Evaluation and Treatment of Substance Use in Veterans with PTSD Disability Claims

患有创伤后应激障碍 (PTSD) 残疾索赔的退伍军人的药物使用评估和治疗

• 批准号: 8393245
• 负责人: Marc I Rosen
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8393245
• 关键词: Abstinence; Accounting; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Attitude; Award; Belief; Caring; Clinical Trials; Data; Databases; Diagnosis; Disability Evaluation; Disabled Persons; Disease; Drug usage; Evaluation; Financial compensation; Fostering; Guidelines; Illicit Drugs; Intervention; Intoxication; Measures; Mental Health; Military Personnel; Nature; Notification; Outcome; Patients; Perception; Post-Traumatic Stress Disorders; Randomized; Research Personnel; Sampling; Schedule; Services; Severities; Staging; Substance Use Disorder; Substance abuse problem; Symptoms; Time; Treatment Efficacy; Treatment outcome; Veterans; base; brief intervention; disability; disability payment; drinking; follow-up; high risk; improved; screening; screening, brief intervention, referral, and treatment; secondary outcome; substance abuse treatment; treatment duration

DESCRIPTION (provided by applicant): Post-deployment screening suggests that approximately 10% of veterans returning from OIF endorse screening questions suggesting they have PTSD, and because of these symptoms, are at particularly high risk for alcohol and other substance use disorders. Fully half of all OEF/OIF veterans and a majority of those with PTSD are expected to apply for disability benefits. Claimants undergo the required VA Compensation examination to determine the nature and severity of their disability and ultimately, the amount they will be compensated. Veterans with PTSD symptoms who apply for Compensation benefits are at a crucial stage in their disease course because they are making far-reaching global decisions about whether to consider themselves disabled, what their diagnoses are, and whether to engage in treatment. The disability evaluation presents a perfectly-timed opportunity to evaluate veterans' concomitant substance abuse and offer treatment, but this opportunity is typically missed. There is also much speculation but little data concerning what factors determine which veterans with PTSD attend treatment and the relationship of this attendance to their Compensation claim. In the Evaluative Component of this study, a fixed-ratio sample of 640 OEF/OIF veterans undergoing PTSD disability evaluations will complete an assessment battery consisting of potential predictors of outcome: substance use, PTSD severity, attitudes concerning Compensation examinations and others. Approximately 160 veterans identified as having a Substance Use Disorder or risky alcohol use will then enter the Clinical Trial Component of the study, and will be randomly assigned to an intervention based on SAMHSA's SBIRT (Screening, Brief Intervention and Referral to Treatment) or No-Additional-Treatment. The primary clinical trial outcomes will be weeks attending any mental health and/or substance abuse treatment and days abstinent from illicit drugs and alcohol. All veterans, including those from the Evaluation Component, will be re-assessed four weeks and twelve weeks after the Compensation examination and VA service use data will be extracted through the period after a disability determination has been made. The effect of the predictors on veterans' substance use, PTSD severity, and attendance at mental health and/or substance abuse treatment will be determined for the time periods before applying for service connection, after applying, and after disability determination. The proposed studies will determine (i) the impact of substance abuse on outcomes and attendance at treatment; (ii) the impact of attitudes about the Compensation exam and other predictors on outcomes and attendance at treatment; and (iii) the efficacy of screening and referral to treatment, a treatment approach that has the potential to transform a widely-used point of contact with VA.

描述（由申请人提供）： 部署后筛查表明，大约10%的从OIF返回的退伍军人赞同筛查问题，表明他们患有PTSD，并且由于这些症状，酒精和其他物质使用障碍的风险特别高。预计OEF/OIF退伍军人中有整整一半和大多数患有PTSD的人将申请残疾福利。索赔人接受规定的VA赔偿检查，以确定其残疾的性质和严重程度，并最终确定他们将获得的赔偿额。有创伤后应激障碍症状的退伍军人申请补偿福利正处于疾病过程的关键阶段，因为他们正在做出影响深远的全球决定，决定是否认为自己残疾，他们的诊断是什么，以及是否进行治疗。残疾评估提供了一个完美的时机来评估退伍军人的伴随药物滥用和提供治疗，但这个机会通常是错过了。也有很多猜测，但很少有数据关于什么因素决定哪些退伍军人与创伤后应激障碍参加治疗和这种出席的关系，他们的赔偿要求。在本研究的评估部分，640名接受PTSD残疾评估的OEF/OIF退伍军人的固定比例样本将完成一组评估，包括结果的潜在预测因素：物质使用，PTSD严重程度，对赔偿检查的态度等。大约160名被确定为患有物质使用障碍或危险酒精使用的退伍军人将进入该研究的临床试验部分，并将根据SAMHSA的SBIRT（筛选，简短干预和转诊治疗）或无额外治疗随机分配干预。主要临床试验结果将是参加任何精神健康和/或药物滥用治疗的周数和戒除非法药物和酒精的天数。所有退伍军人，包括来自评估部门的退伍军人，将在赔偿检查后四周和十二周进行重新评估，并将在做出残疾确定后的整个期间提取退伍军人管理局服务使用数据。预测因素对退伍军人的物质使用，PTSD严重程度和参加心理健康和/或物质滥用治疗的影响将在申请服务连接之前，申请之后和残疾确定之后确定。拟议的研究将确定（i）药物滥用对治疗结果和出勤率的影响;（ii）对补偿考试和其他预测因素的态度对治疗结果和出勤率的影响;以及（iii）筛查和转诊治疗的有效性，这种治疗方法有可能改变广泛使用的VA接触点。

项目成果

Comparison of attitudes towards the service connection claims process among veterans filing for PTSD and veterans filing for musculoskeletal disorders.

• DOI: 10.1097/md.0000000000027068
• 发表时间: 2021-09-03
• 期刊: Medicine
• 影响因子: 1.6
• 作者: Spinola S;Fenton BT;Meshberg-Cohen S;Black AC;Rosen MI
• 通讯作者: Rosen MI