Women Veterans' Substance Abuse Treatment

Not Applicable

Completed

Conditions: Substance Use Disorders

Interventions: Behavioral: A Woman's Path to Recovery
Behavioral: 12-Step Facilitation

Registration Number: NCT00734903

Lead Sponsor: VA Office of Research and Development

Brief Summary: The purpose of this study is to examine the efficacy of a gender-focused addiction treatment model (A Woman's Path to Recovery) versus a non-gender focused addiction treatment model (12-Step Facilitation) in a sample of women Veterans with substance use disorder.

Detailed Description: Substance use disorder (SUD) is problem among women military Veterans, especially younger ones. The goal of this study was to examine the efficacy a gender-focused model of SUD treatment (A Woman's Path to Recovery, WPR) compared to an evidence-based active comparator that is not gender-specific (12-Step Facilitation, 12SF), in a sample of for women Veterans. The investigators randomized 66 women Veterans, ages 18-65, who were diagnosed with current SUD and used substances in the last 90 days. The treatment phase was 12 weekly individual therapy sessions and all participants could also obtain treatment-as-usual (any other treatments they chose to attend). Assessments were conducted at baseline, end of treatment and 3-month follow up. Sample size was based on power analysis (an effect of .80 at a .05 level of significance). The primary outcome variable was substance use, with various secondary outcomes also studied (e.g., psychosocial functioning, psychiatric symptoms, coping skills, 12-step attendance). Urinalysis / breathalyzer (biological measures) were also included to validate substance use self-report. The investigators hypothesized that participants in the experimental condition (WPR) would have more positive outcomes on both primary and secondary variables compared to those in the comparison condition (12SF). The investigators also hypothesized that WPR patients would increase coping skills more and 12SF would increase 12-step attendance more, relative to the other condition.

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 66

Inclusion Criteria

Female Veteran
18-65 years of age
Meet DSM-IV criteria for current SUD with "current" defined as meeting SUD criteria per the DSM-IV and having used a substance within the 90 days prior to intake (to be able to accurately evaluate changes in their substance use from baseline)
Plan to stay in the Boston area for the next 6 months
Have a mailing address and live close enough to come to the hospital once weekly for treatment and/or assessment
Able to complete the Statement of Informed Consent
Willing to participate in all assessments and breathalyzer/urine testing
Willing to provide a release of information such that study staff can contact her other providers as needed regarding any concerns during her participation
Able to obtain medical clearance
Willing to allow us to contact family and/or friends if participant loses contact with us
Literate
Not pregnant or planning to become pregnant

Exclusion Criteria

Any acute medical condition that would interfere with the participant's ability to participate in treatment, or would be of such severity as to affect the individual's psychological functioning (e.g., cancer)
Current bipolar I disorder, schizophrenia or other psychotic disorders or mental retardation or organic mental disorder (determined by screening interview)
Any clinical sign that the client is not sufficiently stable to participate in the treatment, such as client's treatment provider indicating that participation in the treatment would be contraindicated
Dangerousness that would present a threat to other staff or other clients (e.g., history of recent assault)
Client is mandated to treatment
Psychopharmacologic treatment that is planned to change or likely to change substantively over the 3-month active treatment phase (with "substantive" defined as any addition of a new medication or major shift in dosage)

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
A Woman's Path to Recovery (WPR)	A Woman's Path to Recovery	A gender-focused approach to addiction recovery
12-Step Facilitation (TSF)	12-Step Facilitation	An evidence-based, non-gender-focused approach to addiction recovery

