We compared the effectiveness of Seeking Safety (SS), an integrated cognitive behavioral treatment for substance use disorder (SUD) and post-traumatic stress disorder (PTSD), to an active comparison health education group (Women's Health Education [WHE]) within NIDA's Clinical Trials Network. We randomized 353 women to receive 12 sessions of SS (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment at post-treatment and 3-, 6-, and 12-months post-treatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS) and PTSD Symptom Scale-Self Report (PSS-SR), and substance use (self-reported abstinence in the prior 7 days and days per week of any substance use). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively), but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline, when 46% of participants were abstinent. Study results do not favor SS over WHE as an adjunct to SUD treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript in community based drug treatment, revealing a significant need for therapeutic approaches that can address adverse psychiatric consequences (e.g., Shore, Vollmer, & Tatum, 1989;Breslau, Davis, Andreski, & Peterson, 1991;Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). Yet, treatment research in this area remains limited.Quasi-experimental and small controlled studies (i.e., Finkelstein et al., 2004) suggest that a services model integrating cognitive behavioral treatment for trauma with substance abuse services can result in modest improvements in outcome (e.g., Amaro et al., 2007;Morrissey et al., 2005). For PTSD without co-occurring substance abuse, cognitive behavioral approaches have shown evidence of efficacy (e.g., Cloitre, Koenen, Cohen, & Han, 2002;Foa, Rothbaum, & Riggs, 1991). There has been concern, however, that discomfort aroused by focusing on the trauma could be harmful in substance dependent patients, who might escalate substance use or flee treatment. At the same time, the demand for specific interventions for patients with trauma and substance abuse has been mounting in community-based treatment systems (Cohen, Dickow, Horner, Zweben, & Balabis, 2003;Morrissey et al.).To address this need, Najavits (2002) developed Seeking Safety (SS), anintegrated cognitive behavioral treatment of PTSD and substance use disorder. Thus far, SS has been researched in various studies including a multisite controlled trial with homeless women veterans (Desai, Harpaz-Rotem, Najavits, & Rosenheck, 2008); two randomized control trials with low-income urban women and adolescent girls (Hien, Cohen, Miele, Litt & Capstick, 2004;Najavits, Gallop, & Weiss, 2006);...

Purpose Analyses used data from an extended longitudinal study to examine the relationship between childhood physical and sexual abuse (CPA and CSA, respectively) and adolescent and adult smoking behavior. Two questions guided the study: (1) Is there an association between childhood abuse and adolescent and adult smoking behavior? (2) Does the relationship between childhood abuse and later cigarette smoking differ for males and females? Methods A censored-inflated path model was used to assess the impact of child abuse on adolescent and adult lifetime smoking prevalence and smoking frequency. Gender differences in significant model paths were assessed using a multiple-group approach. Results Results show no significant relation between CPA or CSA and risk of having ever smoked cigarettes in adolescence or adulthood. However, for males, both CPA and CSA had direct effects on adolescent smoking frequency. For females, only CSA predicted increased smoking frequency in adolescence. Adolescent smoking frequency predicted adult smoking frequency more strongly for females compared to males. Conclusions CPA and CSA are risk factors for higher frequency of smoking in adolescence. Higher frequency of cigarette smoking in adolescence increases the risk of higher smoking frequency in adulthood. Results underscore the need for both primary and secondary prevention and intervention efforts to reduce the likelihood of childhood abuse and to lessen risk for cigarette smoking among those who have been abused.

This systematic review analyzes the role of gender in the association between childhood maltreatment and substance use outcomes, among longitudinal papers published between 1995 and 2011. Ten papers examined gender as a moderating variable. Results on gender differences were mixed. When studies that found no gender effects were compared with studies that did identify gender effects, differences in measurement, sample composition, and developmental timing of outcomes were identified. This review also examines how gender effects are assessed. Implications and limitations of these findings are discussed. Areas for future research are identified.

Studies have demonstrated that the effects of two well-known predictors of adolescent substance use, family monitoring and antisocial peers, are not static but change over the course of adolescence. Moreover, these effects may differ for different groups of youth. The current study uses time-varying effect modeling (TVEM) to examine the changes in the association between family monitoring and antisocial peers and marijuana use from ages 11 to 19, and to compare these associations by gender and levels of behavioral disinhibition. Data are drawn from the Raising Healthy Children study, a longitudinal panel of 1,040 youth. The strength of association between family monitoring and antisocial peers and marijuana use was mostly steady over adolescence, and was greater for girls than boys. Differences in the strength of the association were also evident by levels of behavioral disinhibition: youth with lower levels of disinhibition were more susceptible to the influence of parents and peers. Stronger influence of family monitoring on girls and less disinhibited youth was most evident in middle adolescence, whereas the stronger effect of antisocial peers was significant during middle and late adolescence. Implications for the timing and targeting of marijuana preventive interventions are discussed.

A substantial number of women who enter substance abuse treatment have a history of trauma and meet criteria for Post Traumatic Stress Disorder (PTSD). Fear regarding the extent to which PTSD treatment can evoke negative consequences remains a research question. This study explored adverse events related to the implementation of an integrated treatment for women with trauma and substance use disorder (Seeking Safety) compared with a non-trauma focused intervention (Women's Health Education). Three hundred fifty-three women enrolled in community substance abuse treatment were randomized to one of the two study groups and monitored weekly for adverse events. There were no differences between the two intervention groups in the number of women reporting study-related adverse events (28 [9.6%] for the Seeking Safety group, 21 [7.2%] for the Women's Health Education group). Implementing PTSD treatment in substance abuse treatment programs appears to be safe, with minimal impact on intervention-related adverse HHS Public Access