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Individuals with substance use disorders are often plagued by psychiatric comorbidities and histories of physical and/or sexual trauma. Males and females, although different in their rates of expressed trauma and psychiatric symptomatology, experience comparable adverse consequences, including poorer substance abuse treatment outcomes, diminished psychosocial functioning, and severe employment problems. This study’s goal was to examine the relationships between trauma history, lifetime endorsement of psychiatric symptoms, and gender in a sample of individuals participating in outpatient substance abuse treatment.
Study participants (N=625) from six psychosocial counseling and five methadone maintenance programs were recruited as part of a larger study of an employment intervention conducted through the National Drug Abuse Treatment Clinical Trials Network (CTN-0020, “Job Seekers Training for Patients with Drug Dependence”). Measures included lifetime trauma experience (yes/no), type of trauma experienced (sexual, physical, both), lifetime depression/anxiety, and lifetime suicidal thoughts/attempts (as measured by the Addiction Severity Index-Lite (ASI-Lite)). Lifetime endorsement of psychiatric symptoms was compared between individuals with and without trauma history. The role of gender was also examined. Results indicated that the experience of trauma was associated with an increase in lifetime report of psychiatric symptoms. Experience of physical and combined physical and sexual trauma consistently predicted positive report of psychiatric symptoms in both males and females, even when controlling for demographic and treatment-related variables. Employment outcomes, however, were not predicted by self-reported history of lifetime trauma.
Conclusions: Consistent with previous research, a substantial proportion of the study sample — nearly 50% — reported a lifetime history of physical and/or sexual victimization. Also not surprisingly, the hypothesis regarding gender differences in rates of abuse was also confirmed in this study, a finding consistent with prior research demonstrating that women with SUDs typically experience dramatically higher rates (2 times or greater) of lifetime physical and sexual trauma than men. That said, although rates of trauma in the current sample were higher for women, the severity of mental health symptoms was comparable in males and females, suggesting that the aftermath of trauma equally affects both sexes. These findings highlight the need for improved gender-specific trauma screening and intervention strategies, as well as future research on techniques to better identify and treat the overlooked population of men with trauma histories.
Related protocols: CTN-0020
This is the primary outcomes paper for CTN-0020.
Unemployment is associated with negative outcomes both during and after drug abuse treatment. Interventions designed to increase rates of employment may also improve drug abuse treatment outcomes. The purpose of this multi-site clinical trial, protocol CTN-0020, was to evaluate the Job Seekers’ Workshop (JSW), a three-session, manualized program designed to train patients in the skills needed to find and secure a job. Study participants were recruited through the National Drug Abuse Treatment Clinical Trials Network (CTN) from six psychosocial counseling (n=327) and five methadone maintenance (n=301) drug treatment programs. Participants were randomly assigned to either standard care (program-specific services plus brochure with local employment resources) (SC) or standard care plus JSW. Three 4-h small group JSW sessions were offered weekly by trained JSW facilitators with ongoing fidelity monitoring. JSW and SC participants had similar 12- and 24-week results for the primary outcome measure (i.e., obtaining a new taxed job or enrollment in a training program). Specifically, one-fifth of participants at 12 weeks (20.1-24.3%) and nearly one-third at 24 weeks (31.4-31.9%) had positive outcomes, with “obtaining a new taxed job” accounting for the majority of cases.
Conclusions: JSW group participants did not have higher rates of employment/training than SC controls. Rates of job acquisition were modest for both groups, suggesting more intensive interventions may be needed. Alternate targets (e.g., enhancing patient motivation, training in job-specific skills) warrant further study as well. Secondary analyses of present study findings will examine potential mediators and moderators of study outcomes, with a focus on barriers to employment and other variables.
Related protocols: CTN-0020
The National Drug Abuse Treatment Clinical Trials Network (CTN) has faced many challenges over its first eleven years. This review explores some of these challenges and the paths the CTN took to meet these challenges, including: designing clinical trials that reflect the CTN’s mission and changing public health needs, finding the synergies in the varied expertise of clinical treatment providers and academic researchers, promoting evidence-based practices, and expanding the Network into mainstream medical practices to reach a broader patient population. Included in this exploration are specific examples from CTN clinical trials.
