Intervention Summary

A Woman's Path to Recovery (Based on A Woman's Addiction Workbook)

A Woman's Path to Recovery is a clinician-led program for women with substance use disorders. The model uses chapters from "A Woman's Addiction Workbook: Your Guide to In-Depth Healing" as the basis for 12 90-minute sessions conducted by clinicians over 8 weeks. The workbook is divided into two main sections: exploration and healing. The "exploration" section helps women look at their lives in relation to gender and addiction issues. It provides background information on the relationship between gender and addiction, differences between women and men in addiction and recovery, historical barriers to treatment faced by women, and subgroups of women at risk for addiction. It then encourages women to identify their life themes in five key areas relevant to women and addiction: body and sexuality, stress, relationships, trauma and violence, and thrill-seeking. They can also evaluate their addiction and co-occurring mental disorders. The "healing" section of the book guides women through methods of recovery. It is organized into four domains--relationships, beliefs, actions, and feelings--and includes a series of exercises for each domain. The book conveys a supportive tone for the journey to healing and provides specific recovery resources. Overall, the model addresses social and emotional problems unique to women. Difficult areas in a woman's life are explored through the psychology that underlies female addictive behavior.

The research to date on A Woman's Path to Recovery has been conducted with women addicted to opiates and other substances; however, the intervention can also be used to address nonsubstance addictions, such as addiction to shopping and eating. In addition, session length and program duration can be modified, depending on the setting or group of women. The workbook was originally created as a self-help model for women and adolescent girls and can be used in a self-help format (i.e., without the involvement of a clinician). This self-help model was not reviewed by NREPP.

Descriptive Information

Areas of Interest	Substance use disorder treatment
Outcomes	1: Substance use 2: Global clinical improvement 3: Impulsive and addictive behavior 4: Knowledge of workbook concepts
Outcome Categories	Alcohol Drugs Mental health Quality of life Social functioning
Ages	26-55 (Adult)
Genders	Female
Races/Ethnicities	Hispanic or Latino White
Settings	Outpatient
Geographic Locations	Urban
Implementation History	"A Woman's Addiction Workbook: Your Guide to In-Depth Healing" was published.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: No Evaluated in comparative effectiveness research studies: No
Adaptations	Parts of the workbook are being translated into French.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	IOM prevention categories are not applicable.

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Najavits, L. M., Rosier, M., Nolan, A. L., & Freeman, M. C. A new gender-based model for women's recovery from substance abuse: Results of a pilot outcome study. American Journal of Drug and Alcohol Abuse, 33(1), 5-11.

Supplementary Materials

Client handouts

Eisen, S. V., Wilcox, M., Leff, H. S., Schaefer, E., & Culhane, M. A. Assessing behavioral health outcomes in outpatient programs: Reliability and validity of the BASIS-32. Journal of Behavioral Health Services and Research, 26(1), 5-17.

Najavits, L. M.. A Woman's Path to Recovery Adherence Scale. Unpublished manuscript.

Najavits, L. M.. A Woman's Path to Recovery Adherence Scale score sheet. Unpublished manuscript.

Najavits, L. M. Women and addiction: The untold story [training outline]. Unpublished manuscript.

Quality Assurance Protocol--A Woman's Addiction Workbook (aka A Woman's Path to Recovery When Clinician-Led)

Outcomes

Outcome 1: Substance use
Description of Measures	Substance use was measured using the drug composite score from the Addiction Severity Index (ASI)--Lite. The ASI-Lite is a shortened version of the ASI, a semi-structured interview instrument that evaluates the severity of psychosocial problems across seven life domains: drug, alcohol, medical, employment, family/social, legal, and psychiatric. Composite scores of 0 to 1 are generated for each domain, with higher scores reflecting greater problem severity. Random urinalysis was used approximately weekly to verify self-reported drug use.
Key Findings	Participants in the workbook-based, group session program showed significant decreases in self-reported substance use from pretreatment (intake) to posttreatment (2 months after intake) (p < .005).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.6 (0.0-4.0 scale)

