Attendance and substance use outcomes for the Seeking Safety program: Sometimes less is more.

This study uses data from the largest effectiveness trial to date on treatment of co-occurring posttraumatic stress and substance use disorders (National Drug Abuse Treatment Clinical Trials Network protocol CTN-0015), applying advances in statistical methodology to model treatment attendance and membership turnover in rolling groups. Women receiving outpatient substance abuse treatment (N=353) were randomized to 12 sessions of Seeking Safety of a health education control condition (Women’s Health Education). Assessments were completed at baseline and at 1 week, 3, 6, and 12 months post-treatment. Outcome measures were alcohol and cocaine use in the prior 30 days captured using the Addiction Severity Index. Latent class pattern mixture modeling (LCPMM) was used to estimate attendance patterns and to test for treatment effects within and across latent attendance patterns and group membership turnover. Across LCPMM analyses for alcohol and cocaine use, similar treatment attendance patterns emerged: Completers never decreased below an 80% probability of attendance, droppers never exceeded a 41% probability of attendance, and titrators demonstrated a 50% to 80% probability of attendance. Among completers, there were significant decreases in alcohol use from baseline to 1-week post-treatment, followed by nonsignificant increases in alcohol during follow-up. No differences between treatment conditions were detected. Titrators in Seeking Safety had lower rates of alcohol use from 1-week through 12-month follow-up compared with control participants. Droppers had nonsignificant increases in alcohol during both study phases. Cocaine use findings were similar but did not reach significant levels.

Conclusions: The impact of client self-modulation of treatment dosage and group membership composition may influence behavioral treatment outcomes among this population. Providers should consider that female patients with comorbid PTSD and SUD may be in the best position to determine when, how often, or which sessions to attend; such perspectives might not only be empowering to patients but more efficacious as well.

Related protocols: CTN-0015