Attendance and substance use outcomes for the Seeking Safety program: sometimes less is more

Abstract

Objective: This study uses data from the largest effectiveness trial to date on treatment of co-occurring posttraumatic stress and substance use disorders, using advances in statistical methodology for modeling treatment attendance and membership turnover in rolling groups.

Method: Women receiving outpatient substance abuse treatment (N = 353) were randomized to 12 sessions of Seeking Safety or a health education control condition. Assessments were completed at baseline and at 1 week, 3, 6, and 12 months posttreatment. Outcome measures were alcohol and cocaine use in the prior 30 days captured using the Addiction Severity Index. Latent class pattern mixture modeling (LCPMM) was used to estimate attendance patterns and to test for treatment effects within and across latent attendance patterns and group membership turnover.

Results: Across LCPMM analyses for alcohol and cocaine use, similar treatment attendance patterns emerged: Completers never decreased below an 80% probability of attendance, droppers never exceeded a 41% probability of attendance, and titrators demonstrated a 50% to 80% probability of attendance. Among completers, there were significant decreases in alcohol use from baseline to 1-week posttreatment, followed by nonsignificant increases in alcohol during follow-up. No differences between treatment conditions were detected. Titrators in Seeking Safety had lower rates of alcohol use from 1-week through 12-month follow-up compared with control participants. Droppers had nonsignificant increases in alcohol during both study phases. Cocaine use findings were similar but did not reach significance levels.

Conclusions: The impact of client self-modulation of treatment dosage and group membership composition may influence behavioral treatment outcomes among this population.

Trial registration: ClinicalTrials.gov NCT00078156.

Conflict of interest statement

All other authors report no competing interests.

(PsycINFO Database Record (c) 2012 APA, all rights reserved).

Figures

Figure 1

Latent class pattern mixture model: yb–y12mp = Binary indicators of substance use from baseline through 12-month follow-up; SS/WHE = treatment condition (Seeking Safety = 1; Women’s Health Education = 0); αITI = estimated level of the outcome at time = 0; βITI = estimated rate of change from baseline to immediate posttreatment (in-treatment interval); βPTI = estimated rate of change from immediate posttest through 1-year follow-up.

Figure 2

Latent class membership histogram across calendar time.

Figure 3

Predicted probability of alcohol use over time by treatment group (Seeking Safety or Women’s Health Education) and latent class membership.

Figure 4

Attendance probabilities by latent class.