“We have to put the fire out first before we start rebuilding the house”: practitioners’ experiences of supporting women with histories of substance use, interpersonal abuse and symptoms of post-traumatic stress disorder

Abstract

Introduction and aims: The high prevalence of women experiencing co-occurring substance use, interpersonal abuse, and symptoms of post-traumatic stress disorder (PTSD) has led to international calls for trauma-specific substance use treatments and wider trauma-informed practice. The aim of this study was to explore how services in England have developed practice responses with limited historical precedence for this work. Design and Methods: A purposive sample of 14 practitioners from substance use, interpersonal violence and criminal justice services were chosen for their integrated practice. Semi-structured interviews exploring their understanding of the co-occurring issues, staged treatment models and wider traumainformed practice, and the challenges associated with this. Thematic analysis was employed. Results: Three key interlinking themes were identified: practitioners' philosophical approach; tailored clinical practice, and system responsiveness. Analyses identified the importance of relational, non-pathologising practice, extensive focus on physical and emotional safety, and cautionary approaches towards using trauma-specific treatments involving trauma disclosure. Challenges included poor service integration, time-limited treatments and tokenistic trauma informed practice. Discussion: Practitioners from across disciplines emulated important components of trauma-informed practice and promoted a 'safety-first' approach reliant on multi-agency working and wider system responses. Trauma-specific interventions required skilled and experienced practitioners, and longer treatment programmes comprising first stage work. Conclusions: In the context of limited gender-responsive substance use treatment in the UK, practitioners demonstrated integrated practice that supported the recommended staged PTSD model and trauma-informed practice. Organisational leadership and support from service commissioners and funders are recommended to promote growth of this approach across the UK. ARTICLE HISTORY

Family focused interventions that address parental domestic violence and abuse, mental ill-health, and substance misuse in combination: A systematic review

“…We suggest that integrated approaches for parental DVA, MH, and SU may need to go beyond these measures to concurrently recognise and address the bi-directional and complex nature of these issues [10][11][12][13][14][15][16], while also addressing the underlying risk factors that may give rise to, or exacerbate, them. Other researchers have highlighted the importance of adopting such an approach, particularly when working with women experiencing DVA, MH, and SU [134][135][136]. In our review, the only study that demonstrated combined impacts on two outcomes (DVA and MH) conceived the relationship between these issues as bi-directional; providing concurrent support for DVA and MH through a culturally informed, empowerment intervention, empathetic-understanding component, and social support from the person delivering the intervention [93].…”

Understanding Models of Support for People Facing Multiple Disadvantage: A Literature Review

“…To achieve a gender-informed approach across mental health services, Agenda (2015) calls for women's needs to be explicitly considered in national me ntal health policy and strategy; every mental health trust to appoint a clinical lead for women's mental health and a strategy to take into account women's needs; mental health services to implement routine enquiry about women's experiences of violence and abuse which are accompanied by pathways into proper support and care; dedicated women-only services for women with multiple needs to be available in every area; and frontline workers to receive training on women's mental health, trauma, abuse, and to implement trauma-informed practice. Bailey et al (2019a) argue that a significant 'culture shift' is required in substance use services in England to embrace an approach that recognises the ubiquity of interpersonal abuse (physical, emotional or sexual violence/abuse in adulthood or childhood) experienced by female users, that is 'non-pathologizing, strengths-based, and centred on 'growth-fostering relationships'. Promising practice shows a commitment to understanding women's multiple disadvantage, including an understanding of intersectional disadvantage, experiences of Violence against Women and Girls (VAWG), and associated trauma (Homeless Link, 2018b).…”

Exploring gendered differences among polish migrants in the UK in problematic drinking and pathways into and through alcohol treatment

“…There is evidence to suggest that women are more likely to drink heavily when they are also experiencing psychological and/or emotional distress when compared to men (Erol & Karpyak, 2015), suggesting a need for a more psychologically focused approaches to treatment for women. Coupled with the acknowledgement that a large proportion of women who use substances (40-70%) have experienced some form of interpersonal abuse (including physical, sexual, psychological and emotional abuse) there is a need for alcohol treatment services to be able to provide holistic support to women that takes account of these additional needs (Bailey et al, 2020;Thomas & Bull, 2018).…”

“…Practitioners working within UK systems of substance use treatment are most likely to reject a medical model of addiction/treatment and tend to work from a strengths-based model (e.g. Bailey et al, 2020). This contrasts with the predominance of the medical model of substance use treatment that informs services based in Poland and has been described as 'homogenous and abstinence-oriented' (Klingemann, 2016, p. 437).…”