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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3082 — A Randomized Controlled Trial of a Money-Management Based Intervention Targeting Substance Use

Rosen MI (VA Connecticut), Carroll KM (Yale University), Stefanovics EA (Yale University), Rosenheck RA (VA Connecticut)

Money management has been implemented, often in bundled interventions, as a strategy to counteract spending of public support checks and other funds on drugs and alcohol. We conducted the first randomized controlled trial of a voluntary money management based program as an adjunctive treatment for patients in treatment for mental illness and/or substance abuse disorders. In the Advisor-Teller Money Manager (ATM) intervention, a money manager stores patient checkbooks and bank cards, trains patients to manage their own funds, and links spending to activities that further treatment goals.

Eighty-five veterans with recent use of alcohol or cocaine were randomly assigned to 36 weeks of ATM or a control intervention (completion and review of a simple financial workbook).

ATM was well-received and well-attended in that 75% of veterans assigned to ATM gave their checkbook to their money manager to hold. Veterans assigned to ATM attended significantly more therapy sessions than those assigned to the control therapy (mean of 20.6 vs. 8.1) and rated ATM as more helpful with their budgeting and money management. Although participants assigned to ATM did not show significantly greater improvement over time on the primary outcomes (self-reported abstinence from alcohol and cocaine and negative urine tests for cocaine metabolite), they did reduce their ASI drug and alcohol use composite scale scores more rapidly than control participants. High rates of abstinence in both groups created a ceiling effect limiting the power to detect improved abstinence rates.

In this relatively small trial, ATM showed promise in engaging patients, improving their money management and improving some substance abuse outcomes.

These promising findings suggest that money management-based treatment should be considered for veterans with substance abuse problems. Future studies are needed to extend and replicate these findings, and to examine the efficacy of money management-based treatments when veterans apply for and receive benefits for service connected conditions but substance abuse is an important comorbidity.

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