Improving the Transition from Residential to Outpatient Addiction Treatment: Gender Differences in Response to Supportive Telephone Calls

Substance use relapse rates are often high in the first months after discharge from inpatient substance abuse treatment, and patient adherence to aftercare plans is often low. Four residential addiction treatment centers participated in a feasibility study designed to estimate the efficacy of a post-discharge telephone intervention intended to encourage compliance with aftercare. A total of 282 participants (100 women, 182 men) with substance use disorders were included in this secondary analysis. The findings revealed that women were more likely than men to attend aftercare. This “gender effect” persisted after adjustment for a number of potential mediators.     

Improving the transition from residential to outpatient addiction treatment: gender differences in response to supportive telephone calls

Substance use relapse rates are often high in the first months after discharge from inpatient substance abuse treatment, and patient adherence to aftercare plans is often low. Four residential addiction treatment centers participated in a feasibility study designed to estimate the efficacy of a post-discharge telephone intervention intended to encourage compliance with aftercare. A total of 282 participants (100 women, 182 men) with substance use disorders were included in this secondary analysis. The findings revealed that women were more likely than men to attend aftercare. This "gender effect" persisted after adjustment for a number of potential mediators.     

Comparative profiles of women with PTSD and comorbid cocaine or alcohol dependence

This study examined differences in substance abuse severity, trauma history, posttraumatic stress disorder (PTSD) symptomatology and psychiatric comorbidity among treatment-seeking women (N= 74) with PTSD and either comorbid cocaine or alcohol dependence. Women in the cocaine/PTSD group, compared with the alcohol/PTSD group, demonstrated greater occupational impairment (e.g., greater severity on the employment subscale of the Addiction Severity Index, less monthly income, fewer days worked in past month), more legal problems (e.g., greater number of months incarcerated and arrests for prostitution), and greater social impairment (e.g., fewer number of close friends, less likely to be married). Women in the alcohol/PTSD group evidenced higher rates of exposure to serious accidents, other situations involving serious injury, and other extraordinarily stressful life events. Rates of major depression and social phobia were higher among the alcohol/PTSD group than the cocaine/PTSD group. Women in the alcohol/PTSD group scored higher on the CAPS avoidance, hyperarousal, and total subscale scores. The current findings enhance our understanding of the substance-specific profiles of women with PTSD and comorbid substance use disorders and may have important implications for the design of dual-diagnosis interventions.     

Exploring the relationship between eating disorder symptoms and substance use severity in women with comorbid PTSD and substance use disorders

Background: Eating disorders (ED) and substance use disorders (SUD) commonly co-occur, especially in conjunction with posttraumatic stress disorder (PTSD), yet little is known about ED and ED symptoms in women presenting to addiction treatment programs. Objective: We examined the association between ED symptoms and substance use frequency and severity in a sample of women with a DSM IV diagnosis of current SUD and PTSD enrolled in SUD treatment. Method: Participants were 122 women from four substance abuse treatment sites who participated in a multi-site clinical trial through the National Institute of Drug Abuse Clinical Trials Network (NIDA CTN). The Eating Disorder Examination-Questionnaire (EDE-Q), the Clinician’s Administered PTSD Scale (CAPS) and the Addiction Severity Index (ASI) were administered at baseline and correlational analyses were performed. Variables that significantly correlated with EDE-Q total and subscale scores were entered into a linear regression analysis. Results: Scores on the EDE-Q Global scale, as well as the Eating Concern, Weight Concern and Shape Concern subscales of the EDE-Q were significantly associated with Caucasian race/ethnicity, past 30 day opiate use, higher ASI Psychiatric Subscale score and lower ASI Employment Subscale score. Conclusion: Although exploratory, these findings suggest that there may be a relationship between addiction severity, use of certain drugs of abuse and eating disorder symptoms, particularly those involving weight and shape concerns in women with comorbid PTSD and SUD.     

