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Abstract: The aim of this research was to explore the association of abuse experiences (child sexual abuse and adult physical/sexual violence) to sexual relationship power among Black substance-abusing women. The study was a secondary analysis of baseline data collected from 124 Black women in 12 drug treatment programs across the United States who initially participated in an HIV risk reduction trial conducted within the NIDA Clinical Trials Network. The findings revealed that adult sexual abuse, but not childhood sexual or adult physical abuse, was associated with lower relationship control and decision-making dominance as measured by the Sexual Relationship Power Scale. Conclusions: These findings suggest that a history of adult sexual abuse may disempower Black substance-abusing women from negotiating for safer sex. That argues for addressing a history of adult sexual abuse as a strategy for empowering women to advocate for their sexual health. Designing and implementing sexual risk reduction interventions that address adult sexual violence may enhance the relationship power of Black substance-abusing women and in turn may promote safer sex practices. Related protocols: CTN-0019

Abstract:

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

Abstract:

The National Institute of Drug Abuse’s National Drug Abuse Treatment Clinical Trials Network (CTN) was established to foster translation of research into practice in substance abuse treatment settings. The multi-site, translational clinical trials of the CTN provide a unique opportunity to examine the outcomes of treatment interventions targeting vulnerable subgroups of women, the comparative effectiveness of gender-specific protocols to reduce risk behaviors, and gender differences in clinical outcomes. This review examined gender-related findings from published CTN clinical trials and related studies from January 2000 to March 2010. CTN studies were selected for inclusion if they focused on treatment outcomes or services for special populations of women with substance use disorders (SUDs) including those with trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors; or implemented gender-specific protocols. Overall, the CTN has randomized 11,500 participants (41% women) across 200 clinics in 24 randomized controlled trials in community settings, of which 4 have been gender-specific.

Conclusions: These published studies have expanded the evidence base regarding interventions for vulnerable groups of women with SUDs as well as gender-specific interventions to reduce HIV risk behaviors in substance-using men and women. The results also underscore the complexity of accounting for gender in the design of clinical trials and analysis of results. To fully understand the relevance of gender-specific moderators and mediators of outcome, it is essential that future translational studies adopt more sophisticated approaches to understanding and measuring gender-relevant factors and plan sample sizes that are adequate to support more nuanced analytic methods.

Abstract:

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