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，大约有10％的退伍军人从OIF认可筛查问题中返回的问题表明他们患有PTSD，并且由于这些症状，饮酒和其他药物使用障碍的风险特别高。所有OEF/OIF退伍军人中的一半和大多数具有PTSD的人都将申请残疾益处。索赔人接受所需的VA补偿检查，以确定其残疾的性质和严重性，最终将其补偿金额。申请薪酬福利的有PTSD症状的退伍军人处于其疾病课程的关键阶段，因为他们对是否考虑自己是否残疾，诊断是什么以及是否从事治疗做出了深远的全球决策。残疾评估为评估退伍军人伴随药物滥用并提供治疗的机会提供了一个完美的机会，但通常会错过此机会。也有很多猜测，但很少有数据关于哪些因素决定了哪些有PTSD的退伍军人参加治疗以及此次出席的关系与他们的薪酬索赔的关系。在本研究的评估部分中，接受PTSD残疾评估的640个OEF/OIF退伍军人的固定比例样本将完成一个评估电池，该评估电池包括潜在的结果预测因素：使用物质使用，PTSD严重程度，态度，态度concestring concerning conferning Conferting Ressisation Consinication Consinication和其他。然后，大约有160名退伍军人被确定为具有药物使用障碍或危险的饮酒，然后将进入研究的临床试验部分，并将根据SAMHSA的SBIRT（筛查，简短的干预和治疗）或无预期治疗将其随机分配给干预措施。主要的临床试验结果将在任何精神健康和/或药物滥用治疗中参加数周，并戒除非法药物和酒精。所有退伍军人，包括评估部分中的退伍军人，将在进行残疾确定后的整个期间提取赔偿和VA服务使用数据后的四个星期和十二周重新评估。预测因子对退伍军人使用，PTSD严重程度以及对心理健康和/或药物滥用治疗的出席的影响将在申请服务连接，申请和残疾确定后的时期内确定。拟议的研究将确定（i）药物滥用对结果和治疗的出席的影响； （ii）对薪酬考试和其他预测因素的态度对预后和出席治疗的影响； （iii）筛查和转介治疗的功效，这种治疗方法有可能改变与VA的广泛接触点。

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