Motivating Substance Abusing Veterans, via Family to Seek Treatment

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DESCRIPTION (provided by applicant): In keeping with the guidelines and points of emphasis established by the VHA Uniform Mental Health Services Code, the third submission of this research study is a Phase II randomized clinical trial designed to evaluate the efficacy of two interventions for the concerned significant others (CSOs) of OEF/OIF/OND veterans with substance abuse disorders (SUD). Community Reinforcement and Family Training (CRAFT) has demonstrated efficacy in civilian populations, and will be compared to a standard community treatment option, Al-Anon Facilitation. Data obtained in recent years has made it increasingly evident that harmful levels of alcohol drinking and substance abuse are extremely prevalent amongst OEF/OIF/OND veterans who have enrolled with Veterans Affairs Health Care System (regardless of the type of health services received), as well as within the 58% of eligible OEF/OIF/OND veterans who have not pursued treatment at the VA. The consequences of SUD in families are profound, and VA is keen to offer useful interventions aiding family members of OEF/OIF/OND veterans (cf., Public Law 110-387 Veterans' Mental Health and Other Care Improvements Act of 2008). A secondary outcome of family intervention can be veteran treatment seeking. The willingness of OEF/OIF/OND veterans to access mental health services is alarmingly low, despite the negative consequences (e.g. health, financial, legal) to their families and to themselves. The overall goal of this propoal is to determine whether an intervention designed to target the CSOs of veterans will improve CSO interactions with veterans, subsequently resulting in increased use of existing evidence-based treatment for their SUD. A total of 104 CSOs (the spouse or intimate partner) who report concern about their OEF/OIF/OND veterans substance abuse will be randomly assigned to therapist-guided CRAFT (n=52) or therapist-guided Al-Anon Facilitation (e.g. 12-Step; n=52). Both treatments will be delivered in individual sessions on an outpatient basis for 12- weeks. Primary and secondary outcome measures will be assessed at baseline, at the end of treatment, and 24, 36 and 48 weeks after treatment completion. Predictive variables will be assessed weekly, following therapy sessions. The proposed research is innovative because it will teach CSOs different styles of coping with veteran's drinking and how to motivate their OEF/OIF/OND veterans who are treatment resistant to seek treatment for their SUD. We expect that this research will prove successful at improving the relationship functioning of the CSO and the veteran. The major impact of this research will be to address a gap in the knowledge-base by testing and refining a method to encourage treatment-avoidant veterans to participate in existing evidence-based treatments. PUBLIC HEALTH RELEVANCE: Families of veterans returning from the current Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND) conflicts are at increased risk for consequences of Substance Abuse Disorder (SUD) including familial alcohol misuse. Whereas several effective treatment programs have been developed and are readily accessible to these individuals, returning OEF/OIF/OND veterans are often particularly reluctant to seek treatment. Within civilian populations, the Community Reinforcement and Family Training (CRAFT) intervention has been proven to be effective at increasing the success of concerned significant others in motivating SUD partners to treatment. The goal of the current study is to determine whether this treatment can be applied to the concerned significant other partners of OEF/OIF/OND veterans in order to improve treatment seeking. This objective is consistent with the VHA Uniform Mental Health Services Codes.