Outcome 2: Global clinical improvement
Description of Measures	Global clinical improvement was measured using the patient version of the Clinical Global Impressions Scale (CGIS). Using this tool, patients complete the statement "Compared with how I felt before beginning this study, I am now" with one of these phrases: (1) "very much improved," (2) "much improved," (3) "minimally improved," (4) "unchanged," (5) "minimally worse," (6) "much worse," or (7) "very much worse."
Key Findings	Participants in the workbook-based, group session program reported significant global clinical improvement from midtreatment (1 month after intake) to posttreatment (2 months after intake) (p < .005).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.4 (0.0-4.0 scale)

Outcome 3: Impulsive and addictive behavior
Description of Measures	Impulsive and addictive behavior was evaluated using the Impulsive and Addictive subscale of the Behavior and Symptom Identification Scale (BASIS-32). The BASIS-32 measures self-reported symptom and problem difficulty across five functional domains: Relation to Self and Others, Depression and Anxiety, Daily Living and Role Functioning, Impulsive and Addictive Behavior, and Psychosis.
Key Findings	Participants in the workbook-based, group session program showed significant decreases in self-reported impulsive and addictive behavior from pretreatment (intake) to posttreatment (2 months after intake) (p < .05).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	2.3 (0.0-4.0 scale)

Outcome 4: Knowledge of workbook concepts
Description of Measures	Knowledge of workbook concepts was measured using two "quizzes"--an 18-item multiple-choice quiz and a 10-item true/false quiz--offered in the appendix of A Woman's Addiction Workbook.
Key Findings	Participants in the workbook-based, group session program showed significantly improved knowledge of workbook concepts from pretreatment (intake) to posttreatment (2 months after intake) (p < .005 for multiple-choice quiz, p < .05 for true/false quiz).
Studies Measuring Outcome	Study 1
Study Designs	Preexperimental
Quality of Research Rating	1.8 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	26-55 (Adult)	100% Female	87.5% White 12.5% Hispanic or Latino

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Substance use	3.9	3.9	3.0	2.6	1.2	1.2	2.6
2: Global clinical improvement	3.3	3.3	2.5	3.3	1.2	1.2	2.4
3: Impulsive and addictive behavior	3.0	2.5	2.5	3.3	1.2	1.2	2.3
4: Knowledge of workbook concepts	1.0	1.8	2.5	3.3	1.2	1.2	1.8

Study Strengths

The study verified substance use through urine screens, used good additional measures, and had good fidelity outcomes. The encouraging results from this small pilot study could be the basis for a larger clinical trial.

Study Weaknesses

This was a small, preliminary pilot study. The offer of expedited admission to a methadone maintenance treatment program for volunteer participants may have introduced a sampling bias. Reliability and validity were not established for the outcome on knowledge of workbook concepts. The very small sample size and lack of a control or comparison group are major threats to validity (i.e., one cannot verify that the outcomes resulted from the intervention). The study had no follow-up data.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Najavits, L. M. A woman's addiction workbook: Your guide to in-depth healing. Oakland, CA: New Harbinger Publications.

Najavits, L. M.. A Woman's Path to Recovery Adherence Scale. Unpublished manuscript.

Najavits, L. M.. A Woman's Path to Recovery Adherence Scale score sheet. Unpublished manuscript.

Najavits, L. M. Women and addiction: The untold story [training outline]. Unpublished manuscript.

Quality Assurance Protocol--A Woman's Addiction Workbook (aka A Woman's Path to Recovery When Clinician-Led)

Training handouts

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
1.5	1.5	2.0	1.7

Dissemination Strengths

The program workbook is very well written. One-day training is available to interested implementers. An adherence scale provides a foundation for a fidelity assessment and reporting system.

Dissemination Weaknesses

A detailed implementation protocol is not provided. Although the program is described as a simple model that could be implemented by anyone qualified to work in a treatment program, the materials and adherence standards use concepts and language that suggest a more advanced level of clinical training may be needed. No information is provided on the selection, preparation, and monitoring of adherence evaluators. It is not clear how data derived from the adherence scale are summarized, to whom the data are reported, or how the data are used to improve program delivery.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
A Woman's Addiction Notebook: Your Guide to In-Depth Healing	$22 each, one per participant	Yes
1-day clinician training provided on site or by phone	About $1,600 per day plus travel expenses if applicable	No
Phone consultation	About $115 per hour	No