Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men.
Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men.
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DOI：
10.1016/j.janxdis.2014.10.009
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发表时间：
2015-03
影响因子：
10.3
通讯作者：
McHugo G
中科院分区：
文献类型：
--
作者：
Wolff N;Huening J;Shi J;Frueh BC;Hoover DR;McHugo G
一项寻求安全（SS）和男性创伤恢复授权模型（M-TREM）的对照试验研究了合并创伤后应激障碍（PTSD）和物质使用障碍（SUD）的综合团体治疗在监禁男性PTSD和心理健康症状、自尊和疗效方面的实施和有效性。研究样本（n = 230）是18岁或以上的男性囚犯，主要是非白人，高中毕业生或同等学历，有童年创伤史，有暴力犯罪，有严重的精神疾病，居住在最高安全监狱。被监禁的PTSD和SUD筛查呈阳性的男性被随机分配（n = 142）或根据偏好（n = 88）接受SS或M-TREM，等待名单组（n = 93）。手动干预组给予14周。主要结果是创伤后应激障碍和其他精神健康症状。次要结果是自尊、应对和自我效能。在矫正环境中不能测量SUD的结果。实施的可行性通过招募、筛选、分配和保留参与者的能力来展示。有效性结果取决于样本、设计和分析方法。使用一个等候名单对照组，没有随访期，我们发现治疗对PTSD症状没有总体效果，尽管，当分开时，发现M-TREM改善了PTSD严重程度，SS改善了一般心理健康症状和心理功能。通过意向治疗和完整分析，SS和M-TREM在主要或次要结局上的相对表现没有显著差异。当纵向数据最大化并以反映数据层次性质的方式建模时，我们发现SS和M-TREM在PTSD严重程度和次要结局方面的表现优于未治疗，并且治疗益处持续存在。研究结果谨慎地支持实施“寻求安全”或M-TREM来治疗合并PTSD和成瘾问题的在押男性。
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.