Background:
High inpatient readmissions among Veterans with substance use disorders (SUD) constitutes
a costly and persistent healthcare problem. Studies demonstrate that patients with SUDs
return to inpatient treatment multiple times and that high inpatient service utilization
in this population is associated with high rates of co-occurring mental illness (SUD/MI),
homelessness, suicidality, and continued impairment in health and social functioning. A
significant proportion (21%) of Veterans with SUD/MI are homeless, at high-risk for
suicide, and represent one of the largest, most chronic groups of psychiatric patients
treated in the VA Healthcare System. In effort to ameliorate inpatient readmission rates,
VHA Handbook 1160.06, drafted in 2013, espouses the development and implementation of
uniform recovery-oriented mental health (MH) services, which include treatment of SUDs
addressing goals of recovery, improved quality of life, and community integration. The
three types of treatments that will be evaluated are:
Combined Recovery Program (CRP), a six-session treatment group designed to explore
goals, values, and personal strengths about making a change for overall quality of
life, health and well-being combined with skill building designed for helping to
live a more stable life in their own home that will include money management for
financial success and home maintenance.
A Home Telehealth program, called Stable and Able (S&A), designed to help maintain
skills to stay sober and allows continued communication with one of the mental
health staff on a daily basis to provide additional support for the next 3 months
after discharge.
Treatment-as-usual (TAU), which is the treatment currently provided on the unit,
consisting of various mental health topics and sessions designed to help with
recovery.
All participant will receive TAU.
Objectives:
Specific Aim I: Assess the relative effects of Treatment Engagement and Substance Use
[and SUD-related problems] between CRP+S&A+TAU vs. CRP+TAU and CRP+S&A+TAU vs. TAU only
by 3-mos follow-up.
Primary Hypothesis 1a: Treatment Engagement: Participants in CRP + S&A+TAU will attend
more outpatient SUD treatment sessions and general MH treatment sessions compared to
participants in CRP and to TAU.
Primary Hypothesis 1b: Substance Use: Participants in CRP + S&A+TAU will lower quantity
and frequency of substance use and SUD-related problems compared to participants in
CRP+TAU and to TAU only.
Secondary Hypothesis 1c: Preventable Services: Participants in CRP + S&A+TAU will reduce
Preventable Healthcare Services (hospital readmissions and emergency department visits)
compared to participants in CRP+TAU and to TAU only.
Secondary Hypothesis 1d: Participants in CRP + S&A+TAU will report Greater QoL; # of Days
Living in Stable Housing; and # of Days Engaging in Community Events and/or Activities
compared to CRP+TAU and to TAU only.
Specific Aim II: Conduct Veteran participant and Staff thematic interviews and to assess
qualitative facilitators and barriers to implementation.
Methods:
195 Veterans with SUDs admitted into the Charleston VAMC inpatient unit will be
recruited. Participants will be randomly assigned to: (1) CRP + S&A + TAU; (2) CRP+TAU;
and (3) TAU. All participants will be followed-up at 1 and 3-months and data analyzed
using mixed methods.