CTN studies have shown that quality clinical trials can be successfully implemented into practice settings unfamiliar with research logistics by taking clinicians’ practical needs and research knowledge level into account. The challenges yet to be faced in the CTN’s efforts to expand opportunities to offer existing treatments to the segment of the drug-abusing population that utilizes mainstream health care seem large, but not as large as the potential for improvements in public health.
Related protocols: CTN-0001, CTN-0002, CTN-0003, CTN-0004, CTN-0005, CTN-0006, CTN-0007, CTN-0009, CTN-0010, CTN-0011, CTN-0013, CTN-0014, CTN-0015, CTN-0017, CTN-0018, CTN-0019, CTN-0020, CTN-0021, CTN-0027, CTN-0028, CTN-0029, CTN-0030, CTN-0031, CTN-0032, CTN-0037, CTCN-0044, CTN-0047, CTN-0048, CTN-0049
This article describes a CTN platform study that evaluated the feasibility and effectiveness of adapting the Job Seeker’s Workshop (JSW), developed as part of CTN-0020, to a residential setting within a Massachusetts-based substance use disorder treatment agency. Implementation of the adapted JSW consisted of a continual sequence of three weekly sessions that focused on job interview rehearsals, practice completing job applications, and identification of job leads. Data were compiled on the employment rates of the 188 patients discharged from the residential treatment program during July to December 2006 (baseline participants, n=95) and January to June 2007 (JSW intervention participants, n=93). The effectiveness of the adapted JSW was evaluated through a comparison of baseline and intervention participants’ employment rates at discharge from residential treatment.
Analyses indicated a trend toward a significant increase in employment at discharge for the intervention period (40.9%) compared with baseline (29.5%). Further evaluation of the JSW in residential settings is necessary, but this preliminary research suggests that the intervention could begin to address the need for vocational services in residential treatment for substance use disorders.
Related protocols: CTN-0020
Employment is a potent predictor of positive treatment outcome. Efforts to improve rates of employment in persons with substance use disorders (SUDs) have generally been disappointing. This study examined psychosocial and medical co-morbidities in unemployed patients, separately in methadone maintenance and psychosocial abstinence-focused programs participating in protocol CTN-0020, “Job Seekers Training for Patients with Drug Dependence.” Results found that methadone maintenance patients (MM) were more likely to be older, female, unemployed, or disabled, and less likely to be Caucasian, than drug-free patients (DF). MM patients also spent significantly less time enrolled in psychiatric treatment than DF participants, but were more likely to experience chronic medical problems. Future research will examine how psychosocial characteristics related to employment outcomes with Job Seekers Workshop intervention and control group conditions.
Study findings have implications for future drug abuse treatment programming and linkages with programs that provide job training and employment support.
Related protocols: CTN-0020
The Southwest Node of the National Drug Abuse Treatment Clinical Trials Network conducted a single-site adaptation of protocol CTN-0020 (“Job Seekers Training for Patients with Drug Dependence”) in a Native American treatment program in the American Southwest. Native American participants (N=102) were randomized to either (1) a three-session, manualized program (JSW) or (2) a 40-minute Job Interviewing Video (JIV). No main effect of was no main effect of treatment. This secondary analysis tested for potential moderating effects at both the three-month and six-month follow-up points. Intake data were assembled from the ASI-Lite, Wide Range Achievement Test, pre-treatment Vocational Survey, and demographics form for study participants. Analyses were then conducted to determine whether these variables were predictive of employment status.
The researchers found that some variables that predict future employment, such as local unemployment, age, and work history, were not amenable to employment interventions. Gender and tribal affiliation were not significant predictors of employment at any follow-up. However, it appears that it may be possible to improve employment outcomes by designing interventions to improve reading skill or other job-related skills.
Related protocols: CTN-0020
Rates of physical and sexual abuse in substance use disorder (SUD) patients vary greatly across studies. In this ancillary investigation, the researchers examined prevalence rates in a diverse SUD sample and their medical/psychiatric correlates with the goal of informing future practice. Recruitment sites were six psychosocial and five methadone maintenance programs enrolled in the National Drug Abuse Treatment Clinical Trials Network protocol about the Job Seekers’ Workshop (protocol CTN-0020).
Participants (N=628) met DSM-IV criteria for drug abuse/dependence, reported recent unemployment/underemployment and completed at least 30 days in treatment at baseline assessment. Women with SUDs reported physical and sexual abuse at rates twice those of men. History of physical or sexual abuse was associated with increased rates of depression and trouble controlling violence in both genders. Men with physical abuse were more likely to present for treatment with a chronic medical problem. This constellation of problems suggests both men and women with histories of abuse would benefit from psychiatric evaluation and ancillary intervention services.
