reduce IPV and
depressive symptoms Program Components:
|
Eligibility: Past-month
intimate partner violence Substance use - Currently receiving treatment for substance misuse Sample size Intervention group N = 7 Control group N= 7 Recruited from a community outpatient substance use treatment program |
Usual care (substance use focused) – motivational interviewing, relapse prevention, counseling, medication management |
Follow-up: 1-, 3- and
12-months posttreatment Outcomes assessed: IPV, depressive symptoms, quality of life |
Demographics - Adult
females Mental Health - Significant reductions in depressive symptoms, but no between-group differences Substance Use - No significant differences in drug use between groups; Reduction in alcohol use was significantly greater in experimental group Violence - Significant reductions in IPV in both groups, non-significantly favoring intervention condition. Significant difference in reduction of psychological maltreatment |
Statistical power/sample size; Differential attrition; Participation and compliance to study condition activities; No inactive control |
| Zlotnick et al., 2009 | Seeking Safety + TAU; United States |
Objective: Reduce substance
use, legal problems and psychopathology Program Components:
|
Eligibility: Violence not an
eligibility criterion but 94% lifetime sexual violence and 90% lifetime
physical violence Full or sub-threshold PTSD Substance use - Substance misuse issues Sample size Intervention group N= 27 Control group N= 22 Recruited from a residential substance use program in a women’s prison |
Usual care - individual and group residential prison-based treatment; 12-step model |
Follow-up: 12-weeks after
intake, 3- and 6-months post-prison release Outcomes assessed: Psychopathology, substance use, legal problems |
Demographics - Incarcerated
adult females; 47% White; 33% Black Mental Health - Reduction in PTSD symptoms over follow-up, but no significant between-group differences Substance Use - Reduction in substance use severity over follow-up, but no significant between-group differences |
No masking – information bias; contamination; differential follow-up protocols between groups; Statisti cal power |
CBT: Cognitive-behavioral therapy; ED: Emergency department; HCT: HIV counseling and testing; ICBT: Integrated cognitive behavioral therapy; IPV: Intimate partner violence; PTSD: Post-traumatic stress disorder; SBIRT: Screening, brief intervention and referral to treatment; SUD: substance use disorder; TAU: Treatment as usual; USO: unprotected sexual occasions.