Helping Women Recover & Beyond Trauma (HWR/BT)
About This Program
Target Population: Adult women with addictive disorders and a trauma history (e.g., abuse, domestic violence, community violence, etc.)
Program Overview
HWR/BT is a combined intervention of 32 sessions that integrates three theories: a theory of addiction, a theory of women's psychological development, and a theory of trauma; and then adds a psychoeducational component that teaches women what trauma is, its process, and its impact. The program model is organized into seven modules. The first four: Self, Relationships, Sexuality, and Spirituality are areas that recovering women have identified as triggers for relapse and as necessary for growth and healing. The last three: Violence, Abuse, and Trauma; The Impact of Trauma on Women's Lives; and Healing from Trauma; focus on the trauma with a major emphasis on coping skills, with specific exercises for developing emotional wellness. The program comes with facilitator's manuals, two participant workbooks (A Women's Journal and A Healing Journey), and 3 DVDs. The materials are designed to be user-friendly and self-instructive. A special edition for criminal justice settings has also been developed.
Note: The Beyond Trauma materials were expanded and revised in 2017. The changes include an additional session, expanded sessions, inclusion of information from neuroscience, updated statistics, and resources. These changes have not been reviewed by the CEBC and are not included in the program's Scientific Rating. The Helping Women Recover materials were expanded and revised in 2019. The changes include adding trauma-sensitive yoga exercises, updated gender information, expanded mindfulness information, new brain research as it relates to addiction and trauma, updated statistics, Adverse Childhood Experiences (ACEs) information, and the process of trauma and its effects on the mind and body. These changes have not been reviewed by the CEBC and are not included in the program's Scientific Rating.
Program Goals
The overall goals of Helping Women Recover & Beyond Trauma (HWR/BT) are:
- Decrease substance use disorders
- Decrease depression
- Increase understanding of trauma
- Decrease posttraumatic stress disorder (PTSD)
- Decrease trauma symptoms
- Increase self-efficacy
- Stabilize recovery
Logic Model
The program representative did not provide information about a Logic Model for Helping Women Recover & Beyond Trauma (HWR/BT).
Essential Components
The essential components of Helping Women Recover & Beyond Trauma (HWR/BT) include:
- The Helping Women Recover part of the combined curriculum with four modules with specific topic areas for each of the 20 sessions (there is also a self-administered recovery scale for each module):
- Opening Session: Introduction to the Program with total of 3 activities
- Module A: Self - 4 sessions with a total of 11 activities:
- Defining Self
- Sense of Self
- Self-Esteem
- Sexism, Stereotyping, and Power
- Module B: Relationships - 7 sessions with a total of 17 activities:
- Family of Origin
- Mothers
- Mother Myths
- Fathers
- Understanding Abuse and Trauma
- Interpersonal Violence
- Creating Supportive and Loving Relationships
- Module C: Sexuality - 5 sessions with a total of 15 activities:
- Sexuality and Addiction
- Body Image
- Gender Identity and Sexual Orientation
- Challenges to Healthy Sexuality
- Healthy Sexuality
- Module D: Spirituality - 3 sessions with a total of 11 activities:
- What is Spirituality?
- Mindfulness, Prayer, and Meditation
- Creating a Vision
- The Beyond Trauma part of the combined curriculum with three modules with specific topic areas for each of the 12 sessions.
- Module A: Violence, Abuse and Trauma - 4 sessions with a total of 11 activities:
- Introduction to the Program
- The Connections between Violence, Abuse and Trauma
- Power and Abuse
- The Process of Trauma and Reactions to Trauma
- Module B: The Impact of Trauma on Women's Lives - 2 sessions with a total of 8 activities:
- How Trauma Impacts our Lives
- Abuse and the Family
- Module C: Healing from Trauma - 6 sessions with a total of 21 activities:
- The Connection between Trauma and Addiction: Spirals of Recovery and Healing
- Grounding and Self-Soothing
- The Mind and Body Connection
- Our Feelings
- Healthy Relationships
- Endings and Beginnings
- Recommended group size: 6-12 women with one facilitator
- Each session also has an adaptation option for girls ages 13-18
Program Delivery
Adult Services
Helping Women Recover & Beyond Trauma (HWR/BT) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:
- Substance abuse, interpersonal violence, symptoms from experiencing trauma
Recommended Intensity:
One or two 2-hour sessions of Helping Women Recover each week. One or two 2-hour sessions of Beyond Trauma each week.
