Development and feasibility Integrated trauma-focused psychotherapy for substance use disorders- role of identity and meaning making.

The present study aims to develop and test the feasibility of integrated trauma focussed psychotherapy for individuals with Substance Use Disorders. It further attempts to explore the role of identity and meaning making processes within this intervention. The objectives of the study include developing the therapy module, testing the effectiveness of the module in 20 participants in terms of substance use outcomes, trauma related outcomes (trauma perception, meaning making and Post Traumatic Growth), Identity processes, change mechanisms (Therapeutic Alliance) and overall functioning. A single group pre-post-follow-up mixed methods design is followed. Purposive sampling will be used to recruit clients from the Centre for Addiction Medicine and Adult Psychiatry Units, NIMHANS who meet the inclusion and exclusion criteria and give consent. The study will be conducted in two phases. The therapy module has been developed in the pilot phase based on a detailed needs assessment (interviews, focus-group discussions and review of literature) regarding what components are relevant for trauma focussed psychotherapy in SUD treatment. Based on the pilot data, a total of 15-20 sessions over 2-3 months have been finalized. Expert validation for the intervention modules has been done and the intervention outline has been provided below. The sample size (20 subjects) has been estimated using a combination of pragmatic factors such as how many patients are referred for Substance Use Disorders treatment, drop-out rates estimated based on previous studies conducted in the field of interventions for SUDs, and minimal sample needed to detect a positive change. Analysis will be planned using descriptive measures, repeated measures ANOVA and qualitative analysis. The ethical considerations have been done keeping in mind the guidelines for conducting research in the field of trauma. Psychotherapy intervention outline: 

Sr.No

Name of the phase/module

Targets

Number of sessions

|1

Recruitment and assessment

Informed consent and administering assessments

3

|2

PHASE I- Safety and Stabilization

Ensuring safety, psychoeducation and socializing the patient into treatment

2-4

|3.

Phase II- Resource building

|A. Regulating Substance use

Reduction/ abstinence from substance use

2-3

|B. Optimizing emotional and interpersonal resources

Regulating emotions

Interpersonal skills

3-5

|4

Phase III- Trauma and abuse

5-6

|Exploring trauma narratives- processing and integration

Exposure for traumatic memories

|Making meaning and looking ahead

Meaning making, positive psychological growth post trauma

|5

Termination

Terminating therapy and assessments

2

|ELECTIVES

|1

Managing suicidal thoughts and behaviors

Suicidal ideation, suicide attempts

2-3

|2

Self-care

Sleep hygiene, regular meal times, structure in daily routine

1

|3

Building a network of support- Family and Significant others

Psychoeducation for family members/ significant others; eliciting support from family members/ significant others

2

|4

Enhancing motivation.

Motivation enhancement for substance use

2