Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)]

Scientific Rating:
2
Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] has been rated by the CEBC in the area of: Substance Abuse Treatment (Adult).

Target Population: Adult women with addictive disorders and a trauma history (e.g., abuse, domestic violence, community violence, etc.)

Brief Description

HWR/BT is a combination of two manualized curricula, Helping Women Recover (HWR): A Program for Treating Addiction and Beyond Trauma (BT): A Healing Journey for Women, that in order to replicate the research protocol and outcomes, they both need to be used, as this entry details. When used individually, there is not enough research evidence to be able to rate either curricula on the CEBC Scientific Rating Scale.

HWR/BT is a 29-session intervention that integrates three theories: a theory of addiction, a theory of women’s psychological development, and a theory of trauma; and then adds a psychoeducational component that teaches women what trauma is, its process, and its impact. The program model is organized into seven modules. The first four: Self, Relationships, Sexuality, and Spirituality are areas that recovering women have identified as triggers for relapse and as necessary for growth and healing. The last three: Violence, Abuse, and Trauma; The Impact of Trauma on Women’s Lives; and Healing from Trauma; focus on the trauma with a major emphasis on coping skills, with specific exercises for developing emotional wellness. The program comes with facilitator’s manuals, two participant workbooks (A Women’s Journal and A Healing Journey), and 3 DVDs. The materials are designed to be user-friendly and self-instructive. A special edition for criminal justice settings has also been developed.


Program Goals:

The overall goals of Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] are to accomplish a/an:

  • Decrease in substance abuse
  • Decrease in depression
  • Increase in understanding of trauma
  • Decrease in trauma symptoms
  • Increase in self-efficacy
  • Stabilized recovery

Essential Components

The essential components of Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] include:

  • The Helping Women Recover part of the combined curriculum with four modules with specific topic areas for each of the 17 sessions (there is also a self-administered recovery scale for each module):
    • Module A: Self - 4 sessions with a total of 13 activities:
      • Defining Self
      • Sense of Self
      • Self-Esteem
      • Sexism, Racism, and Stigma
    • Module B: Relationships - 5 sessions with a total of 18 activities:
      • Family of Origin
      • Mothers
      • Mother Myths
      • Interpersonal Violence
      • Creating Healthy Relationships and Support Systems
    • Module C: Sexuality - 5 sessions with a total of 14 activities:
      • Sexuality and Addiction
      • Body Image
      • Sexual Identity
      • Sexual Abuse
      • Fear of Sex while Clean and Sober
    • Module D: Spirituality - 3 sessions with a total of 10 activities:
      • What is Spirituality?
      • Prayer and Meditation
      • Creating a Vision
  • The Beyond Trauma part of the combined curriculum with three modules with specific topic areas for each of the 12 sessions.
    • Module A: Violence, Abuse and Trauma - 4 sessions with a total of 13 activities:
      • Introduction to the Program
      • The Connections between Violence, Abuse and Trauma
      • Power and Abuse
      • The Process of Trauma and Reactions to Trauma
    • Module B: The Impact of Trauma on Women’s Lives - 2 sessions with a total of 8 activities:
      • How Trauma Impacts our Lives
      • Abuse and the Family
    • Module C: Healing from Trauma - 6 sessions with a total of 23 activities:
      • The Connection between Trauma and Addiction: Spirals of Recovery and Healing
      • Grounding and Self-Soothing
      • The Mind and Body Connection
      • Our Feelings
      • Healthy Relationships
      • Endings and Beginnings
    • Recommended group size: 6-12 women with one facilitator
    • Each session also has an adaptation for girls ages 13-18 option

Adult Services

Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Substance abuse, interpersonal violence, symptoms from experiencing trauma

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Jail
  • Outpatient Clinic
  • Prison or pre-release center
  • Residential Care Facility
  • Reentry Agency/Facility

Homework

Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] includes a homework component:

Women have two journals used consecutively to process their group experience and practice skills.

Languages

Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Facilitator’s guides
  • Flip chart
  • Workbooks
  • Room with chairs in a circle
  • A group facilitator
  • Art supplies for collage work

Minimum Provider Qualifications

Licensed addiction counselor with experience in the field and with group work or a college graduate

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training can be provided onsite. There are also trainings available at various sites in California (some are free) and other parts of the U.S.

