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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1031 — Brief Counseling for Veterans with Musculoskeletal Disorders, Risky Substance Use and Service-Connection Claims

Lead/Presenter: Marc Rosen, COIN - West Haven
All Authors: Rosen MI (VA Connecticut, Yale) Becker WC (VA Connecticut, Yale) Black AC (VA Connecticut, Yale) Martino S (VA Connecticut, Yale) Edens EL (VA Connecticut, Yale) Kerns RD (VA Connecticut, Yale)

The service-connection application is an ideal point-of-contact for referring Veterans to counseling, an early intervention for this at-risk population. Among musculoskeletal disorder (MSD) claimants who also reported risky substance use, we pilot-tested a counseling intervention targeting pain and risky substance use called Screening Brief Intervention and Referral to Treatment-Pain Management (SBIRT-PM).

Veterans presenting for service-connection examinations for back, neck, shoulder or knee pain were randomly assigned in a 2:1:1 ratio to SBIRT-PM, Pain-Module counseling only, or Treatment-as-Usual (TAU). Participants assigned to either counseling condition were offered a single meeting with a study therapist with two follow-up telephone calls as needed. Participants also completed outcome assessments of pain treatment uptake, pain severity (Brief Pain Inventory) and risky substance use (timeline follow-back calendars) at 4 and 12 weeks after randomization.

Of 257 Veterans evaluated, 101 reported risky substance use and were randomized. Counseling was attended by 75% of Veterans offered it and was well-received. VA pain-related services were used by 51% of participants in either of the pain-focused conditions but only by 27% in TAU (p < .04). Starting with average pain severity ratings of 5.1/10 at baseline, only minimal changes in mean pain severity were noted regardless of condition. Self-reported risky substance use was significantly lower over time in the SBIRT-PM condition relative to the two other conditions (p < .02).

Veterans applying for MSD-related service-connection reported substantial current pain and high proportions reported risky substance use. SBIRT-PM showed promise as a way to engage Veterans in pain treatment and reduce substance use.

In the 2015 fiscal year, 97,223 Veterans under the age of 35 were newly awarded compensation, and as of 2015, 559,999 post-9/11 Veterans received compensation for back or neck conditions. Early intervention around the time of a service-connection examination can facilitate Veterans' engagement in efforts to address pain and risky substance use.