Attendance and substance use outcomes for the Seeking Safety program: sometimes less is more
Open accessAbstract
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.
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In another treatment trial for comorbid PTSD and SUD, a person-centered analysis derived early dropout, titration, and completion patterns, and treatment titration was not associated with poorer outcomes relative to completion.
“Another treatment trial for comorbid PTSD and SUD used a person-centered approach to empirically derive distinct attendance patterns of early dropout, titration, and completion—importantly; treatment titration was not associated with poorer outcomes relative to completion (Hien et al., 2012).”
From Identifying attendance patterns in a smoking cessation treatment and their relationships with quit success (2017) · cites this paper as Hien et al., 2012
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“Another treatment trial for comorbid PTSD and SUD used a person-centered approach to empirically derive distinct attendance patterns of early dropout, titration, and completion—importantly; treatment titration was not associated with poorer outcomes relative to completion (Hien et al., 2012).”
BackgroundResult
- Authors
- Hien, D. A., Morgan-Lopez, A. A., Campbell, A. N. C., Saavedra, L. M., Wu, E., Cohen, L., Ruglass, L., & Nunes, E. V.
- Affiliations
- The Graduate Center, CUNY (US)
- New York State Psychiatric Institute (US)
- RTI International (US)
- Columbia University (US)
- City College of New York (US)
- ORCID
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2012-02
- Volume
- 80
- Issue
- 1
- Pages
- 29-42
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3682930
- OpenAlex
- W2156534035
- Semantic Scholar
- b33880fdca6485d1862ff8f0b8894f892035c9ea
- Cited by
- 50
- References
- 54
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 6 · 2021: 7 · 2020: 5 · 2018: 3 · 2017: 5 · 2016: 2 · 2015: 5 · 2014: 4 · 2013: 5
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (U10DA13035, U10 DA13714, U10 DA13038, U10 DA13732, U10 DA13727, U10 DA013720, U10 DA013046, K24 DA022412, R01DA025198)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- treatment attendance, treatment discontinuation, substance use disorders, alcohol consumption, cocaine use, women, outpatient substance abuse treatment
- MeSH terms
- Adult, Female, Follow-Up Studies, Humans, Patient Compliance, Patient Dropouts, Patient Education as Topic, Psychotherapy, Group, Severity of Illness Index, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Treatment Outcome, Substance-Related Disorders, Cocaine-Related Disorders
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