Attendance at Treatment Clinical Trial
Official title:
Evaluation and Treatment of Substance Use in Veterans With PTSD Disability Claims
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.
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.
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