Feasibility and outcomes of a trauma-informed model of care in residential treatment for substance use

Z C Walter; M Carlyle; V Mefodeva; S Glasgow; G Newland; R D V Nixon; V E Cobham; L Hides

doi:10.1016/j.josat.2024.209571

Feasibility and outcomes of a trauma-informed model of care in residential treatment for substance use

J Subst Use Addict Treat. 2024 Nov 19:169:209571. doi: 10.1016/j.josat.2024.209571. Online ahead of print.

Authors

Z C Walter¹, M Carlyle², V Mefodeva², S Glasgow³, G Newland³, R D V Nixon⁴, V E Cobham⁵, L Hides⁶

Affiliations

¹ School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; Lives Lived Well, Brisbane, QLD, Australia. Electronic address: [email protected].
² School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; Lives Lived Well, Brisbane, QLD, Australia.
³ School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia.
⁴ Flinders University Institute for Mental Health and Wellbeing, Flinders University, Adelaide, SA, Australia; College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.
⁵ School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; Children's Health Queensland, Child and Youth Mental Health Service, Brisbane, QLD, Australia.
⁶ School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia; Lives Lived Well, Brisbane, QLD, Australia. Electronic address: [email protected].

PMID: 39566845
DOI: 10.1016/j.josat.2024.209571

Abstract

Introduction: History of trauma and PTSD are both common among individuals with substance use disorder (SUD) and associated with poorer SUD treatment retention and outcomes. Recommended trauma-informed care (TIC) approaches in SUD treatment have been underutilized in residential substance use treatment services.

Methods: This study conducted a single-armed, phase 1 feasibility and outcomes trial for a novel TIC model developed and delivered in a young adult (18-35 years) residential substance use treatment service in Australia. Measures of client acceptability, staff acceptability, and treatment fidelity assessed feasibility. The study collected client substance use (global substance use and alcohol, methamphetamine, and cannabis use involvement) and mental health outcomes (depression, anxiety, and PTSD symptoms) at service entry, and 3, 6, and 12 months later. Staff professional quality of life, and perceptions and confidence in delivering TIC were collected at baseline (prior to staff training in TIC), and at 3, 6, 12 and 18 months following training in the model.

Results: The program was delivered as per the TIC model approximately 88 % of the time, where 48 % of clients completed the full 6-week treatment program. Mixed effect models showed significant reductions in substance involvement, particularly for substance use at 3 months (d = 0.67). Improvements in depression, anxiety, and PTSD were also found (ps < .01). Staff levels of support and self-efficacy to implement TIC remained high over the duration of the evaluation, and trauma knowledge scores were higher at follow-up time points. Staff professional quality of life also remained high across the study.

Conclusion: The novel TIC model was acceptable for residential clients and staff and was associated with improved mental and substance use outcomes. These findings support TIC as feasible in residential service, with likely benefits for staff and clients.

Ethics: The study received ethical approval by the University of Queensland (Approval number: 2020000949).

Trial registration number: ACTRN12621000492853.

Keywords: Comorbidity; Substance use disorder; Trauma; Trauma-informed care.