TY  - JOUR
PY  - 2020//
TI  - "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
JO  - Addiction research and theory
A1  - Bailey, Karen
A1  - Trevillion, Kylee
A1  - Gilchrist, Gail
SP  - 289
EP  - 297
VL  - 28
IS  - 4
N2  - 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 trauma-informed practice, and the challenges associated with this. Thematic analysis was employed.<br><br>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.<br><br>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.<br><br>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.<p />  <p>Language: en</p>
LA  - en
SN  - 1606-6359
UR  - http://dx.doi.org/10.1080/16066359.2019.1644323
ID  - ref1
ER  -