For more information see, www.stephaniecovington.com and www.centerforgenderandjustice.org

Number of days/hours:

Generally 2 days

Additional Resources:

There currently are additional qualified resources for training:

Please contact the Training Contact above for a list of certified trainers.

Implementation Information

Since Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)].

Formal Support for Implementation

There is formal support available for implementation of Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] as listed below:

Certified trainers can provide additional training and ongoing support as requested.

Fidelity Measures

There are fidelity measures for Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] as listed below:

A standard fidelity measurement scale is available upon request through the Office of Stephanie Covington, PhD, LCSW, either via phone: 858-454-8528 or email: info@stephaniecovington.com

Implementation Guides or Manuals

There are implementation guides or manuals for Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)] as listed below:

The Facilitator Guide provides complete directions and implementation guidelines and suggestions. It is available upon request through the Office of Stephanie Covington, PhD, LCSW, either via phone: 858-454-8528 or email: info@stephaniecovington.com.

Research on How to Implement the Program

Research has not been conducted on how to implement Helping Women Recover & Beyond Trauma (HWR/BT) [Substance Abuse Treatment (Adult)].

Relevant Published, Peer-Reviewed Research

This program is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 6 months has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Covington, S., Burke, C., Keaton, S., & Norcott, C. (2008). Evaluation of a trauma-informed and gender-responsive intervention for women in drug treatment. Journal of Psychoactive Drugs, SARC Supplement 5, 387-398.

Type of Study: One group pretest-posttest
Number of Participants: 202 (at intake)

Population:

  • Age — 18-54
  • Race/Ethnicity — 41% White, 31% Hispanic, 18% Black/African American, and 10% Other
  • Gender — Women
  • Status — A twelve-month residential drug and alcohol treatment program for women.

Location/Institution: California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the use of the Helping Women Recover and Beyond Trauma (HWR/BT) curricula in a residential drug and alcohol treatment facility for women. Women who successfully completed the HWR/BT program were assessed at several points in time. Measures included the Trauma Symptom Checklist, Beck Depression Inventory, and Addiction Severity Index for females. The findings indicated less substance use, less depression, and fewer trauma symptoms (including anxiety, sleep disturbances, and dissociation) after participation in the HWR/BT curricula. Limitations included the lack of a comparison or control group and a high rate of attrition between intake and exit.

Length of postintervention follow-up: None.

*Messina, N., Grella, C. E., Cartier, J., & Torres, S. (2010). A randomized experimental study of gender-responsive substance abuse treatment for women in prison. Journal of Substance Abuse Treatment, 38(2), 97–107.

Type of Study: Randomized controlled trial
Number of Participants: 115

Population:

  • Age — Average age=36
  • Race/Ethnicity — 48% White, 26% Hispanic, 17% Black, and 9% Other
  • Gender — 100% female
  • Status — Participants were women who participated in a prison-based substance abuse treatment program.

Location/Institution: California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared post-release outcomes for women who participated in prison-based substance abuse treatment. Women were randomized to a gender-responsive treatment program using the manualized Helping Women Recover & Beyond Trauma (HWR/BT) curriculum or a standard prison-based therapeutic community. Data were collected from the participants at prison program entry and 6 and 12 months after release. Measures included the Addiction Severity Index (ASI) Lite and the Posttraumatic Stress Diagnostic Scale, along with administrative records from the prison and treatment providers. Results indicate that both groups improved in psychological well-being; however, HWR/BT participants had greater reductions in drug use, were more likely to remain in residential aftercare longer, and were less likely to have been re-incarcerated within 12 months after parole. Limitations included a lack of fidelity measures during the active treatment phase and the relatively small sample size and limited power in the study.

Length of postintervention follow-up: One year.

Messina, N., Calhoun, S., & Warda, U. (2012). Gender responsive drug court treatment: A randomized controlled trial. Criminal Justice and Behavior, 9(12), 1539-1558.

