Trauma-Informed Women's SUD Care — Speaker Companion

⏱️ Duration: 40 Minutes
👥 Audience: Psychiatry Residents, Addiction Fellows
📊 Slides: 18

Quick Reference

Key Statistic
50% of women in SUD treatment have trauma history
Critical Safety Point
Never screen for IPV with partner present
Board Trap
"Sequential" PTSD/SUD treatment (correct = integrated)
Equity Alert
Black women receive SUD counseling at half the rate of white women

Session Timing

0:00–0:05 Introduction & Epidemiology
0:05–0:15 Active Ingredients & Program Components
0:15–0:25 Integrated PTSD Treatment (COPE spotlight)
0:25–0:32 Do-No-Harm Practices & IPV Workflow
0:32–0:40 Equity, Cases, & Q&A
Slide 01
Title Slide
2 min

Speaker Notes

  • Welcome audience, establish credibility
  • Preview disclosure: off-label interventions discussed
  • Set expectation: interactive cases ahead
  • Emphasize practical application over theory
💡 Tip: Make eye contact with back row during welcome
→ Transition: "Today we'll cover the active ingredients that actually improve outcomes for women with SUD..."

Anticipated Questions

Q1 "Is this presentation accredited for CME?"

Yes, this session is approved for AMA PRA Category 1 Credit™. Instructions for claiming credit are in your email.

Easy · 1 min
Q2 "Will slides be available after?"

Yes, PDF will be emailed within 24 hours. The interactive HTML version is available on the learning portal.

Easy · 1 min
Slides 03–04
The Problem & Barriers
5 min

Speaker Notes

  • Emphasize the gap: 1/3 of SUD population but 1/5 in treatment
  • "Telescoping" = accelerated progression despite lower use
  • Structural barriers are NOT "excuses"—they're treatment variables
  • Only 6% offer childcare—this is a system failure, not patient failure
⚠️ Watch for: Trainees attributing dropout to "low motivation" rather than structural barriers
🎯 Key Point: Women have equal/better retention once engaged—the problem is access, not ability

Anticipated Questions

Q1 "Why can't women just use standard mixed-gender programs?"

Mixed-gender settings often trigger trauma responses. Women report remaining silent about IPV, sexual violence, and shame when men are present. The WRG study showed women-only groups had better outcomes. It's not segregation—it's safety.

Medium · 2 min
Q2 "Isn't providing childcare enabling dependency?"

No—childcare is a structural facilitator, not an enabler. Research shows it's a statistically significant predictor of retention. A mother who cannot find childcare cannot attend treatment. This is harm reduction, not enabling.

Medium · 2 min
Slides 06–07
Integrated PTSD Treatment
8 min

Speaker Notes

  • The "sequential" model is outdated and harmful
  • Removing substances without addressing trauma → PTSD rebound → relapse
  • COPE: 2025 Swedish RCT confirms safety and efficacy
  • Emphasize: PTSD improvement drives alcohol reduction more than reverse
⚠️ Watch for: Trainees suggesting "get sober first, then treat trauma"
🎯 Key Point: COPE and Seeking Safety are safe in active substance use

Anticipated Questions

Q1 "Won't trauma therapy destabilize early recovery?"

This was the historical concern, but evidence refutes it. The 2025 COPE RCT found no safety concerns. Seeking Safety is specifically designed to be non-exposure based for early recovery. The risk is NOT treating trauma—patients relapse when PTSD symptoms rebound.

Hard · 3 min
Q2 "What's the difference between COPE and Seeking Safety?"

COPE uses exposure therapy (prolonged exposure) and is more intensive. Seeking Safety is present-focused, non-exposure, and teaches coping skills. COPE may be better for stable patients; Seeking Safety for early recovery or unstable patients.

Medium · 2 min
Slide 09
IPV Screening Workflow
5 min

Speaker Notes

  • ALWAYS screen alone—this is non-negotiable
  • Universal framing: "We ask all patients these questions"
  • Warm referral = calling WITH the patient, not handing a card
  • Do NOT pressure abstinence without safety plan
⚠️ Watch for: Screening with partner in room or asking "Are you safe at home?" (ineffective)
🎯 Key Point: Substance use may be part of abuser's control tactics

Anticipated Questions

Q1 "What if she denies IPV but I suspect it?"

Document your suspicion, provide universal education (CUES approach), and offer resources regardless of disclosure. Safety planning can be done hypothetically: "If you ever felt unsafe, here's what you could do..." Build trust for future disclosure.

Hard · 3 min
Q2 "Do I have to report IPV to police?"

Mandatory reporting laws vary by state. Most do NOT require reporting competent adults. Know your state law. Reporting without consent can endanger the victim. Focus on safety planning and warm referrals to advocacy organizations.

Hard · 3 min
Slide 11
Interactive Case: Maria
5 min

Speaker Notes

  • Read case details slowly
  • Pause for audience to formulate answer
  • Click reveal button AFTER discussion
  • Emphasize: "This is a board trap"
⚠️ Watch for: Trainees suggesting increased dose or stricter attendance policies
🎯 Key Point: The answer is structural (women-only + trauma-informed), not pharmacological
→ Transition: "This case illustrates why gender-responsive care isn't optional..."

Anticipated Questions

Q1 "What if our program can't offer women-only groups?"

Even within mixed-gender programs, create women-only sessions for specific topics (trauma, relationships, parenting). Partner with local women's programs for referrals. Advocate for program changes—cite the WRG evidence.

Medium · 2 min
Slide 17
Board-Style Question
3 min

Speaker Notes

  • This tests the "sequential vs integrated" concept
  • The distractor is "complete detox first"—this is outdated
  • Emphasize that the patient's previous failure was likely due to sequential approach
🎯 Key Point: COPE and Seeking Safety are specifically designed for co-occurring disorders

Anticipated Questions

Q1 "What if the patient refuses integrated treatment?"

Meet the patient where they are. If they refuse trauma work, start with SUD treatment using a trauma-informed approach (safety, trust, collaboration). Revisit integrated treatment as trust builds. Document the offer and rationale.

Medium · 2 min