Helping Families Help Veterans With PTSD and Alcohol Abuse: An RCT of VA-CRAFT

Background PTSD and AUDs are highly prevalent psychiatric disorders among combat Veterans
that can lead to substantial impairments and disability. Although empirically supported
treatments are available, the majority of Veterans suffering PTSD or AUDs do not engage in
any mental health care. Data show that encouragement and support by family members play a
key role in Veterans' willingness to engage in mental health care. However, many family
members may not know how best to help their Veterans engage in mental health care. VA-CRAFT
is an innovative adaptation of an empirically supported family training intervention (CRAFT)
that has been shown to dramatically increase treatment engagement among substance abusing
civilian samples. VA-CRAFT includes Veteran-specific content, a focus on PTSD, SUDs, or
both, and also make use of interactive web-technology to increase its efficiency and reach.
Pilot research is needed to begin to evaluate the effectiveness of this adaptation of an
existing, efficacious intervention, to provide feedback to VA-CRAFT developers for possible
modifications to content and delivery, and to inform future studies.

Objectives Specific aims are to: 1) provide pilot data on the effectiveness of VA-CRAFT on
Veterans' mental health service utilization; 2) provide pilot data on the effectiveness of
VA-CRAFT on family members' wellbeing, personal quality of life, perceived relationship
quality with Veteran, and communication about treatment seeking; 3) obtain pilot data to
explore possible differences in intervention response between Veterans with AUDs only, PTSD
only, or both; and 4) provide information regarding potential changes in content and
delivery as well as mediators and moderators of outcome for VA-CRAFT.

Methods This is a randomized controlled trial of VA-CRAFT that will obtain preliminary
information on its effectiveness and pilot information to inform future studies.
Participants will be drawn from a cohort of Veterans and family members enrolled in the
Readiness and Resilience in National Guard Soldiers studies (RINGS; Polusny & Erbes, PIs).
Using Veterans' responses to post-deployment RINGS surveys and administrative data, family
members of Veterans who screen positive for PTSD or AUDs will be recruited and divided into
1 of 3 subsamples: 1) family of Veterans with AUDs only (anticipated n = 38), 2) family of
Veterans with PTSD only (anticipated n = 72), and 3) family of Veterans with both PTSD and
AUDs (anticipated n = 74; total anticipated N =184 across the 3 subsamples). Family member
participants will complete baseline questionnaires of perceived Veteran PTSD and AUD
symptoms, family functioning and communication, and well-being and will be randomly assigned
to VA-CRAFT or Control (no treatment) conditions. Those assigned to the VA-CRAFT condition
will complete the online VA-CRAFT course. Progress through VA-CRAFT will be monitored and
stepped outreach efforts (emails, phone contacts) will be systematically used, as necessary,
to promote completion of the intervention. Three months after the baseline assessment,
family members and Veterans will complete follow-up questionnaires. Primary outcomes will
include: 1) Veteran's mental health service utilization during the 3 months following
initiation of VA-CRAFT as assessed by VA administrative data and 2) family member
self-reports of wellbeing and quality of life and 3) family and Veteran reports of perceived
relationship quality and communication about treatment seeking. Effect sizes will be
estimated for each outcome within each subsample of participants (AUD only, PTSD only, and
comorbid) and, if patterns are similar within subsamples, for the sample overall. Following
the post-intervention questionnaires, qualitative interviews will be conducted with up to 40
family participants to examine possible moderators and mediators of treatment responses and
to elicit participant feedback on VA-CRAFT modules and development to inform future VA-CRAFT
development.

Inclusion Criteria:

- Family participants:

- must have participated in a Readiness and Resilience in National Guards Soldiers
- (RINGS) study and be a spouse, partner, or family member of a Veteran who has
also participated in a RINGS study

- report frequent contact with the Veteran

- be paired with a Veteran who has not received mental health services at VA or in
the community for the past 3 months and who has screened positive for PTSD or
AUDs

- and have regular access to the internet.

- Veteran participants:

- must have participated in a RINGS study

- be in significant contact with a spouse/partner/family member who has enrolled
in this protocol

- screened positive for PTSD and/or AUD through their responses to a RINGS survey

- and have not received mental health care (based on VA administrative data) or in
the community for the past 3 months

Exclusion Criteria:

- Family members (and thus Veterans) will not be eligible for the study if they or
their Veteran have reported severe levels of interpersonal violence in their
relationship in the past 3 months.