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Randomized Controlled Trial
. 2015 Mar:30:66-80.
doi: 10.1016/j.janxdis.2014.10.009. Epub 2015 Jan 9.

Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men

Nancy Wolff  1 , Jessica Huening  2 , Jing Shi  2 , B Christopher Frueh  3 , Donald R Hoover  2 , Gregory McHugo  4
Affiliations
Randomized Controlled Trial

Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men

Nancy Wolff et al. J Anxiety Disord. 2015 Mar.

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.

Keywords: Incarcerated men; Integrated treatment; PTSD; Seeking Safety; Trauma Recovery and Empowerment Model (MTREM).

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Figures

Fig. 1
Fig. 1
CONSORT diagram for recruitment.
Fig. 2
Fig. 2
Participation, assignment to treatment, and retention.
See this image and copyright information in PMC

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