Perceived Treatment Needs Among Women with Co-Occurring Substance Use Disorders and PTSD

Background & Purpose: Perception of need is a key factor that influences decisions to seek help and complete treatment for substance use and mental health problems (Mojtabai, Olfson & Mechanic, 2002; Resko & Mendoza, 2013). Although researchers have suggested there is considerable variation in how women with co-occurring PTSD and substance use problems view their treatment needs, few empirical studies have been conducted in this area. The purpose of the current study is to 1) examine patterns of perceived treatment needs among women with co-occurring substance use disorders and PTSD (latent class analysis) and 2) explore how these patterns were associated with demographic characteristics (e.g. age, race, education), psychosocial variables (e.g. PTSD severity), and treatment-related factors (e.g. legal coercion) (multinomial logistic regression).

Methods: Data were drawn from the NIDA Clinical Trial Network’s Women and Trauma Study (Hien et al., 2009). Participants (n=348) were women receiving treatment at seven outpatient substance abuse programs located throughout the U.S. All participants met DSM-IV criteria for PTSD, reported substance use within the past 6 months, and had a current substance use disorder diagnosis. The sample included women between the ages of 18-65 (mean=39.2 sd=9.3) and was 46% White; 34% African American; 21% other races/ethnicities. Perceptions of treatment needs were assessed before starting treatment and were focused on treatment needs related to substance use, psychological/emotional, medical, family and social problems.

Results: A three group model representing unique perceptions of treatment needs demonstrated the best fit (BIC = 2101.43; entropy = 0.86, average posterior probabilities = 0.82, 0.96, and 0.91). In class 1 (“Multiple Needs” 37.5%), participants reported high levels of need in all areas (substance use, psychological problems and medical, family/social problems). Class 2 (“High Psychological Needs” 22.7%) reported high levels of needs for psychological problems. Class 3 (“High Substance Use Needs” 39.9%) reported high levels of needs for substance use problems, moderate levels of need for psychological problems and low needs in other areas. Legal coercion, PTSD severity and depression were significantly associated with membership in class 2 (OR = 3.46, 1.7, and 0.43 respectively). CPS coercion, PTSD severity, and a history of a suicide attempt were associated with membership in class 3 (OR=0.32, 0.95, and 1.42. Demographic factors (e.g. age, race, education) and number of treatment sessions attended were not significantly associated with class membership.

Conclusions & Implications:  These results provide insight into the heterogeneity of how women with co-occurring PTSD and SUD view their treatment needs.   Findings highlight how many women who are diagnosed with a current substance use disorder and have a trauma history may not identify as having a drug or alcohol problem. Approximately 60% of participants (class 1 and 2) rated their psychological/emotional treatment needs to be greater than their substance use treatment needs. Participants who reported coercion for treatment (legal or CPS) were significantly less likely to identify as having a substance use problem. Additional research is needed to consider factors not assessed by this study (e.g. social support) that may also be related to perception of treatment needs.