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% 从 OIF 返回的退伍军人认可筛查问题，表明他们患有创伤后应激障碍 (PTSD)，并且由于这些症状，他们患酒精和其他物质使用障碍的风险特别高。所有 OEF/OIF 退伍军人和大多数患有 PTSD 的退伍军人预计将申请残疾福利。索赔人接受必要的 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金额。申请补偿福利的患有创伤后应激障碍（PTSD）症状的退伍军人正处于病程的关键阶段，因为他们正在就是否认为自己是残疾人、他们的诊断是什么以及是否接受治疗做出影响深远的全球决定。残疾评估提供了一个评估退伍军人伴随的药物滥用情况并提供治疗的绝佳机会，但这个机会通常会被错过。关于哪些因素决定哪些患有创伤后应激障碍的退伍军人接受治疗以及这种就诊与他们的赔偿要求之间的关系，也有很多猜测，但数据很少。在本研究的评估部分中，接受 PTSD 残疾评估的 640 名 OEF/OIF 退伍军人的固定比例样本将完成一个评估组，其中包括潜在的结果预测因素：物质使用、PTSD 严重程度、对补偿检查的态度等。大约 160 名被确定患有药物滥用障碍或危险饮酒的退伍军人将进入该研究的临床试验部分，并将被随机分配接受基于 SAMHSA 的 SBIRT（筛查、简短干预和转诊治疗）或无额外治疗的干预措施。主要临床试验结果将是接受任何心理健康和/或药物滥用治疗的几周以及戒除非法药物和酒精的几天。所有退伍军人，包括来自评估部分的退伍军人，将在补偿检查后四周和十二周进行重新评估，并在做出残疾确定后的这段时间内提取 VA 服务使用数据。预测因素对退伍军人药物使用、创伤后应激障碍严重程度以及接受心理健康和/或药物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的时间段内确定。拟议的研究将确定（i）药物滥用对治疗结果和就诊率的影响； (ii) 对补偿检查和其他预测因素的态度对结果和治疗出席率的影响； (iii) 筛查和转诊治疗的功效，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