Preventing Violence Among Veterans in Substance Use Disorder Treatment
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | June 2012 |
| End Date: | September 2016 |
Impact of Interventions to Reduce Violence and Substance Abuse Among VA Patients
The purpose of this study is to examine the impact on both clinical (violence and substance
use) outcomes and health services use (substance use disorder and mental health treatment)
compared to standard SUD treatment (enhanced treatment as usual) of
1. an integrated Motivational Interviewing-Cognitive Behavioral Therapy (MI-CBT) violence
prevention treatment intervention delivered during the 8-week early substance use
disorder treatment phase; and
2. MI-CBT plus a continuing care (CC) intervention for the 3-month continuing care period
following the early treatment phase MI-CBT+CC).
The study will provide important new information regarding the role and relative impact of
both early treatment and continuing care interventions designed to impact substance use and
violence, and whether combining such interventions yields additional benefits.
use) outcomes and health services use (substance use disorder and mental health treatment)
compared to standard SUD treatment (enhanced treatment as usual) of
1. an integrated Motivational Interviewing-Cognitive Behavioral Therapy (MI-CBT) violence
prevention treatment intervention delivered during the 8-week early substance use
disorder treatment phase; and
2. MI-CBT plus a continuing care (CC) intervention for the 3-month continuing care period
following the early treatment phase MI-CBT+CC).
The study will provide important new information regarding the role and relative impact of
both early treatment and continuing care interventions designed to impact substance use and
violence, and whether combining such interventions yields additional benefits.
Objective: Rates of violence in Substance Use Disorder (SUD) treatment samples often exceed
50%, with studies showing rates of past-year violence >70% when considering violence
occurring with either intimate partners or others. Violence has numerous costs to Veterans
and their families, in terms of physical (e.g., injuries) and psychosocial problems (mental
health, legal problems, marital problems, poorer functioning for their children, etc.). To
date, only one treatment approach (Behavioral Couples Therapy - BCT) has been established
that reduces both substance use and violence, and BCT focuses exclusively on the couples'
relationship. Given that a small proportion of Veterans in SUD treatment have a partner
willing or able to attend treatment, and that a substantial amount of violence occurs with
non-partners, there is a clear need for interventions that do not require partner
participation and focus on violence and relapse prevention more generally. Based on prior
findings, new intervention approaches targeting the use of violence prevention skills and
means of sustaining substance use remission are needed.
The primary objectives of this study are to examine the impact on both substance use and
violence outcomes of:
1. an acute treatment phase integrated Motivational Interviewing-Cognitive Behavioral
Treatment intervention (MI-CBT); and
2. MI-CBT plus a violence and substance use prevention Continuing Care intervention
(MI-CBT+CC) intervention.
Research Plan: Participants will be randomized to one of three conditions: MI-CBT, MI-CBT+CC
or an enhanced treatment as usual (E-TAU) control condition with follow-up interviews
targeting violence and substance use outcomes at 3, 6 and 12-months. The MI-CBT intervention
involves six individual sessions delivered during the acute SUD treatment phase, combines
Motivational Interviewing (MI) and CBT approaches targeting violence and substance use, and
has been developed, piloted and refined by the investigators. The MI-CBT+CC intervention
includes acute phase MI-CBT plus weekly telephone sessions for an additional 3-month period,
and is designed to address both post-treatment violence and substance use through
facilitating SUD remission and use of violence prevention skills. The MI-CBT+CC intervention
is adapted from a continuing care intervention shown to help consolidate and maintain gains
made in treatment.
Methods: Veterans with substance use disorders will be recruited from the Substance Abuse
Clinic (SAC) at the VA Ann Arbor Healthcare system. Approximately 855 Veterans enrolling in
SAC will be consented and screened, and those screening positive for severe and recent
violence (~30%) and meeting other project inclusion/exclusion criteria will be eligible for
participation in the randomized controlled trial (n = 210). The clinical interventions will
be delivered by master's level clinicians, who will be monitored and supervised by licensed
psychologists. Primary dependent measures (violence, substance use) will be measured at
baseline and follow-up interviews, and the impact of the interventions on services use
during the follow-up period also will be examined.