Type of Study: Randomized controlled trial
Number of Participants: 94

Population:

  • Age — Approximately 36 years old
  • Race/Ethnicity — Predominantly either White (58%) or Hispanic (22%).
  • Gender — 100% Female
  • Status — Participants were women offenders admitted into participating drug court programs.

Location/Institution: San Diego, California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared outcomes for women offenders who participated in four drug court programs. Participants were randomly assigned to either Helping Women Recover and Beyond Trauma (HWR/BT) or standard mixed-gender treatment. Measures utilized include the Posttraumatic Stress Diagnostic Scale (PDS) and the Addiction Severity Index–Lite (ASI). Results showed that there were no significant differences between the HWR/BT and standard groups on drug use at follow-up. HWR/BT participants had better in-treatment performance and more positive perceptions related to their treatment experience. Limitations include the small sample size and concerns regarding treatment fidelity across the sites.

Length of postintervention follow-up: Unclear – approximately 22 months after treatment entry with treatment lasting 15 to 24 months. Subjects still in treatment at follow-up were excluded from the analyses.

Saxena, P., Messina, N., & Grella, C. E., (2014). Who benefits from gender responsive treatment. Accounting for abuse history on longitudinal outcomes for women in prison. Criminal Justice and Behavior, 41(4), 417–432.

Type of Study: Randomized controlled trial
Number of Participants: 115

Population:

  • Age — 35.7- 36.1 years
  • Race/Ethnicity — 48% White, 26% Latina, 17% Black, and 9% Other
  • Gender — 100% Female
  • Status — Participants were women in the California State Prison System.

Location/Institution: Valley State Prison for Women (VSPW) in California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: Study uses the same sample as Messina, Grella, Cartier, & Torres (2010). This study reports on psychological and substance use outcomes for incarcerated women with prior experience with physical/sexual abuse receiving gender response treatment (GRT). The two treatment groups involved were in the Integrity Program (GRT [now called Helping Women Recover and Beyond Trauma (HWR/BT)]) or the Destiny Program (using a standard TC group). Measure utilized was the Posttraumatic Stress Diagnostic Scale (PDS). Random assignment was primarily performed by the assignment lieutenant, who placed all treatment-eligible women with an even California Department of Corrections and Rehabilitation (CDCR) identification number into the Integrity Program and all women with an odd CDCR identification number into the Destiny Program. Results indicate that HWR/BT has shown potential for mitigating negative outcomes (i.e., depression and substance use) associated with histories of abuse for incarcerated women. Women offenders who had experienced prior traumatic events (i.e., physical/sexual abuse) improved their psychological status and decreased the number of substances they used in the trauma-informed gender-responsive substance abuse treatment group. Even when controlling for the presence of clinical level trauma distress (i.e., posttraumatic stress disorder [PTSD]), HWR/BT successfully moderated the associations between abuse and depression and abuse and substance use. Limitations include generalizability to other populations, reliability of self-reported measures; the study did not have a systematic procedure to evaluate the fidelity of the intervention to HWR/BT's principles and specific components.

Length of postintervention follow-up: 6 and 12 months.

References

Covington, S. (December 2013). “Chapter IV: Understanding and applying gender differences in recovery.” In United Nations Interregional Crime and Justice Research Institute (UNICRI) (Eds.), Dawn Drug Alcohol Woman Network: Promoting a gender-responsive approach to drug addiction (a collection of good practices). Turin, Italy: Author.

Covington, S. (2008). Women and addiction: A trauma-informed approach. Journal of Psychoactive Drugs, November (Suppl. 5), 377-385. Retrieved from http://www.stephaniecovington.com/assets/files/CovingtonSARC5.pdf

Poole, N., & Greaves, L. (Eds). (2012). Becoming trauma informed. Toronto, Ontario, Canada: Centre for Addiction and Mental Health (CAMH).

Contact Information

Name: Stephanie S. Covington, PhD, LCSW
Agency/Affiliation: Center for Gender and Justice
Website: www.stephaniecovington.com
Email:
Phone: (858) 454-8528
Fax: (858) 454-8598

Date Research Evidence Last Reviewed by CEBC: March 2016

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: May 2012