Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men |
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| Institution: | 1. Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, 176 Ryders Lane, New Brunswick, NJ 08901, United States;2. Dartmouth Psychiatric Research Center, The Geisel School of Medicine at Dartmouth, United States;3. Department of Psychology, University of Hawaii, 200 W. Kawili St., Hilo, HI 96720, United States;4. The Menninger Clinic, Houston, TX 12303, United States;1. Center for Technology and Behavioral Health (http://www.c4tbh.org), Dartmouth Psychiatric Research Center, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, USA;2. National Development and Research Institutes, Inc., 71 West 23rd Street, New York, NY 10010, USA;1. RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States;2. Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States;3. Department of Psychology, University of Maryland, College Park, 4094 Campus Drive, College Park, MD 20742, United States;1. Brown University, Providence, RI, USA;2. Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, AR, USA;3. The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA;4. National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia;5. Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA;6. Memorial Hospital, Pawtucket, RI, USA;1. University of California, San Diego, Department of Psychiatry, San Diego, CA, United States;2. University of California, San Diego, Department of Family Medicine and Public Health, San Diego, CA, United States;3. VA San Diego, Center of Excellence for Stress and Mental Health, San Diego, CA, United States |
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| Abstract: | A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n = 230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n = 142) or by preference (n = 88) to receive SS or M-TREM, with a waitlist group of (n = 93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co-morbid PTSD and addiction problems. |
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| Keywords: | PTSD Seeking Safety Trauma Recovery and Empowerment Model (MTREM) Incarcerated men Integrated treatment |
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