96P
A Systematic Review of Interventions for Women with Trauma and Substance Abuse: Potential Treatment for Sexually Trafficked Women
Background and Purpose: Sexually trafficked women are at higher risk for substance abuse and PTSD, and are more likely to have histories of sexual abuse. The 2005 reauthorization of the Trafficking Victims Protection Act focused on the recognition of and service provision for victims in the United States, yet very few evidence- based interventions are currently available to identified survivors. With a lack of extant literature regarding trafficking interventions in the US, existing interventions targeting women with trauma and substance abuse may provide effective and urgently needed treatment for this population. As such, the purpose of this review was to 1) identify and describe the types interventions for women with substance abuse and trauma, and 2) determine which interventions are most effective: standard (> 20 sessions) versus brief (< 20 sessions); and outpatient, residential, or prison-based when considering the rigor of the study’s methods.
Methods:A systematic search of 4 databases was conducted to identify articles in peer-reviewed journals published between 2005-2014. Studies were included if they met the following criteria: 1) English-language studies; 2) quantitatively evaluated the outcomes; 3) interventions focused on substance abuse; and 4) served women who identified as survivors of trauma. Methodological rigor of each study was assessed using an adapted version of the Methodological Quality Rating Scale (11 items, potential scores ranging from 0-13) by Miller (1995), which was used to distinguish between low and high levels of methodological rigor using a median split of the total scores. Level of methodological rigor was combined with statistical significance for each outcome of interest to create an outcome attainment score. Primary outcomes included substance abuse and trauma symptoms. Secondary outcomes included HIV/sexual risk. Outcomes were compared by intervention length (brief vs. standard interventions) and intervention type (outpatient, residential, or prison-based).
Results: Fourteen studies met inclusion criteria for this review. Intervention types included: nine standard and five brief interventions; and six delivered in outpatient settings, two in residential programs and one in both, and five in prison. Methodological rigor ranged from 5.5 to 13 points, with a median of 8.25 points. Studies generally produced more statistically significant results for trauma outcomes than substance abuse. Half (n=2) of the brief interventions, as compared to seven of nine interventions standard interventions, produced statistically significant, positive results with regard to trauma outcomes. Of the six interventions that measured sexual risk outcomes, four brief, outpatient interventions had statistically significant results.
Conclusions and Implications: The review found that standard-length interventions have the strongest evidence for reducing trauma. Outpatient programs have the most success with substance abuse, however further information is required for this outcome. Standard-length, trauma-informed substance abuse interventions should be adapted for sexually trafficked women. As most human trafficking programs currently consist of residential shelters, further knowledge is needed to adapt and improve interventions.