Primary Outcome Measures

Name	Time	Method
Addiction Severity Index Alcohol Composite	Baseline, end of treatment (month 3), 3-month post-treatment follow-up	Alcohol use and associated problems as measured by blinded-interviewer rated composite score. Six questions comprise the alcohol composite, of which 4 are answered from 0-30 (number of days in past month) and 2 are subjective Likert ratings 0 (not at all) to 4 (extremely), with higher scores on all items indicating worse pathology. Composite scores are computed and range from 0 (worst outcome) to 1 (best outcome). Breathalyzer was also obtained to verify self-report and was coded as positive (worst pathology, means patient was intoxicated) or negative (not pathological; patient was not intoxicated).
Addiction Severity Index Drug Composite	Baseline, end of treatment (3 months), and 3-month post-treatment followup	Drug use and associated problems as measured by blinded-interviewer rated composite score. Urinalysis/breathalyzer is also obtained to verify self-report.Drug use and associated problems as measured by blinded-interviewer rated composite score. Eleven questions comprise the drug composite, of which 9 are answered from 0-30 (number of days in past month) and 2 are subjective Likert ratings 0 (not at all) to 4 (extremely), with higher scores on all items indicating worse pathology. Composite scores are computed and range from 0 (worst outcome) to 1 (best outcome). Urinanalysis was also obtained to verify self-report and was coded as positive (worst pathology, means patient was intoxicated) or negative (not pathological; patient was not intoxicated).
Brief Addiction Monitor	Baseline, end of treatment (month 3), 3-month post-treatment follow-up	Assesses number of days in the past 30 days that person used substances including alcohol and drugs

Secondary Outcome Measures

Name	Time	Method
Addiction Severity Index Medical Composite Score	Baseline, end of treatment (month 3), 3-month post-treatment follow-up	Medical problems associated with substance use as measured by blinded-interviewer rated composite score. Several questions are answered from 0-30 (number of days in past month) and the remaining 2 are subjective Likert ratings 0 (not at all) to 4 (extremely), with higher scores on all items indicating worse pathology. Composite scores are computed and range from 0 (worst outcome) to 1 (best outcome).
Addiction Severity Index Employment Composite	Baseline, end of treatment (month 3), 3-month post-treatment follow-up	Employment problems associated with substance use as measured by blinded-interviewer rated composite score. Several questions are answered from 0-30 (number of days in past month) and the remaining 2 are subjective Likert ratings 0 (not at all) to 4 (extremely), with higher scores on all items indicating worse pathology. Composite scores are computed and range from 0 (worst outcome) to 1 (best outcome).
Addiction Severity Index Family/Social Composite	Baseline, end of treatment (month 3), 3-month post-treatment follow-up	Family/social problems associated with substance use as measured by blinded-interviewer rated composite score. Several questions are answered from 0-30 (number of days in past month) and the remaining 2 are subjective Likert ratings 0 (not at all) to 4 (extremely), with higher scores on all items indicating worse pathology. Composite scores are computed and range from 0 (worst outcome) to 1 (best outcome).
BASIS-24 Psychosocial Functioning	Baseline, end of treatment (month 3), 3-month post-treatment follow-up	24 items that address how patients feel before and after receiving care. The survey measures the degree of difficulty experienced by the patient during a one-week period on a five-point scale ranging from 0 (no difficulty) to extreme difficulty (4) with the overall score ranging from 0-96.
Coping Skills Measure	Baseline, end of treatment, 3-month post-treatment follow-up	Self-report measure of confidence in ability to cope comprising 18 items, each scaled from 0 (not at all) to 5 (extremely). The mean across all 18 items ranges from 0 to 5 with higher scores indicating less pathology (i.e., stronger ability to cope).
Addiction Severity Index Psychiatric Composite	Baseline, end of treatment (month 3), 3-month post-treatment follow-up	Psychiatric problems associated with substance use as measured by blinded-interviewer rated composite score. Several questions are answered from 0-30 (number of days in past month) and the remaining 2 are subjective Likert ratings 0 (not at all) to 4 (extremely), with higher scores on all items indicating worse pathology. Composite scores are computed and range from 0 (worst outcome) to 1 (best outcome).
Global Severity Index of the Brief Symptom Inventory	Baseline, end of treatment (month 3), 3-month post-treatment follow-up	Self-report measure of severity of general psychiatric symptoms ranging from 0 (not at all) to 4 (extremely). The total scale score Global severity index (GSI) is the mean of all 53 items on the measures. The mean ranges from 0 to 4, with higher indicating worse pathology.
Alcoholics Anonymous (AA) Intention Measure	Baseline, end of treatment (month 3), 3-month post-treatment follow-up	Self-reported attitudes toward attending 12-step meetings; a scale of 17 items, each rated 1 (extremely unlikely) to 7 (extremely likely). The mean across all items thus ranges from 1 to 7 with with more positive scores indicating a more positive attitude toward 12-step meetings.

Trial Locations

Locations (2): Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
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Bedford, Massachusetts, United States
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
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Boston, Massachusetts, United States