Recommended Duration:
32 sessions – approximately 4-7 months
Delivery Settings
This program is typically conducted in a(n):
- Outpatient Clinic
- Community-based Agency / Organization / Provider
- Group or Residential Care
- Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
- Other
Homework
Helping Women Recover & Beyond Trauma (HWR/BT) includes a homework component:
Women have two journals used consecutively to process their group experience and practice skills.
Languages
Helping Women Recover & Beyond Trauma (HWR/BT) has materials available in a language other than English:
Spanish
For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).
Resources Needed to Run Program
The typical resources for implementing the program are:
- Facilitator's guides
- Flip chart
- Workbooks
- Room with chairs in a circle
- A group facilitator
- Art supplies for collage work
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Licensed addiction counselor with experience in the field and with leading groups, or a Bachelor’s degree in a human services field
Manual Information
There is a manual that describes how to deliver this program.
Program Manual(s)
Manual information:
- Covington, S. (1999, rev. 2008 and 2019). Helping Women Recover: A program for treating addiction. John Wiley & Sons, Inc.
- Covington, S. (2003, rev. 2016). Beyond Trauma: A healing journey for women. Hazelden.
The facilitator guides and workbooks can be purchased online, please contact kim@stephaniecovington.com or go to www.stephaniecovington.com and select “Bookstore.”
Training Information
There is training available for this program.
Training Contact:
- Dr. Stephanie S. Covington
www.stephaniecovington.com
sc@stephaniecovington.com
phone: (858) 454-8528
Training Type/Location:
Training can be provided onsite or virtually. There are also trainings available at various sites in California and other parts of the U.S.
For more information, see www.stephaniecovington.com and www.centerforgenderandjustice.org.
Number of days/hours:
Generally 3 full days onsite or 6-7 days for 4 hours per day
Additional Resources:
There currently are additional qualified resources for training:
Please contact the Training Contact above for a list of certified trainers.
Implementation Information
Pre-Implementation Materials
There are no pre-implementation materials to measure organizational or provider readiness for Helping Women Recover & Beyond Trauma (HWR/BT).
Formal Support for Implementation
There is formal support available for implementation of Helping Women Recover & Beyond Trauma (HWR/BT) as listed below:
Formal support for implementation in addition to the written facilitator guide can be provided via consultation to include onsite observations, Zoom meetings, email communication, and telephone calls. Consultation and technical assistance are optional and can be contracted for a specific period of time depending on the needs of the agency. Formal support can include implementation issues, facilitator refresher courses, use of fidelity measures, leadership coaching, and trouble-shooting any challenges the agency is having regarding implementation. More information is available upon request through the program contact (see information at the bottom of the page).
Fidelity Measures
There are fidelity measures for Helping Women Recover & Beyond Trauma (HWR/BT) as listed below:
The fidelity instrument is a checklist. It can be used in a variety of ways: a self-report checklist; a self-report checklist to compare with a checklist completed by an observer; checklist used with video recordings. The Fidelity Instrument is available upon request. Please contact the program contact (see information at the bottom of the page).
Implementation Guides or Manuals
There are implementation guides or manuals for Helping Women Recover & Beyond Trauma (HWR/BT) as listed below:
The Facilitator Guide provides complete directions and implementation guidelines. The guide is available upon request through the program contact (see information at bottom of the page).
Research on How to Implement the Program
Research has not been conducted on how to implement Helping Women Recover & Beyond Trauma (HWR/BT).
Relevant Published, Peer-Reviewed Research
Messina, N., Grella, C. E., Cartier, J., & Torres, S. (2010). A randomized experimental study of gender-responsive substance abuse treatment for women in prison. Journal of Substance Abuse Treatment, 38(2), 97–107. https://doi.org/10.1016/j.jsat.2009.09.004
Type of Study:
Randomized controlled trial
Number of Participants:
115
Population:
- Age — Mean=36 years
- Race/Ethnicity — 48% White, 26% Hispanic, 17% Black, and 9% Other
- Gender — 100% Female
- Status — Participants were women who participated in prison based substance abuse treatment.
Location/Institution: California
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare post-release outcomes for women who participated in prison-based substance abuse treatment. Participants were randomized to a gender-responsive treatment program using the manualized Helping Women Recover and Beyond Trauma (HWR/BT) curricula or a standard prison-based therapeutic community. Measures utilized include the Addiction Severity Index (ASI) Lite and the Posttraumatic Stress Diagnostic Scale, along with administrative records from the prison and treatment providers. Results indicate that both groups improved in psychological well-being, but data from the Posttraumatic Stress Diagnostic Scale was not reported at the follow-up time point. HWR/BT participants had greater reductions in drug use, were more likely to remain in residential aftercare longer, and were less likely to have been re-incarcerated within 12 months after parole. Limitations include a lack of fidelity measures during the active treatment phase, the relatively small sample size, and limited power in the study.
