Behavioral Health News
By Justin Mitchell, LMHC, Vice President, Adult Residential Services, and Peter Provet, PhD, President & CEO
Women who have been physically, sexually, and/or emotionally abused are at a significantly higher risk of abusing alcohol and other drugs. As many as 90 percent of women with mental health and substance abuse disorders have histories of physical, emotional, or sexual abuse. It is impossible to effectively treat women without also incorporating clinical services which target trauma and its connection to substance abuse and mental health disorders.
In the past two decades, significant progress has been made in the integration of substance use and mental health disorder treatment. This progress is the result of years of research that supports the efficacy of treating co-occurring disorders in an inclusive manner. Providers have been slower, however, to recognize and treat co-morbid traumatic stress as it relates to substance use and mental health disorders. While treatment providers have made efforts at integrating trauma-informed and trauma-specific services, more providers need to undertake the programmatic changes that are necessary to effectively treat traumatic stress in relation to substance abuse and mental health disorders.
Odyssey House has undertaken this treatment imperative, and over the last four years we have implemented organizational changes that allow us to evolve our family program into one which is both trauma-informed in its delivery and which provides access to specific clinical services that address trauma, substance abuse, and mental health disorders.
Understanding Treatment Needs Of Women And Children
Women and children have long been at an increased risk of exposure to trauma. This risk only increases when we look at women and children who are struggling with mental health and substance abuse disorders. Research has demonstrated that between 48 to 90 percent of women with mental health and substance abuse disorders also have histories of interpersonal abuse (Lipschitz et al, 1996) and, according to Jahn Moses et al (2003), “Fifty-five to 99 percent of woman substance abusers report being victimized at some point in their lives.” Women with substance use problems are also significantly more likely than men to exhibit recent physical, emotional or sexual abuse (Gentilello et al, 2000); and children of substance abusers are almost three times more likely to be physically or sexually assaulted, and more than four times as likely to be neglected than children whose parents are not substance abusers (CASA, 1999).
Traumatic events experienced by these at-risk women and children include: physical, psychological and sexual abuse; domestic violence; witnessing violence against others; and preventable accidents in the home. In “Women and addiction: A gender-responsive approach,” researcher Stephanie Covington states that “a history of being abused drastically increases the likelihood that a woman will abuse alcohol and other drugs,” and suggests that by “integrating trauma treatment with addiction treatment, we reduce the risk of trauma-based relapse.”
Choosing Best Practice Models For Holistic Family Treatment
In 2009, we began the implementation of a new holistic family treatment model. We called it Healthy Mothers Healthy Families (HMHF) because the program addresses the unique life circumstances and needs of pregnant and postpartum women and their children. Funded by a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), this intensive service combines evidence-based trauma and parenting therapies with substance use disorder treatment in a model of care that incorporates the whole family unit, not just the individual in treatment.
To address clients’ histories of trauma and prevent trauma-related relapse, we implemented four evidence-based trauma-specific services that support clients in treatment for substance abuse and mental health disorders.
The first, Seeking Safety, is a present-focused coping skills approach designed to simultaneously treat substance use disorders and disorders related to histories of trauma. This practice is based on five key concepts: safety as the treatment priority; integrated treatment; a focus on ideals; attention to clinical processes; and the inclusion of cognitive, behavioral, interpersonal, and case management content areas.
The second practice, Trauma, Recovery and Empowerment Model (TREM), is a group-based intervention designed to facilitate trauma recovery among women with histories of exposure to sexual and physical abuse. Drawing on cognitive restructuring, psycho- educational, and skills-training techniques, the genderspecific group emphasizes the development of coping skills and social support. It addresses both short-term and long-term consequences of violent victimization, including mental health symptoms, posttraumatic stress disorder (PTSD), depression, and substance abuse.
The majority of women in treatment at the Odyssey House Family Center are parents. At any one time, 60 parents and 60 children under six years of age live in our residential center in East Harlem or community residence in the Bronx. For these women, and other participants who are seeking custody of their children, we utilize an evidence based practice specifically designed for families with a history of substance abuse. Nurturing Parent Program for Families in Substance Abuse Treatment and Recovery (NPP) is built on the principles of relational development: that parents and children are highly affected by their relationships with each other; that parents and children develop a sense of self through their relationships with each other; and that the parent-child relationship requires a sense of connectedness in order to experience healthy growth and mutual satisfaction. All activities in this practice are designed to help participants learn how to nurture themselves as individuals and in turn lay the foundation for a nurturing family unit.
Approximately 15 percent of women in our family programs are pregnant when they enter treatment. For these vulnerable women, extending their treatment stay through delivery and the postpartum period is a critical goal. The fourth evidence-based practice, Motivational Enhancement Therapy (MET), is designed to improve retention of women who were pregnant entering treatment. The results of applying this practice are particularly heartening. Almost twice as many women who participated in MET remained in treatment for 30 days compared to pregnant women who enrolled in treatment in the three years prior to the implementation of this therapeutic model.
Data-Driven Results Support Efficacy Of Intensive Residential Model
Over the course of the four-year HMHF grant, we served 150 women, 61 of whom were pregnant at the time of admission. Using intake and six-month follow-up screenings the data showed significant positive rates of change in all major areas measured. The largest increases at follow-up were observed in employment/education with one in three women in school or employed compared to one in 10 at intake (177 percent increase), and a 150 percent increase in abstinence. Criminal justice involvement was reduced, with 98 percent of women reporting no involvement at follow-up compared to 88 percent at intake, and almost 100 percent of participants reported improved social connectedness and no consequences of substance use.
The HMHF model has been effective at working with women to see a psychiatrist, if indicated at screening. This resulted in an 83 percent increase in the number of women prescribed medication for psychological or emotional problems, and a significant improvement in participants’ mental health, including a 40 percent reduction in depression, 18 percent reduction in anxiety, and 32 percent reduction in trouble understanding, concentrating or remembering. In addition, 60 percent of the women reported reduced trauma symptoms at follow-up and a 27 percent reduction in difficulty controlling violent behavior.
Future Development Of Best-Practice Substance Abuse And Mental Health Treatment
Odyssey House clinical experience points to the essential benefits of trauma-informed services when treating women with substance abuse and mental health disorders. The most effective model is a comprehensive service that screens and treats trauma-related symptoms using the following criteria:
All clients, especially women, should be screened and assessed for PTSD;
Clients identified with histories of traumatic experience should receive treatment that explores the relationship between substance use/mental health disorders and the traumatic experience;
Evidence-based trauma-specific services should be incorporated into the program structure.
For further information on Odyssey House treatment services for women and children, please call: 212-987-5100, or write to: info@odysseyhousenyc.org.