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A randomized controlled trial of a gender-focused addiction model versus 12-step facilitation for women veterans.

Najavits LM, Enggasser J, Brief D, Federman E. A randomized controlled trial of a gender-focused addiction model versus 12-step facilitation for women veterans. The American journal on addictions. 2018 Apr 1; 27(3):210-216.

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BACKGROUND AND OBJECTIVES: Substance use disorder (SUD) has increased among women, including military veterans, yet SUD treatment was historically designed for males. This randomized controlled trial compared 12 individual sessions of a gender-focused SUD recovery model, A Woman's Path to Recovery (WPR) to an evidence-based, non-gender-focused SUD model, 12-Step Facilitation (TSF) for 66 women veterans with current severe SUD. METHODS: The primary outcome was substance use; secondary outcomes were associated problems (e.g., psychological); coping skills, and 12-step attendance, with assessment at baseline, end-of-treatment, and 3-month followup. RESULTS: Substance use decreased over time, with no difference between conditions. Decreases occurred from baseline to end-of-treatment and baseline to followup and, for drug severity, also from end-of-treatment to followup. Effect sizes were large for alcohol and medium otherwise. Secondary outcomes were largely consistent with this pattern of improvement. Urinalysis/breathalyzer supported self-report. Treatment attendance was 62% for WPR and 57% for TSF (not significantly different). Twelve-step group attendance, surprisingly, did not increase in either condition. DISCUSSION AND CONCLUSIONS: WPR provides a useful addition to women's SUD treatment options, with outcomes no different than an established evidence-based model, TSF. Both showed positive impact on substance use and related areas. Our lack of differences based on gender-focus may reflect women veterans being acculturated to a male military environment. Limitations include lack of an untreated control, a sample limited to veterans, and use of a large effect size for power assumptions. SCIENTIFIC SIGNIFICANCE: This is the first RCT of a gender-focused approach for women veterans with SUD. (Am J Addict 2018;27:210-216).

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