Reducing barriers to trauma inquiry in substance use disorder treatment – A cluster-randomized controlled trial

Background: Despite of the high rate of trauma in clients with substance use disorders, trauma often remains undetected in a majority of treatment-seeking clients. Improving professionals’ knowledge and competences in the inquiry of traumatic events is therefore of utmost importance to appropriately address the specific trauma-related treatment needs. However, professionals in substance use disorder treatment settings frequently report barriers to inquiring about traumatic events, e.g., the fear of offending or harming the client. Such barriers should be addressed by trainings to improve the systemtic inquiry of traumatic events in clients. Methods: In this cluster-randomized trial, we examined whether a one-day training in trauma inquiry (‘Learning How to Ask’) would reduce professionals’ perceived barriers to trauma inquiry. 148 professionals working in outpatient substance use disorder treatment centers were randomized to an intervention (n = 72) or a control group (n = 76). The professionals of the intervention group received a one-day training plus a refresher session 3 months later, the professionals of the control group received no training. Professionals rated their level of six common barriers to trauma inquiry on four-point Likert scales at baseline, at 3-month and 6-month follow-up, namely ‘Feeling uncomfortable when asking about traumatic events’, ‘Fear of offending the client’, ‘Fear of retraumatizing the client’, ‘Fear that client may terminate treatment’, ‘Unsure whether authorities have to be informed when perpetrator is known’, and ‘No trauma-specific treatment available’. Results: Five of the six perceived barriers to inquiring about traumatic events significantly decreased from baseline to 6-month follow-up to a greater extent in the trained group than in the control group (‘Feeling uncomfortable’: b = -0.32, 95% CI [-0.52, -0.12]; ‘Fear of offending the client’: b = -0.33, 95% CI [-0.56, -0.09]); ‘Fear of retraumatizing the client’: b = -0.45, 95% CI [-0.69, -0.22]; ‘Fear that client may terminate treatment’: b = -0.28, 95% CI [-0.49, 0.07]; ‘No trauma-specific treatment available’: b = -0.25, 95% CI [-0.51, -0.01]). Conclusions: Our findings provide first evidence that a one-day training in trauma inquiry is effective in reducing common barriers to trauma inquiry, which may improve detection of traumatic events

Learning How to Ask - Does a one-day training increase trauma inquiry in routine substance use disorder practice? Results of a cluster-randomized controlled trial

Aims To examine the effectiveness of a one-day skills training program for increasing trauma inquiry in routine substance use disorder treatment. Design Cluster-randomized two-armed controlled trial, with 12 substance use disorder (SUD) organizations operating 25 counseling centers, randomly assigned to training in trauma inquiry (13 counseling centers of 8 SUD organizations) or no training (12 counseling centers of 4 SUD organizations). Setting SUD counseling centers in Northern Germany. Cases N = 5204 SUD counseling services. Intervention The professionals assigned to the intervention group received a one-day training in trauma inquiry plus a 1.5-hour refresher session 3 months later. Professionals in the control group received no training. Measures Over a 12-month period, professionals documented for each counseling service whether they asked the client about four traumatic events: physical abuse, emotional abuse, sexual abuse and neglect. Analysis Primary outcomes were rates of asking about physical abuse, sexual abuse, emotional abuse and neglect in the 6 months after training. These were compared across conditions, while adjusting for baseline probabilities in the 6 months before the intervention, using mixed-effects logistic regression. Findings In the 6 months after training, the rate of asking about physical abuse was 18% higher in the SUD counseling services of trained professionals, relative to services of untrained professionals (OR = 1.18, 95% CI = [1.01–1.37, p = .035]). No effect was found for asking about sexual abuse, emotional abuse and neglect. Conclusion A one-day training program in trauma inquiry, combined with a brief refresher session, was effective in increasing inquiries about physical abuse in routine counseling practice. The training was ineffective in increasing inquiries about sexual abuse, emotional abuse and neglect. The effectiveness of a one-day training of trauma inquiry might be increased by a longer training, or by combining it with additional elements, such as ongoing supervision

Problem Gambling in Germany: Results of a mixed-mode population survey

Abstract In representative telephone surveys of the population to record gambling-related problems, which have been conducted in Germany since 2006, no significant changes have yet been discernible, despite the increased availability of gambling, increased turnover and gross gambling revenues for providers, and increased demand for treatment from problem gamblers. Such population surveys have recently been associated with problems, not only in the gambling field, such as decreasing willingness to participate and accessibility of specific population groups. In the present prevalence study, a mixed-mode design was chosen, consisting of a combined telephone and online survey. The weighting of the samples in a ratio of 2 to 1 was checked against plausibility data. The sample consists of 12,303 complete interviews (telephone: 61%, online: 39%). Results on the 12-month prevalence of gambling participation overall as well as in individual forms of gambling in relation to gender, age, migration background, and access routes are presented, as are findings on gambling disorders with corresponding frames of reference. The discussion of the results is primarily in the context of the new survey methodology. Implications Statement In view of the shortcomings of telephone surveys and the advantages of supplementary online surveys, a mixed-mode approach was chosen in which the weighting of the telephone and online sample (web panel) was checked on the basis of plausibility data

Comparative Analysis of Potential Risk Factors for at-Risk Gambling, Problem Gambling and Gambling Disorder among Current Gamblers—Results of the Austrian Representative Survey 2015

Background: The risk of developing a problem gambling behavior is distributed unequally among the population. For example, individuals who report stressful life events, show impairments of mental health or belong to a socio-economically deprived group are affected more frequently by gambling problems. The aim of our study is to investigate whether these risk factors are equally relevant for all gambling groups (social = 0 DSM-5 criteria, at risk = 1 DSM-5 criterion, problem = 2–3 DSM-5 criteria, disordered = 4–9 DSM-5 criteria).Methods: Of a total of 10,000 participants in the representative gambling survey in Austria in 2015, 4,082 individuals reported gambling during the last 12 months and were allocated to the four gambling groups according to DSM-5. With social gamblers as the reference group, relevant risk factors for the other three groups were identified by means of bi- and multivariate multinomial logistic regression.Results: Significant risk factors for gambling disorder are at-risk alcohol use (OR = 4.9), poor mental health (OR = 5.9), young age (≤26 years, OR = 2.1), a low level of formal education (OR = 2.4), having grown up with a single parent (OR = 2.5), parents with addiction problems (OR = 2.3) and belonging to the working class (OR = 2.9). Risk factors for problem gambling are parents with addiction problems (OR = 3.8), poor mental health (OR = 2.6) and a young age (OR = 2.2). With regard to at-risk gambling, only growing up with a single parent was relevant (OR = 2.4).Conclusion: Overall, the results of this study suggest, that the number and the influence of the included risk factors differ between gambling problem groups. Apparently, the development of severe gambling problems is to a lesser extent facilitated by specific risk factors than by their cumulative presence. Therefore, future prevention and treatment measures should place a particular focus on individuals who have experienced growing up in a difficult family situation, have poor mental health, suffer from substance-related problems or have a low level of formal education