Pilot of Pragmatic SBIRT Study
Condition: Substance Use Disorders; Pain
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      Veterans seeking compensation for musculoskeletal (MSD) conditions often develop chronic pain
      and are at high risk for substance misuse. This study is designed to pilot test the
      Screening, Brief Intervention and Referral to Treatment for Pain Management (SBIRT-PM)
      intervention. SBIRT-PM is designed to reduce pain and reduce risky substance use among
      veterans applying for VA Benefits for a musculoskeletal condition, in part by helping
      Veterans get connected to comprehensive pain treatment. This pilot will involve a 2-year
      period to arrange for SBIRT Counselors at a single site to counsel Veterans throughout New
      England by phone with SBIRT-PM to test the acceptability and feasibility of the intervention.
    

Detailed description: 
      In 2015 alone, 97,223 new Veterans under age 35 began receiving compensation for injuries
      related to their military service. In total, there are 559,999 post-9/11 Veterans being
      compensated for back or neck conditions, and a partially overlapping 596,250 for limitation
      of flexion in joints. Veterans seeking compensation for musculoskeletal conditions often
      develop chronic pain and are at high risk for substance misuse. Early intervention is needed
      to arrest worsening pain and risky substance use, particularly among post-9/11 Veterans for
      whom engagement in non-pharmacological pain treatment has the potential to improve their
      overall quality of life and spare them the complications of opioid treatments. The
      service-connection application is an ideal point-of-contact for initiating early intervention
      treatments for these at-risk Veterans.

      This study is designed to pilot test the Screening, Brief Intervention and Referral to
      Treatment for Pain Management (SBIRT-PM) intervention. SBIRT-PM is designed to reduce pain
      and reduce risky substance use among veterans applying for VA Benefits for a musculoskeletal
      condition, in part by helping Veterans get connected to comprehensive pain treatment. This
      pilot will involve a 2-year period to arrange for SBIRT Counselors at a single site to
      counsel Veterans throughout New England by phone with SBIRT-PM to test the acceptability and
      feasibility of the intervention.

      During the two-years pilot trial, the team will prepare SBIRT-PM for implementation by
      establishing communication (Relational Coordination is the theoretical framework) between the
      "hub" where the SBIRT-PM clinician is sited and the "spoke" sites, establishing study-related
      procedures, and piloting the intervention at each of the eight VA medical centers in New
      England.
    

Intervention name(s): SBIRT-PM
Intervention type(s): Behavioral
Intervention description(s): SBIRT-PM involves an initial telephone-delivered session followed by up to three calls to Veterans in a 12-week period to support Veteran engagement in multi-modal non-pharmacological pain care and to motivate those who misuse substances to change this problematic behavior. SBIRT-PM also includes coordination between the SBIRT-PM clinicians and the PACT nurse case manager after the initial session to support these patient outcomes.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Screening