Alcohol and Drug Abuse in Treated Alcoholics: A Comparison of Men and Women

A survey of 229 male patients and 198 female patients who met lifetime DSM-III criteria for alcohol abuse or dependence was carried out in Toronto, Canada. The patients were evaluated with the National Institute of Mental Health Diagnostic Interview Schedule and other substance abuse rating scales. The prevalence of individual alcohol and drug symptoms, the patterns of abuse, and the prevalence of drug disorders were compared in the two sexes. The study patients were younger than previous treatment samples and were more likely to have other drug disorders. While the overall prevalence of drug disorders was similar in male and female alcoholics, women were more likely to abuse sedatives and minor tranquilizers while men were more prone to the abuse of cannabis and tobacco. Men continue to be more likely to have social and occupational problems resulting from alcohol abuse, to start abusing alcohol earlier in their lives, to have been abusing for longer, and to report higher quantity and frequency of alcohol consumption. With one or two exceptions, the sexes do not differ on other indicators of pathologic use, withdrawal or tolerance, medical sequelae or treatment history. While men have significantly more alcohol problems than women, as measured by the DIS and the MAST, these differences disappear when length of alcohol abuse history, antisocial personality disorder and employment status are controlled for. Similarly, when these variables are controlled for, women exhibit more symptoms of alcohol dependence as measured by the ADS. Women alcoholics come into treatment earlier in their alcoholic careers.     

Treatment compliance among prenatal care patients with substance abuse problems

There is an insufficient number of substance abuse treatment programs available to pregnant women; however, even when women do enroll in treatment, they often choose not to comply with particular components of their treatment. To better understand what factors are associated with a woman's likelihood of compliance with treatment, this study assesses 244 pregnant, substance-using women enrolled in a specialized substance abuse treatment program. Women who complied with treatment referrals are compared with those who did not comply with referrals on various factors including their sociodemographic characteristics, types of substance use before and during pregnancy, experiences of violence before and during pregnancy, and prior substance use treatment. Bivariate analysis found that outpatient treatment compliance was more likely among women who smoked cigarettes before pregnancy, women who had received previous substance abuse treatment, and women whose partner had received previous substance abuse treatment. Outpatient treatment compliance did not vary by sociodemographic characteristics, any other type of substance use, or the women's experiences of violence. Inpatient treatment compliance was more likely among women who received prior substance abuse treatment; however, no other characteristic was found to be associated with inpatient treatment compliance. Logistic regression analyses, which controlled for various factors, suggested that past experiences with substance abuse treatment by the woman or her partner were significantly associated with treatment referral compliance. These findings suggest that the previous treatment experiences of women and their partners are important factors in shaping a successful substance abuse treatment program for pregnant women.     

Substance use comorbidity among veterans with posttraumatic stress disorder and other psychiatric illness

There is considerable concern about the emergence of significant substance abuse among younger veterans of war in the Middle East, especially among those with Posttraumatic Stress Disorder (PTSD), but little information exists on the magnitude of this problem. Using national administrative data from the Department of Veterans Affairs (VA) (n = 1,001,996), we examined rates of diagnosed substance use disorders in Veterans who served in Iraq and Afghanistan diagnosed with PTSD compared to other psychiatric disorders; and compared rates among veterans of other service eras. Of VA patients with a selected mental disorder, 21.0% had a comorbid substance diagnosis. Veterans who served in the post-Vietnam era (VET) (1973-1991) had the highest rates of comorbidity. Logistic regression models indicated that veterans with each selected psychiatric diagnosis were significantly more likely to be dually diagnosed in comparison to veterans with PTSD; post-Vietnam veterans were significantly more likely to be dually diagnosed than veterans from other eras. Bipolar disorder and schizophrenia are most strongly associated with dual diagnosis in OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans. There are high rates of substance use disorders among veterans with mental illness. The highest rates of comorbidity occur among those with bipolar disorder and schizophrenia; and in post-VET veterans.     

Effects of childhood physical abuse on course and severity of substance abuse.

The present study sought to assess the course and severity of Substance Related Disorder (SRD) in relation to childhood physical abuse (CPA) using retrospective data on CPA and current indices of substance use, abuse, and related morbidity. A total of 642 patients were assessed, of whom 195 (30.4%) experienced CPA, were assessed in two university medical centers with Alcohol-Drug Programs located within departments of psychiatry. A research assistant obtained demographic data, family history of substance abuse, problems related to substance abuse, and treatment of substance abuse. Data on severity included two measures of SRD-associated problems (one patient-rated and one psychiatrist-rated), substance abuse vs. dependence, self-help activities, and previous treatment. The study found that patients with CPA were more likely to be women, have lower socioeconomic status, and have more extended family members with substance abuse. Their substance abuse was more severe on five out of six severity measures. Patients with CPA showed more lifetime treatment on three out of four measures. Physical abuse during childhood resulted in a more morbid course of substance abuse later in adulthood. Although female gender and lower SES were both associated with CPA, the relationships were separate (i.e., women did not have lower SES).     

