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MHI 20-001 – HSR&D Study

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MHI 20-001
Effectiveness of Advisor - Teller Money Manager (ATM)
Marc I. Rosen MD
VA Connecticut Healthcare System West Haven Campus, West Haven, CT
West Haven, CT
Funding Period: July 2002 - June 2006

BACKGROUND/RATIONALE:
VA investigators have described greater substance use at the beginning of the month when disability and other monthly checks are received. The proposed research addresses an important VA priority—seeing that veterans’ funds are spent to improve veterans’ quality of life and are not misspent on substances of abuse.

OBJECTIVE(S):
The objective was to determine the effectiveness of a money management-based therapy called ATM for veterans who abuse cocaine or alcohol compared to a financial advice control condition.

METHODS:
Veterans were randomly assigned to 36-weeks of ATM or to the control condition, financial advice. ATM (Adviser-Teller Money Manager) involves meeting with a money manager at least weekly. The money manager performs three functions—limiting patients’ access to funds by storing checkbooks and ATM cards, training patients to budget their funds, and linking spending to treatment goals. The control condition involved listing income and expenses in a workbook. Veterans were enrolled from each of two sites if they had spent at least $100 in the preceding 90 days on alcohol or cocaine, and had at least $300 per month income. Measures of treatment fidelity and participation included number of visits attended, whether funds were stored, monthly income and expenses and Likert-scaled ratings from 1-4 of money management-related outcomes. Outcome measures collected included urine toxicology tests and breathalyzers, self-reported substance use as assessed by the ASI follow-up, and secondary measures including quality of life and psychiatric symptomatology.

FINDINGS/RESULTS:
Data collection has been completed. Baseline data has been analyzed.
Altogether, 224 eligible people were screened of whom 81 refused to participate, 52 were not randomized for other reasons, and 5 did not provide follow-up data after randomization leaving a final sample of 85 (ATM n=44, control n= 41). All randomized participants were male except one; 51% were caucasian and 46% were African American. Mean monthly income was $655 (s.d. 638) and 58% received VA benefits. A substantial proportion had concomitant psychiatric illnesses—51% had been hospitalized for psychiatric problems and mean GAF was 54 (s.d.11). Primary drug of choice was alcohol for 57% and cocaine for 43%. Mean ASI composite alcohol severity was .30 (s.d .22) and drug abuse severity was.10 (.09). Outcome analyses are ongoing. Preliminary analyses suggest that satisfaction with ATM was high. In HLM analyses of group X time effects, ATM participants had significantly (p<.05) higher ratings of overall satisfaction, perceived benefit, and having been helped to budget.

IMPACT:
There is an unmet need for codified approaches to help veterans manage their funds, and ATM has been developed to meet that need. Ongoing analyses will determine whether it has therapeutic effects on other domains such as substance use and quality of life.

Rosen MI, Bailey M, Rosenheck RA: Principles of Money Management As a Therapy for Addiction. Psychiatric Services 2003; 54 (2): 171-173.

Rosen MI, Bailey M, Dombrowski E, Ablondi K, Rosenheck RA: A comparison of satisfaction with clinician, family members/friends and attorneys as payees. Community Mental Health Journal 2005; 41 (3): 291-306.

Rosen MI, McMahon TJ, Lin HQ, Rosenheck RA: Effect of Social Security Payments on Substance Abuse in a Homeless Mentally Ill Cohort. Health Services Research 2006; 41 (1): 173-191.

Rosen MI, McMahon TJ, Rosenheck RA: Homeless people whose self-reported SSI/SSDI status is inconsistent with Social Security Administration records. Submitted.

PUBLICATIONS:

Journal Articles

  1. Black RA, Rounsaville BJ, Rosenheck RA, Conrad KJ, Ball SA, Rosen MI. Measuring money mismanagement among dually diagnosed clients. The Journal of nervous and mental disease. 2008 Jul 1; 196(7):576-9.
  2. Rosen MI, Rosenheck R, Shaner A, Eckman T, Gamache G, Krebs C. Do patients who mismanage their funds use more health services? Administration and policy in mental health. 2003 Nov 1; 31(2):131-40.
  3. Rosen MI, Bailey M, Rosenheck RR. Alcohol & drug abuse: principles of money management as a therapy for addiction. Psychiatric services (Washington, D.C.). 2003 Feb 1; 54(2):171-3.
Conference Presentations

  1. Rosen MI, Stefanovics EA, Rosenheck RA. A Randomized Controlled Trial of a Money-Management Based Intervention Targeting Substance Use. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 1; Baltimore, MD.
  2. Rosen I., Bailey , Ablondi, Rounsaville J., Rosenheck A.. Advisor-Teller Money Manager (ATM) Process Measures. Paper presented at: College on Problems of Drug Dependence Annual Meeting; 2007 Jun 20; Quebec City, Canada.
  3. Rosen MI, McMahon TJ, Rosenheck RA. Effect of Social Security Payments on Substance Abuse in a Homeless Mentally Ill Cohort. Paper presented at: Addiction Health Services Research Conference; 2004 May 1; Philadelphia, PA.
  4. Rosen M, Bailey M, Dombrowski E, Ablondi K, Rosenheck R. Do patients who mismanage their funds use more health services? Paper presented at: College on Problems of Drug Dependence Annual Meeting; 2003 Oct 1; Miami, FL.


DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction
DRE: Epidemiology, Treatment - Observational, Prevention
Keywords: Behavior (patient)
MeSH Terms: none