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)

Objectives:
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).

Methods:
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.

Results:
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).

Implications:
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.

Impacts:
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.