How Do Females With PTSD and Substance Abuse View 12-Step Groups? An Empirical Study of Attitudes and Attendance Patterns

Abstract

Background. Self-help groups are beneficial for many people with addiction, predominantly through 12-step models. Yet obstacles to attendance also occur. Objectives. We explored attendance patterns and attitudes toward self-help groups by 165 outpatient females with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD), the first study of its kind. Methods. Cross-sectional self-report data compared adults versus adolescents, and those currently attending self-help versus not attending. We also explored attendance in relation to perceptions of the PTSD/SUD relationship and symptom severity. Results. Adults reported higher attendance at self-help than adolescents, both lifetime and currently. Among current attendees, adults also attended more weekly groups than adolescents. Yet only a minority of both age cohorts attended any self-help in the past week. Adults perceived a stronger relationship between PTSD and SUD than adolescents, but both age groups gave low ratings to the fact that self-help groups do not address PTSD. That item also had low ratings by both those currently attending and not attending self-help. Analysis of those not currently attending identified additional negative attitudes toward self-help (spirituality, addiction as a life-long illness, sayings, and the fellowship). Symptom severity was not associated with attendance, but may reflect a floor effect. Finally, a surprising finding was that all-female groups were not preferred by any subsample. Conclusions/Importance. Creative solutions are needed to address obstacles to self-help among this population. Addressing trauma and PTSD, not just SUD, was valued by females we surveyed, and may be more helpful than all-female groups per se.

Keywords :

• PTSD
• substance abuse
• 12-step groups
• self-help
• attitudes
• females

THE AUTHORS

Lisa M. Najavits, PhD, is professor of psychiatry, Boston University School of Medicine; and lecturer, Harvard Medical School. She is a research psychologist at Veterans Affairs (VA) Boston Healthcare System and the Bedford VA; clinical associate, McLean Hospital; and director of Treatment Innovations. Her major interests are substance abuse, trauma, co-morbidity, behavioral addictions, veterans’ mental health, community-based care, development of new psychotherapies, and outcome research. She is author of over 180 professional publications, as well as the books Seeking Safety: A Treatment Manual for PTSD and Substance Abuse; and A Woman's Addiction Workbook. She also serves on numerous advisory boards.

Hein de Haan, MD/PhD, is a psychiatrist and medical director of Tactus Addiction Treatment Program in the Netherlands. He also participates as a researcher at Nijmegen Institute for Scientist-Practitioners in Addiction. His research topics include trauma, PTSD and addiction, alexithymia, online therapies for addictive disorders, and forensic addiction treatment.

Tim Kok, MSc, is a psychologist at Tactus Addiction Treatment Program in the Netherlands and is in training for a doctoral degree in clinical psychology. He participates as a researcher at Nijmegen Institute for Scientist-Practitioners in Addiction. His dissertation is on trauma and addiction, and some of his recent work includes the development and validation of existing screening instruments for PTSD and studying ways of assessing PTSD.