Studies of women in hospitals and prisons and homeless shelters have
documented high rates of trauma and abuse.
Nonetheless, "the nature and impact of trauma remains too often
misunderstood or neglected," commented Charles Curie, M.A.,
administrator of the Substance Abuse and Mental Health Services Administration
(SAMHSA), in a press release. As a result, most community mental health
programs treat women for their mental disorders in isolation from the trauma
they have experienced.
That situation may be changing, however. Last month SAMHSA released
six-month findings from the second phase of a five-year study of women with
mental disorders and a history of trauma.
The "Women, Co-Occurring Disorders, and Violence Study" is
believed to be the first large, national treatment study of women with mental
and substance abuse disorders and a history of violence-induced trauma.
Nine treatment sites throughout the United States enrolled 2,729 women aged
18 or older in the study. According to SAMHSA program officer Susan Salasin,"
Most of the women were mothers on public assistance with comorbid
health problems including HIV resulting from drug or alcohol abuse."
This population typically uses a lot of health care services that tend to be"
fragmented, less comprehensive, and more institutionally based than
what they needed," she told Psychiatric News.
About 85 percent of the women in the study had been physically abused, and
82 percent had been sexually abused. Moreover, 81 percent had been diagnosed
with a mental disorder, 65 percent had received treatment at the time of the
study; 49 percent had been treated in or admitted to a psychiatric hospital or
psychiatric ward of a hospital at some point in their lives; and 99 percent
had used alcohol, marijuana, or crack/cocaine at some point in their
The women were divided into two treatment groups: one group received the
usual community counseling, and the other received comprehensive counseling
that integrated the treatment of co-occurring disorders and trauma
Six months later, the 2,006 women still enrolled in the study were
interviewed to determine whether their symptoms had improved.
Women who received the comprehensive, integrated counseling had
significantly fewer symptoms of mental illness, alcohol use, and drug use than
the women who received fragmented counseling. Symptoms of mental illnesses
improved in 59 percent of the women receiving integrated counseling compared
with 49 percent of the women receiving usual care.
Further, 50 percent of the women who received integrated counseling
reported that they were no longer using drugs, and 54 percent said they were
no longer using alcohol.
By comparison, 34 percent of the women receiving usual care reported no
drug use, and 37 percent reported no alcohol use.
"The cost of providing comprehensive care including integrated
counseling was-n't greater than the cost of providing usual care,"
Salasin commented. "The combined intervention was cost-effective because
it produced better outcomes than usual care."
The "Women, Co-Occurring Disorders, and Violence Study"
is posted online at<www.wcdvs.com>.▪