Related protocols: CTN-0020
Effectiveness trials are an important step in the scientific process of developing and evaluating behavioral treatments. The focus on effectiveness research presents a different set of requirements on the research design when compared with efficacy studies. The choice of a control condition has many implications for a clinical trial’s internal and external validity. The purpose of this article was to provide a discussion of the issues involved in choosing a control group for effectiveness trials of behavioral interventions in substance abuse treatment. It uses examples from the CTN to present four possible design options for randomized clinical trials conducted in community treatment programs involving treatment-seeking individuals.
Protocols cited include CTN-0014 (Brief Strategic Family Therapy), CTN-0020 (Job Seekers), CTN-0015 (Women and Trauma), and the unpublished protocol CTN-0025, which would have investigated the use of Community Reinforcement and Family Training (CRAFT) and Al-Anon Nar-Anon Facilitation Therapy (ANFT) for partners of substance abusers.
Related protocols: CTN-0014, CTN-0015, CTN-0020
Social support for abstinence and employment are predictors of successful functioning after substance abuse treatment. Unemployment problems are often significant in Native American communities. To address this problem, the Southwest Node of the National Drug Abuse Treatment Clinical Trials Network (CTN) conducted a single-site adaption of its national Job Seekers Workshop study (protocol CTN-0020) in a Native American treatment program.
Participants were randomized to (1) a three-session, manualized program or (2) a 40-minute Job Interviewing Video. Main effects for treatment on job-seeking behavior or employment rates were not found at 3-month follow-up. One explanation for these null findings is that participant characteristics, i.e., treatment history, may have moderated treatment effects. This study tested for potential moderating effects of treatment history on job seeking behaviors at 3-month follow-up among Native Americans enrolled in a larger study.
Related protocols: CTN-0020
Employment difficulties are common among individuals receiving substance abuse treatment, and employment is an important treatment outcome as well as a predictor of success in other areas such as decreasing problematic substance use. Unemployment problems are often particularly significant in Native American communities. To address this problem, the Southwest Node of the National Drug Abuse Treatment Clinical Trials Network (CTN) conducted a single-site adaptation of its national Job Seekers Workshop study (protocol CTN-0020) in a Native American treatment program, the Na’Nizhoozhi Center. The program targets skills needed to find and secure a job, as well as vocational goal setting and methods for locating available employment.
This poster reports on the primary results for employment outcomes and finds that the interventions, while well received by all participants, did not produce significant changes in rates of employment, total work and training hours, or time to employment.
Related protocols: CTN-0020
Ethnic minorities have significantly higher rates of unmet needs for treatment of substance use disorders and are often underrepresented in clinical trials and treatment research. The National Drug Abuse Treatment Clinical Trials Network (CTN) was established in 1999 to conduct research in a wide variety of community based treatment programs across the United States. Through its size and scope, the CTN provides a unique opportunity to address a variety of underserved populations, and in particular to evaluate access to and effectiveness of treatments for ethnic minorities. The CTN has continually sought to reduce barriers to all its studies and has attended carefully to recruitment and retention of women and ethnic minority groups.
This article describes a symposium from the June 2006 CPDD annual meeting that included four presentations on ongoing CTN activities and strategies used to address the issues of ethnic disparities. Kathleen Carroll described a protocol developed specifically to address retention in treatment among Spanish-speaking substance users. Ray Daw described the special issues raised in clinical research among American Indian communities, including those encountered by a CTN protocol that was adapted on site so it could be implemented among American Indian communities. Kathryn Magruder summarized results of a secondary analysis of CTN data, evaluating rates of retention among ethnical minorities. And Lawrence Brown described a secondary analysis of a CTN survey study on national practices regarding the availability of specialized treatment for sexually transmitted diseases in drug abuse treatment, focusing specifically on services for ethnic minorities.
Related protocols: CTN-0012, CTN-0017, CTN-0020, CTN-0021
This brochure, intended for clinicians thinking about participating in the CTN-0020 clinical trial (Job Seekers Training for Patients with Drug Dependence), describes the interventions the study will be investigating, how study therapists will be chosen, and what participants can expect if they become study therapists themselves.
Related protocols: CTN-0020