Perceived Treatment Needs Among Women With Co-occurring Substance Use Disorders and PTSD

ABSTRACT

Objective: Perception of need is a key factor that influences decisions to seek help and complete treatment for substance use and mental health problems. In the current study, we examine patterns of perceived treatment needs among women with co-occurring substance use disorders and posttraumatic stress disorder (PTSD) and explore how these patterns are associated with demographics, psychosocial variables, and treatment-related factors. Methods: Secondary data analysis of the Women and Trauma Study from the National Institute on Drug Abuse's Clinical Trial Network was conducted. The sample included 353 women with co-occurring substance use disorders and PTSD (full or subthreshold) receiving outpatient substance abuse treatment. Latent class analysis was used to examine patterns of perceived treatment need and multinomial logistic regression was used to identify characteristics associated with these patterns. Results: The sample included women between the ages of 18 and 65 (mean = 39.2, SD = 9.3) and was 46% White, 34% African American, and 21% other races/ethnicities. A three-class model representing unique perceptions of treatment needs demonstrated the best fit (Bayesian information criterion = 2101.43; entropy = 0.76; average posterior probabilities ≤ 0.82). Class one reported elevated needs in multiple areas (38%), class two reported low needs (23%), and class three reported substance use and psychological needs (40%). Living with a substance abuser, depression symptoms, recent substance use, and treatment coercion were significantly associated with membership in class 2 (OR = .28, .84, .22, and 2.32, respectively). Other race, being married, depression symptoms, recent substance use, and criminal justice involvement were associated with membership in class 3 (OR = 2.32, 2.32, .94, .42, and 1.69, respectively). Number of treatment sessions attended was not significantly associated with class membership. Conclusions: Results provide insight into how women with co-occurring PTSD and substance use disorders view their treatment needs. While some women reported high levels of self-identified need in other areas (e.g., physical health, employment/financial support, and family or social relationships), others did not identify as having any problems (including substance use or psychological problems). Level of severity and temporal aspects of problems may be significant factors that influence women's perceived need for treatment. This clinical trial is registered at www.clinicaltrials.gov as trial #NCT00078156.

KEYWORDS:

• Women and trauma
• co-occurring substance use and PTSD
• treatment needs

Acknowledgments

An earlier version of this paper was presented at the 2015 annual meeting of the Society for Social Work and Research: Resko, S. M., Brown, S., Mendoza, N. S., Crosby, S. D., & González-Prendes, A. A. (2015, January 14–18). Perceived treatment needs of women with co-occurring substance use disorders and PTSD. Oral presentation at the annual meeting of the Society for Social Work and Research. New Orleans, LA. The information reported here results from secondary analyses of data from clinical trials conducted as part of the National Drug Abuse Treatment Clinical Trials Network sponsored by National Institute on Drug Abuse. Specifically, data from Protocol 15: Women's Treatment for Trauma and Substance Use Disorders were included. Clinical trial network databases and information are available at www.ctndatashare.org.

Disclosures

The authors acknowledge they have received financial support for research and/or training during the past 3 years: NORC at the University of Chicago (Resko), the Michigan Department of Community Health (Resko), the National Institute of Justice (Resko), the Substance Abuse and Mental Health Services Administration (Brown and González-Prendes), the City of Pheonix Prosecutor's Office (Mendoza), the National Institute of Health and National Institute on Drug Abuse Loan Repayment Program (Mendoza), the Council on Social Work Education (Crosby), and the Flinn Foundation (González-Prendes). All authors report no relationships with commercial financial interests.

Funding

The Wayne State University School of Social Work provided financial support for this work through the School's Substance Use, Violence, and Mental Health Research Collaborative.

Notes

¹ The separate alcohol and drug questions from the Addiction Severity Index were combined into one substance use variable (scored with the higher of the two individual ratings).

² Full information maximum likelihood estimation (FIML; also known as maximum likelihood estimation or direct maximum likelihood estimation) is an implicit imputation approach for handling missing data that has several advantages over traditional approaches for addressing missing data (e.g., listwise deletion, mean imputation). It uses maximum likelihood estimation and allows a researcher to analyze all available data (i.e., participants with full data as well as those with incomplete data). FIML has a strong theoretical foundation and assumptions that are less restrictive than traditional missing data approaches (Enders, 2010). FIML is also appealing because it has the potential to reduce statistical bias and yield greater statistical power. For an introduction to modern approaches to missing data, see Enders (2013) and Baraldi and Enders (2010); for a more advanced discussion of FIML and other modern approaches to handling missing data, see Enders (2010).