Self‐wise, Other‐wise, Streetwise (SOS) training, an intervention to prevent victimization in dual‐diagnosis patients: results from a randomized clinical trial

BACKGROUND AND AIMS: Patients with co‐occurring substance use and other mental disorders are vulnerable to crime victimization, yet no evidence‐based preventive interventions exist. Our aim was to test the efficacy of a new intervention, Self‐wise, Other‐wise, Streetwise training (SOS training), to prevent victimization in these dual‐diagnosis patients as an add‐on to care as usual. DESIGN: Multi‐site single‐blind parallel randomized controlled trial. SETTING: Three sites within one psychiatric service in Amsterdam, the Netherlands. PARTICIPANTS: Adult in‐patients and out‐patients with dual diagnosis (n = 250), who were predominantly male (70.4%), aged on average 42.1 years, and diagnosed with 3.7 DSM‐IV disorders. INTERVENTION AND COMPARATOR: Care as usual, consisting of pharmacotherapy combined with individual psychotherapy, group psychotherapy and/or supportive counselling (n = 125) was compared with care as usual plus SOS training: a 6‐week, 12‐session manualized group training focused on enhancing emotion regulation skills, conflict resolution skills and street skills (n = 125). MEASUREMENTS: Victimization was assessed with the Safety Monitor, the Dutch equivalent of the International Crime Victims Survey, in a face‐to‐face assessment. The primary outcome measure was treatment response (yes/no), with ‘yes’ defined as reporting at least a 50% reduction in the number of past‐year victimization incidents at the 14‐month follow‐up compared with baseline. Analyses were performed according to the intention‐to‐treat principle. FINDINGS: The proportion of participants achieving treatment response for total victimization was 54.0% in the control group and 67.6% in the experimental group, a significant difference [odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.02–3.11, P = 0.042]. Treatment response for violent victimization was achieved by 68.7% of the control group and 79.3% of the experimental group (OR = 1.75, 95% CI = 0.91–3.34, P = 0.092). With a Bayes factor of 2.26, this result was inconclusive. CONCLUSIONS: Among dual‐diagnosis patients, care as usual plus Self‐wise, Other‐wise, Streetwise training was more effective in preventing victimization than care as usual alone.