Evaluation and Treatment of Substance Abuse in Veterans With PTSD Disability Claims
Condition: Attendance at Treatment; PTSD, Substance Use, and Attendance at Treatment
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      Veterans can apply for compensation and pension (C & P) benefits for a disability related to
      military service. The application exam for these benefits provides an opportunity for
      Veterans returning from service to access VA care. The investigators will recruit Veterans
      applying for C & P to participate in this study. All enrolled participants will complete
      questionnaires around the time of their C & P exam related to substance abuse, PTSD, service
      use, and attitudes. The investigators will monitor enrolled Veterans' attendance at treatment
      over time, and examine whether C & P award, substance use, and beliefs about benefits are
      related to treatment attendance. Some enrolled participants will be assigned to one of two
      study groups: a treatment group and a no-additional-treatment group. People assigned to these
      groups will complete the same substance abuse, PTSD, service use, and attitudes
      questionnaires two additional times during the study. Participants assigned to the treatment
      group will receive information about the relationship between substance use and PTSD and will
      be referred to relevant treatment. The investigators will test whether Veterans who receive
      no-additional-treatment have different symptoms over time and attend less treatment sessions
      (mental health or substance abuse) than people assigned to treatment.
    

Detailed description: 
      The Compensation examination that determines if a Veteran is entitled to any disability
      payments related to military service is a crucial gateway to accessing VA care for returning
      OEF/OIF Veterans. However, researchers and oversight agencies have noted that examiners
      typically do not have guidelines for evaluating comorbid conditions like substance abuse and
      for referring patients to treatment.

      In the Evaluative Component of this study, OEF/OIF Veterans presenting for Compensation
      evaluations for PTSD will be approached to undergo a paid battery of confidential substance
      use, PTSD, service use and attitude assessments prior to their scheduled Compensation
      examinations. The batteries will be collected again twice, four and twelve weeks after the
      Compensation examinations. Long-term follow-up data will be extracted from VA databases
      including diagnoses, the results of the Veterans' Compensation evaluations, award
      determination, use of VA services and attendance at mental health and/or substance abuse
      treatment.

      In the Clinical Trial Component of this study, one hundred sixty Veterans identified during
      the baseline evaluation as having a substance use disorder will be randomly assigned to a
      session of Screening, Brief Intervention and Referral to Treatment (SBIRT) or to
      No-Additional-Treatment. SBIRT is an approach to identifying and treating patients with
      substance abuse issues who are presenting for purposes other than substance abuse treatment.
      It involves Motivational Interviewing, which has been a consistently effective approach to
      facilitating engagement in substance abuse treatment in Veterans (Davis, Baer et al. 2003)
      and other populations. The study will examine factors associated with attendance at treatment
      including substance use, Veterans' beliefs about benefits, and compensation award. Group
      comparisons will be conducted on rates of treatment attendance, alcohol use, and PTSD
      symptoms.
    

Intervention name(s): SBIRT
Intervention type(s): Behavioral
Intervention description(s): SBIRT Therapy overview-
Therapist explains purpose of the therapy.
Inquiry about Compensation examination-ask if Veteran has questions about determination process and address concerns.
Discuss relationship between PTSD and substance use- long-term substance use is a form of avoidance and barrier to recovery.
Discuss treatment needs, administer screening, provide feedback.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment