Does Mandated Treatment Improve Outcomes for Women with Co-occurring Disorders and Histories of Violence?

Although there is extensive literature on mandated treatment for people with substance use and mental health disorders, few studies address its effectiveness in women who also have histories of violence. Researchers examined data on 2726 such women from nine study sites participating in the national Women, Co-occurring Disorders, and Violence Study to determine if women mandated to substance abuse treatment had better substance use, mental health, and trauma outcomes compared with demographically similar women who entered treatment voluntarily. Analyses also compared the effect of integrated, trauma-informed treatment to services as usual in both groups. At baseline, more than one-third of participants had been mandated to treatment. Outcomes were measured at six and 12 months.

• Participants mandated to treatment (68% residential) showed significantly greater improvement on all four outcome measures (mental health, drug use, alcohol use, and trauma symptoms).
• Participants receiving integrated treatment also showed significantly greater improvement across all four outcome areas.
• There were no significant interactive effects between coercive status (mandatory or voluntary) and treatment condition (integrated or usual services) on any of the four outcome measures.

Comments by Norma Finkelstein, PhD, LICSW
This study confirms the value of mandatory treatment for women with co-occurring disorders regardless of whether they receive integrated treatment or services as usual. Although women mandated to treatment benefited even more from integrated treatment including mental health and trauma services, even those receiving services as usual showed improvement on all four domains. It would be interesting to see if these results held true for the subgroups of women in outpatient treatment or in later stages of recovery. It is also important to reiterate the authors' concern that these treatment results should not be generalized to retraumatizing practices such as seclusion and restraint.