Impact of Trauma On Personal Networks Among Women in Substance Abuse Treatment: Longitudinal Analyses
Methods: Women with SUD who received treatment at three county-funded, women-only intensive treatment programs (N = 375) were interviewed at intake (T1) and at follow ups 1 (T2), 6 (T3) and 12 (T4) months later (81% retention). A network software program, Ego Net, elicited 25 network members (alters), social support, and network connections at each assessment. At intake, trauma symptomatology (Trauma Symptom Checklist 40), co-occurring mental disorders (Computerized Diagnostic Interview Schedule), duration of SUD, treatment history, and Treatment Motivation were assessed. Abstinence Self Efficacy, substance use (past 30 days), and treatment status were also assessed at each assessment. Approximately 93% (n=349) of the sample completed > 2 of the 4 possible assessments for the present longitudinal analysis. A mixed model repeated measures analysis with maximum likelihood estimation and unstructured covariance matrix was used to account for correlated responses within a subject. Covariates correlated at least two time points to the outcome p<.20 were controlled in the analyses to examine the contribution of trauma on compositional and social support changes.
Results: Participants were 60% African American, with a mean age of 36.5 (SD=10.4). 41% had lower than high school education. Only 7% (n=27) of the sample were married at intake, 43% (n=162) had experienced homelessness at some time in their lives, and 45% (n=168) reported current legal involvement (being on parole, probation, or awaiting sentencing). 57% reported cocaine dependence; 47% reported alcohol dependence; and 56% were dependent on more than one drug. Mean substance use duration was 6.43 (SD=7.75) years. Most (73%) had co-occurring mental disorders. On average 34% of the network members were substance users.
After controlling for covariates, higher levels of trauma symptomatology were associated with greater numbers of treatment related alters (professionals, AA peers) (F=4.67, df=1, 378, p=.03), substance using alters (F=12.42, df=1, 371, p<.001), alters with whom alcohol and/or drugs were used (F=10.22, df=1, 361, p<.002), more negative relationships (F=6.32, df=1, 374, p=.01), and less close relationships (F=4.46, df=1, 376, p=.035) in their personal networks at all time points. Trauma symptoms were not related to the number of alters providing emotional, concrete, or sobriety support.
Conclusions & Implications: Findings highlighted the potential role of trauma in determining the composition and quality of relationships within personal networks among women with SUD. Despite no relationship between trauma and number of alters providing emotional, concrete, or sobriety support, women with greater trauma symptoms had more alters who were negative toward them and emotionally distant in their network. Also, effects of trauma on the personal network were not decreased over the follow-up period, underscoring the importance of trauma informed practice in substance abuse treatment for women with SUD.