Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, United States of America.
Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, United States of America; Department of Psychology, The City College of New York, United States of America.
J Subst Abuse Treat. 2022 Aug;139:108766. doi: 10.1016/j.jsat.2022.108766. Epub 2022 Mar 22.
Black women are at heightened risk for trauma exposure, post-traumatic stress disorder (PTSD), and substance use disorders (SUDs), compared to White women and the general population. However, disparities in treatment engagement and retention persist, particularly for Black women with co-occurring PTSD+SUD. Although therapeutic alliance is an important predictor and mediator of treatment retention and outcomes, we know little about predictors of alliance and the mediating role of alliance for PTSD+SUD outcomes among Black women.
This study utilized data previously collected for the National Drug Abuse Treatment Clinical Trials Network (CTN) Women and Trauma Study. Participants were 88 Black/African American women (M = 41.90, SD = 7.72) participating in a clinical trial comparing Seeking Safety (a cognitive-behavioral intervention for PTSD+SUD) to Women's Health Education (control). This study includes participants from both arms. Measures included the Helping Alliance Questionnaire, Addiction Severity Index-Lite, and Clinician Administered PTSD Scale. Women in the intervention arm also completed the Seeking Safety Feedback Questionnaire.
Stepwise, hierarchical linear regressions indicated that years of education and previous alcohol/drug treatment attempts significantly predicted early alliance in the second week of therapy (β = 0.411, p = .021 and β = 0.383, p = .011, respectively), but not late alliance in the last week of therapy (ps > .794). Greater education and more treatment attempts were associated with higher early alliance. Alliance did not mediate relationships between these significant predictors and treatment outcomes (e.g., attendance, post-treatment PTSD and SUD symptoms) or treatment feedback in the Seeking Safety group.
Education and prior treatment attempts predicted early alliance among Black/African American women in PTSD+SUD group treatment, and higher education level was associated with poorer Seeking Safety feedback topic ratings. Educational level and treatment history should be considered during alliance building in therapeutic interventions with Black women. Clinicians may consider the integration of pre-treatment alliance-building strategies with Black female patients who have lower levels of education. This study provides insight into the relative impact of several important factors that influence early alliance among Black women with co-occurring PTSD+SUD.
与白人女性和普通人群相比，黑人女性遭受创伤、创伤后应激障碍（PTSD）和物质使用障碍（SUD）的风险更高。然而，治疗参与和保留方面的差异仍然存在，特别是对于同时患有 PTSD+SUD 的黑人女性。尽管治疗联盟是治疗保留和结果的重要预测因素和中介因素，但我们对联盟的预测因素以及联盟对 PTSD+SUD 结果的中介作用知之甚少。
本研究利用了先前为国家药物滥用治疗临床试验网络（CTN）妇女与创伤研究收集的数据。参与者是 88 名黑人/非裔美国女性（M=41.90，SD=7.72），她们参加了一项比较寻求安全（一种治疗 PTSD+SUD 的认知行为干预）和妇女健康教育（对照组）的临床试验。本研究包括来自两个臂的参与者。测量包括帮助联盟问卷、成瘾严重程度指数-精简版和临床医生管理的创伤后应激障碍量表。干预组的女性还完成了寻求安全反馈问卷。
逐步的，分层线性回归表明，教育年限和以前的酒精/药物治疗尝试显著预测了治疗的第二周的早期联盟（β=0.411，p=0.021 和β=0.383，p=0.011），但不预测治疗的最后一周的晚期联盟（ps>.794）。更多的教育和更多的治疗尝试与更高的早期联盟相关。联盟并没有调解这些显著预测因素与治疗结果（例如，出勤率、治疗后 PTSD 和 SUD 症状）或寻求安全组中的治疗反馈之间的关系。
教育和以前的治疗尝试预测了 PTSD+SUD 组治疗中黑人/非裔美国女性的早期联盟，较高的教育水平与较差的寻求安全反馈主题评级相关。在与黑人女性的治疗干预中建立联盟时，应考虑教育水平和治疗史。临床医生可能会考虑为教育程度较低的黑人女性患者整合治疗前的联盟建设策略。本研究提供了有关影响黑人女性同时患有 PTSD+SUD 的早期联盟的几个重要因素的相对影响的见解。