50%, with studies showing rates of past-year violence >70% when considering violence
occurring with either intimate partners or others. Violence has numerous costs to Veterans
and their families, in terms of physical (e.g., injuries) and psychosocial problems (mental
health, legal problems, marital problems, poorer functioning for their children, etc.). To
date, only one treatment approach (Behavioral Couples Therapy - BCT) has been established
that reduces both substance use and violence, and BCT focuses exclusively on the couples'
relationship. Given that a small proportion of Veterans in SUD treatment have a partner
willing or able to attend treatment, and that a substantial amount of violence occurs with
non-partners, there is a clear need for interventions that do not require partner
participation and focus on violence and relapse prevention more generally. Based on prior
findings, new intervention approaches targeting the use of violence prevention skills and
means of sustaining substance use remission are needed.
The primary objectives of this study are to examine the impact on both substance use and
violence outcomes of:
1. an acute treatment phase integrated Motivational Interviewing-Cognitive Behavioral
Treatment intervention (MI-CBT); and
2. MI-CBT plus a violence and substance use prevention Continuing Care intervention
(MI-CBT+CC) intervention.
Research Plan: Participants will be randomized to one of three conditions: MI-CBT, MI-CBT+CC
or an enhanced treatment as usual (E-TAU) control condition with follow-up interviews
targeting violence and substance use outcomes at 3, 6 and 12-months. The MI-CBT intervention
involves six individual sessions delivered during the acute SUD treatment phase, combines
Motivational Interviewing (MI) and CBT approaches targeting violence and substance use, and
has been developed, piloted and refined by the investigators. The MI-CBT+CC intervention
includes acute phase MI-CBT plus weekly telephone sessions for an additional 3-month period,
and is designed to address both post-treatment violence and substance use through
facilitating SUD remission and use of violence prevention skills. The MI-CBT+CC intervention
is adapted from a continuing care intervention shown to help consolidate and maintain gains
made in treatment.
Methods: Veterans with substance use disorders will be recruited from the Substance Abuse
Clinic (SAC) at the VA Ann Arbor Healthcare system. Approximately 855 Veterans enrolling in
SAC will be consented and screened, and those screening positive for severe and recent
violence (~30%) and meeting other project inclusion/exclusion criteria will be eligible for
participation in the randomized controlled trial (n = 210). The clinical interventions will
be delivered by master's level clinicians, who will be monitored and supervised by licensed
psychologists. Primary dependent measures (violence, substance use) will be measured at
baseline and follow-up interviews, and the impact of the interventions on services use
during the follow-up period also will be examined.
Inclusion Criteria:
- Participants with severe and recent violence (i.e., injuring another person in the
past year) will be eligible for the RCT.
- Eligible patients also will meet DSM-IV criteria for either alcohol or illicit drug
(e.g., cocaine, marijuana, opiates, etc.) abuse/dependence.
- The study will include those with comorbid mood and/or anxiety problems (e.g.,
depression, PTSD and other anxiety disorders), whether or not on medication at the
point of recruitment, with the exception of those who have schizophrenia and/or are
mentally incompetent (e.g., unable to provide informed consent).
- A brief mental status screen will with an established cutoff will be required for
competency.
Exclusion Criteria:
- Participants who are suicidal (ideation, intent and plan) at the point of recruitment
will not be enrolled in the study. Rather, research staff will inform clinical staff
at the study site if a potential participant is currently suicidal.
- Participants who report transient suicidal ideation but no intent or plan will be
eligible to participate.
- As noted, individuals with schizophrenia and/or who are mentally incompetent to
consent for participation will be excluded. Finally, participants who live outside
the study catchment area (i.e., a 45 mile radius of the VA Ann Arbor Healthcare
System) will be excluded.
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