Length of controlled postintervention follow-up: 1 year.
Messina, N., Calhoun, S., & Warda, U. (2012). Gender responsive drug court treatment: A randomized controlled trial. Criminal Justice and Behavior, 9(12), 1539–1558. https://doi.org/10.1177/0093854812453913
Type of Study:
Randomized controlled trial
Number of Participants:
94
Population:
- Age — Mean=36 years
- Race/Ethnicity — 58% White and 22% Hispanic
- Gender — 100% Female
- Status — Participants were women offenders admitted into participating drug court programs.
Location/Institution: San Diego, CA
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare outcomes for women offenders who participated in four drug court programs. Participants were randomly assigned to either Helping Women Recover and Beyond Trauma (HWR/BT) or standard mixed-gender treatment. Measures utilized include the Posttraumatic Stress Diagnostic Scale (PDS) and the Addiction Severity Index–Lite (ASI). Results indicate that there were no significant differences between the HWR/BT and standard groups on drug use or PTSD symptoms at follow-up. HWR/BT participants had better in-treatment performance and more positive perceptions related to their treatment experience. Limitations include the small sample size and concerns regarding treatment fidelity across the sites.
Length of controlled postintervention follow-up: Varies (5.7 to 6.9 months on average).
Saxena, P., Messina, N., & Grella, C. E., (2014). Who benefits from gender responsive treatment. Accounting for abuse history on longitudinal outcomes for women in prison. Criminal Justice and Behavior, 41(4), 417–432. https://doi.org/10.1177/0093854813514405
Type of Study:
Randomized controlled trial
Number of Participants:
115
Population:
- Age — Mean=35.7–36.1 years
- Race/Ethnicity — 48% White, 26% Latina, 17% Black, and 9% Other
- Gender — 100% Female
- Status — Participants were women in the California State Prison System.
Location/Institution: Valley State Prison for Women (VSPW) in California
Summary:
(To include basic study design, measures, results, and notable limitations)
The study used the same sample as Messina et al. (2010). The purpose of the study was to report on psychological and substance use outcomes for incarcerated women with prior experience with physical/sexual abuse receiving gender response treatment (GRT). Participants were randomized to the Integrity Program (GRT [now called Helping Women Recover and Beyond Trauma (HWR/BT)]) or the Destiny Program (using a standard TC group). Measures utilized include the Posttraumatic Stress Diagnostic Scale (PDS). Results indicate that women offenders who had experienced prior traumatic events (i.e., physical/sexual abuse) improved their psychological status and decreased the number of substances they used in the trauma-informed gender-responsive substance abuse treatment group. Even when controlling for the presence of clinical level trauma distress (i.e., posttraumatic stress disorder [PTSD]), HWR/BT successfully moderated the associations between abuse and depression and abuse and substance use. Limitations include lack of generalizability to other populations, reliability of self-reported measures, and the study did not have a systematic procedure to evaluate the fidelity of the intervention to HWR/BT's principles and specific components.
Length of controlled postintervention follow-up: 6 and 12 months.
Additional References
Covington, S. (December 2013). "Chapter IV: Understanding and applying gender differences in recovery." In United Nations Interregional Crime and Justice Research Institute (UNICRI) (Eds.), Dawn Drug Alcohol Woman Network: Promoting a gender-responsive approach to drug addiction (a collection of good practices). Author.
Messina, M. (2021). The evolution of gender-and trauma-responsive criminal-justice interventions for women. HSOA Journal of Addiction & Addictive Disorders, 8(2), Article 100070.https://doi.org/10.24966/AAD-7276/100070
Poole, N., & Greaves, L. (Eds). (2012). Becoming trauma informed. Toronto, Ontario, Canada: Centre for Addiction and Mental Health (CAMH).
Contact Information
- Stephanie S. Covington, PhD, LCSW
- Agency/Affiliation: Center for Gender and Justice
- Website: stephaniecovington.com/books/bookstore
- Email: sc@stephaniecovington.com
- Phone: (858) 454-8528
- Fax: (858) 454-8598
Date Research Evidence Last Reviewed by CEBC: October 2024
Date Program Content Last Reviewed by Program Staff: June 2022
Date Program Originally Loaded onto CEBC: June 2013
