Study Highlights Need for Integrated Counseling for Women

The Substance Abuse and Mental Health Services Administration (SAMHSA) today released study findings showing that women with mental and substance abuse disorders and histories of violence (trauma) can improve when treated with counseling that addresses all three of their service needs. Women who have a voice in their own treatment report better outcomes than women who do not.

The findings come from the Women, Co-occurring Disorders and Violence Study (WCDVS), a five-year study conducted by SAMHSA of over 2,000 women with co-occurring mental and substance abuse disorders and trauma histories. The study was not randomized, but rather, women who fit the study eligibility criteria were recruited into a group receiving integrated services, or a group receiving usual care, which treated mental health, substance abuse, and trauma issues in isolation from each other.

Women in the study who received counseling that addressed all three aspects of their lives together improved more than women in usual care. Women's symptoms also improved when they participated in the planning, implementation, and delivery of their own integrated services. Integrated services that involved the women themselves in treatment decisions cost the same as usual care and produced better outcomes, making the services cost-effective.

"The nature and impact of trauma remains too often misunderstood or neglected," explained SAMHSA Administrator Charles Curie. "Many women suffer tremendously as a result of misdiagnosis, mistreatment, an absence of integrated care and a lack of a voice in their own treatment. The Women, Co-Occurring Disorders and Violence Study results provide a roadmap for recovery for women with co-occurring disorders and trauma histories."

According to SAMHSA's National Survey on Drug Use and Health, in 2003, an estimated 4.2 million persons 18 and older met diagnostic criteria for both serious mental illness and a substance use disorder (dependence or abuse) in the past year. Of these, 2.0 million were male and 2.2 million were female.

The study builds on recommendations from SAMHSA's Treatment Improvement Protocol (TIP) #25, "Substance Abuse Treatment and Domestic Violence." TIP #25 noted that to treat victims of domestic violence with substance abuse disorders, "holistic, collaborative, [and] coordinated" services are needed, as well as studies on collaborative, linked social service programs. The study results confirm clinical recommendations in TIP #25 that treating substance abuse issues without addressing a woman's history of violence is ineffective, and that all clients in substance abuse treatment programs should be assessed for domestic violence and childhood physical and sexual abuse.

The WCDVS went further by addressing the interplay of not only substance abuse disorders and trauma in the lives of women, but mental illness as well. The WCDVS also demonstrated the empowerment and healing that comes when a woman is directly involved in her own care and recovery. At the systems level, women with co-occurring disorders and trauma histories often receive services that are fragmented, and less comprehensive and more institutionally based than what they need. The WCDVS also addressed these issues in the study's guiding principles:

• Service providers must better recognize the presence of trauma, past and present, as a central concern in a woman's life.
• Women should be encouraged to play an active role in their healing process and provided with a better understanding of how to do so, from the onset.
• There must be a more widespread and comprehensive recognition that violence and trauma significantly impact a person's belief system, self-perception and relationships with others.
• Providers need to meet women where they are mentally and emotionally, with careful readiness assessments, pacing and patience.

The WDCVS as well as TIP #25 call on policymakers and service providers to collaborate and coordinate services in order to improve care for women with co-occurring disorders and trauma.

Source: www.jointogether.org