Abortion and subsequent substance abuse

A statistical association between a history of substance abuse and a history of abortion has been identified in several studies, but this association has not yet been thoroughly analyzed. This study draws on a subset of data from a reproductive history survey that included a nonparametric self-assessment of past substance abuse distributed to a random sample of American women. Analysis of this substance abuse variable showed that a report of substance abuse following a first pregnancy was associated significantly with (a) abortion for all women, (b) abortion for adolescents, and (c) abortion for women over 19 years of age. Women who aborted a first pregnancy were five times more likely to report subsequent substance abuse than women who carried to term, and they were four times more likely to report substance abuse compared to those who suffered a natural loss of their first pregnancy (i.e., due to miscarriage, ectopic pregnancy, or stillbirth). Women with a history of abortion or a history of substance abuse were significantly more likely to feel discomfort in responding to the survey. The findings of this study have important implications for the design of future studies examining substance abuse, adolescents, and women. These findings may also have clinical and counseling implications.     

Benzodiazepine use and anxiolytic abuse and dependence in treated alcoholics

The prevalence and correlates of benzodiazepine use and anxiolytic abuse and dependence are examined in a sample of 427 patients in Toronto, Canada, who met lifetime DSM-III criteria for alcohol abuse or dependence. The patients were evaluated with the NIMH-DIS and other standard psychiatric and substance abuse rating scales. Forty per cent were recent users of benzodiazepines and 20% had abused or been dependent upon anxiolytics, including benzodiazepines, during their lifetime. Patients with antisocial personality disorder (ASPD) were at higher risk for an anxiolytic disorder as were women and the unemployed. Recent users of benzodiazepines showed more current psychological distress, depressive symptomatology and more severe substance abuse problems than other patients and were more likely to have a lifetime DSM-III anxiety disorder. Patients with anxiolytic disorders, even if ASPD was controlled for, showed more psychiatric impairment and drug abuse problems than the remaining patients. Of those with a positive urine screen, 46% did not report using benzodiazepines in the previous week. Nineteen per cent of the patients who did not report benzodiazepine use in the previous week had a positive urine screen and were more likely to be found in the detoxification unit.     

Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment

BACKGROUND: The purpose of this report is to identify self-reported health problems and functional impairment associated with screening positive for posttraumatic stress disorder (PTSD) in women seen for care at a Department of Veterans Affairs (VA) medical center. METHODS: A survey was mailed to all women (N = 1935) who received care at the VA Puget Sound Health Care System between October 1996 and January 1998. The survey inquired about health history and habits. It included the PTSD Checklist-Civilian Version (PCL-C) and validated screening measures for other psychiatric disorders. The veteran's version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36-V) was included to assess health-related quality of life. RESULTS: Of the 1259 eligible women who completed the survey, 266 women (21%) screened positive for current PTSD (PCL-C score >or= 50). In age-adjusted bivariate analyses, women who screened positive for PTSD reported more psychiatric problems, substance abuse, and lifetime exposure to domestic violence. They were significantly more likely to endorse physical health problems including obesity, smoking, irritable bowel syndrome, fibromyalgia, chronic pelvic pain, polycystic ovary disease, asthma, cervical cancer, and stroke. In fully adjusted multivariate models, a PCL-C score of 50 or greater was independently associated with scoring in the lowest quartile on SF-36-V subscales and composite scales. CONCLUSIONS: Symptoms of PTSD are common in women treated at VA facilities. In addition, PTSD is associated with self-reported mental and physical health problems and poor health-related quality of life in these patients. These findings have implications for the design of VA primary care services for the growing population of female veterans.     

Substance use before and during pregnancy: links to intimate partner violence

Although some research has found links between women's experiences of intimate partner violence and their use of substances, little research has examined how this potential relationship changes when women become pregnant. Furthermore, most of the past research examining women's experiences of intimate partner violence and their use of substances has focused on only one type of violence, typically, physical assault. Thus less is known concerning how other important forms of violence, such as psychological aggression and sexual coercion, may be related to women's substance use and substance abuse disorders. This research studies 85 prenatal care patients to describe the women's use of alcohol and illicit drugs, both before and during pregnancy, in relation to their experiences of various types of intimate partner violence before and during pregnancy (including psychological aggression, physical abuse, and sexual coercion). The Conflict Tactics Scales 2 was used to assess the women's experiences of intimate partner violence. The women were asked about their frequency of alcohol use, and alcohol using women were administered a short version of the Michigan Alcohol Screening Test to assess the women for symptoms of alcohol disorder. The women's use of illicit drugs was assessed by asking the women about their frequencies of various types of drug use and drug using women were administered the Drug Abuse Screening Test to assess the women for symptoms of drug disorder. The results showed that before pregnancy, women who were physically assaulted by their partners were somewhat more likely to drink alcohol and use illicit drugs compared with women who did not experience such violence, even though these differences did not reach the traditional level of statistical significance; however, among the substance using women, those who experienced each type of violence were more likely to be frequent users of substances compared with the non-victims, and they evidenced a greater number of substance disorder symptoms compared with the non-victims. After the women became pregnant, the links between women's experiences of intimate partner violence and their use of substances became stronger, with the women who experienced each type of partner violence being more likely to use both alcohol and illicit drugs. Furthermore, among the substance-using women, those who were psychologically and physically abused had somewhat elevated levels of substance disorder symptoms during pregnancy compared with women who did not suffer such victimization. These findings underscore the importance of providing routine screening for various types of violent victimization and substance use within the context of many types of women's health care settings, including substance abuse treatment programs, domestic violence programs, and prenatal care services.     

Gender differences in individuals with comorbid alcohol dependence and post-traumatic stress disorder

This study investigated gender differences in a sample of outpatient, treatment-seeking individuals (N=84) with comorbid alcohol dependence and post-traumatic stress disorder (PTSD). Assessments included substance use severity, trauma history, PTSD symptomatology, and comorbid psychiatric disorders. Men reported an earlier age of onset of alcohol dependence, greater alcohol use intensity and craving, and more severe legal problems due to alcohol use. Women reported greater exposure to sexually related traumas, greater frequency and intensity of avoidance of trauma-related thoughts and feelings, and greater social impairment due to PTSD. Women were more likely than men to demonstrate higher rates of other anxiety disorders and test positive for cocaine at treatment entry. PTSD more often preceded alcohol dependence in women than in men. The results illustrate a number of gender differences that may shed light on etiologic models of comorbid alcohol dependence and PTSD.     

A comparison of women seeking drug and alcohol treatment in a specialist women's and two traditional mixed-sex treatment services

The paucity of research on the treatment needs of women with substance abuse problems has been a serious impediment to the development of empirically validated treatment programmes. Women continue to be seriously under-represented as research subjects and clients of treatment services. This study compares the characteristics of 80 women attending a specialist women's treatment service with those of eighty women attending two traditional mixed-sex treatment agencies. Women attending a gender-sensitive service were significantly more likely to have dependent children, to be lesbian, to have a maternal history for drug or alcohol problems and to have suffered sexual abuse in childhood. These results suggest that gender-sensitive treatment services may be recruiting women who might not otherwise have sought treatment for their substance dependence problems.     

Substance Use Before and During Pregnancy: Links to Intimate Partner Violence

Although some research has found links between women's experiences of intimate partner violence and their use of substances, little research has examined how this potential relationship changes when women become pregnant. Furthermore, most of the past research examining women's experiences of intimate partner violence and their use of substances has focused on only one type of violence, typically, physical assault. Thus less is known concerning how other important forms of violence, such as psychological aggression and sexual coercion, may be related to women's substance use and substance abuse disorders. This research studies 85 prenatal care patients to describe the women's use of alcohol and illicit drugs, both before and during pregnancy, in relation to their experiences of various types of intimate partner violence before and during pregnancy (including psychological aggression, physical abuse, and sexual coercion). The Conflict Tactics Scales 2 was used to assess the women's experiences of intimate partner violence. The women were asked about their frequency of alcohol use, and alcohol using women were administered a short version of the Michigan Alcohol Screening Test to assess the women for symptoms of alcohol disorder. The women's use of illicit drugs was assessed by asking the women about their frequencies of various types of drug use and drug using women were administered the Drug Abuse Screening Test to assess the women for symptoms of drug disorder. The results showed that before pregnancy, women who were physically assaulted by their partners were somewhat more likely to drink alcohol and use illicit drugs compared with women who did not experience such violence, even though these differences did not reach the traditional level of statistical significance; however, among the substance‐using women, those who experienced each type of violence were more likely to be frequent users of substances compared with the non‐victims, and they evidenced a greater number of substance disorder symptoms compared with the non‐victims. After the women became pregnant, the links between women's experiences of intimate partner violence and their use of substances became stronger, with the women who experienced each type of partner violence being more likely to use both alcohol and illicit drugs. Furthermore, among the substance using women, those who were psychologically and physically abused had somewhat elevated levels of substance disorder symptoms during pregnancy compared with women who did not suffer such victimization. These findings underscore the importance of providing routine screening for various types of violent victimization and substance use within the context of many types of women's health care settings, including substance abuse treatment programs, domestic violence programs, and prenatal care services.     

Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users: a potential mediating pathway

We explored links between childhood sexual abuse (CSA), childhood physical abuse (CPA), posttraumatic stress disorder (PTSD)/depression, and women injection drug users' (IDUs') risk in 113 women recruited from two syringe exchange sites. More than half (56%) reported CSA, 68% CPA, 23% likely were depressed-only, and 53% likely had PTSD/depression. CSA was associated with sexual (p = 0.003) and drug risk (p = 0.05); CPA was not. CSA was associated with PTSD/depression (p = 0.03); PTSD/depression was associated with sexual (p < 0.01) and drug (p < 0.03) risk. After PTSD/depression adjustment, CSA was no longer associated with sexual or drug risk. These results suggest that women IDUs' CSA-to-risk path is mediated by PTSD/depression.     

Substance Abuse Treatment Characteristics of Probation‐Referred Young Adults in a Community‐Based Outpatient Program

Although rates of substance abuse continue to rise among young adults ages 18–25, there is little information on the clinical characteristics of young adults referred to treatment, their readiness to change substance use behaviors, and treatment outcomes. These aspects were examined in young (18–25 years old) and older adult (26–45 years old) substance abusers entering treatment at a large, urban, outpatient substance abuse treatment facility. All clients were referred for outpatient treatment by the local Offices of Adult Probation during 1998–1999. The demographic and substance use characteristics, motivation level/readiness to change substance use behaviors, treatment attendance, completion, and “drug‐free” status based on patient self‐report and urine/breathalyzer data were assessed. Results. Substance‐abusing young adult probationers were more likely to be African‐American, with a significantly earlier age of onset of primary substance use. They were more likely to have a marijuana use disorder as compared with older adults, who in turn, were more likely to meet criteria for alcohol use disorders. Furthermore, as compared with older adults, young adults had significantly higher scores on precontemplation, and significantly lower scores on contemplation, determination, action, and maintenance subscales of motivation/change readiness. A significantly higher number of young adults did not complete outpatient treatment and were “drug‐positive” at discharge, as compared with older adults. Conclusions. Young adult probationers referred to substance abuse treatment show significantly different substance abuse and treatment characteristics as compared with their older adult counterparts. The findings suggest that specialized treatment approaches that focus on enhancing treatment readiness and motivation to change substance use behaviors may be of particular benefit to substance abusing young adults.     

The association of trauma and PTSD with the substance use profiles of alcohol- and cocaine-dependent out-of-treatment women

The association of trauma and posttraumatic stress disorder (PTSD) with alcohol and cocaine use is explored to determine if there is additive risk associated with dual dependence. Data were collected from out-of-treatment women enrolled in an HIV-prevention study. Women who experienced a DSM-IV qualifying event (n = 791) were stratified into four substance use groups based on lifetime alcohol and cocaine use. Women with lifetime comorbid alcohol and cocaine dependence experienced significantly more traumatic events and had a higher prevalence of violent events and lifetime diagnosis of PTSD and PTSD-related impairment. There is added risk for associated trauma and subsequent PTSD among women who have dual substance dependence.