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RRP 13-447 – HSR&D Study

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RRP 13-447
SUD Treatment for Dually Diagnosed Patients in PTSD Outpatient Programs
Quyen Q. Tiet PhD
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: July 2014 - June 2016

BACKGROUND/RATIONALE:
There is a high rate of comorbidity between posttraumatic stress disorder (PTSD) and substance use disorder (SUD). However, these individuals usually do not access treatment adequately, and it is common that substance use problems are not detected or treated among Veterans receiving services in PTSD specialty outpatient treatment programs.

OBJECTIVE(S):
The overarching goal of this developmental evaluation study aims to examine access to PTSD treatment and to describe SUD treatment practices for patients with co-occurring PTSD and SUD disorders. The primary aim (AIM 1) of this study focuses on identifying modifiable factors that are associated with PTSD programs serving a higher percentage of patients identified as having SUDs. AIM 2 focuses on describing SUD Treatment practices within PTSD specialty outpatient treatment programs, and identifying practices that are associated with programs that provide evidence-based treatment to a higher percentage of patients with co-occurring PTSD/SUD disorders. AIM 3 focuses on identifying models of systemic assessment and monitoring of PTSD (e.g., PCL) and SUD (e.g., BAM) outcomes that are adopted by existing programs, reasons that such models are adopted, and how such models facilitate evidence-based SUD or integrated PTSD/SUD services.

METHODS:
The proposed study will use the Northeast Program Evaluation Center (NEPEC) report data and the National Patient Care Database data to stratify existing PTSD outpatient treatment programs into quartiles of PTSD outpatient treatment programs, based on the percentage of SUD patients being served and percentage of patient receiving timely dose of SUD treatment. Fifteen programs at the top quartile for both criteria and fifteen programs at the bottom quartile for both criteria will be selected (2 quartiles x15 programs = 30 programs). We will administer a survey and then follow up with an interview with the program director and the PTSD/SUD specialist in each program (2 interviews X 30 programs). Data will be transcribed verbatim and analyzed based on themes of the contents using standard qualitative data analytical methodology, guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Based on results of the qualitative data, profiles of PTSD specialty outpatient treatment programs will be identified and examined for each of the study aims.

FINDINGS/RESULTS:
The project is currently conducting data analysis and getting ready for preparing reports, presentations and publications.

No results are available at this point.

IMPACT:
The findings of the study will hopefully lead to more patients with comorbid PTSD and SUD being served in PTSD specialty outpatient treatment programs by (1) improving the integrated and/or co-located treatment of SUD and co-occurring PTSD disorders, (2) improving practices that are associated with higher likelihood of detecting and providing SUD treatment (e.g., psychotherapy, pharmacotherapy, smoking cessation) among patients treated in PTSD specialty outpatient programs, and (3) reducing barriers to PTSD treatment entry for Veterans with SUD disorders.

PUBLICATIONS:

Journal Articles

  1. Koo KH, Tiet QQ, Rosen CS. Relationships between racial/ethnic minority status, therapeutic alliance, and treatment expectancies among veterans with PTSD. Psychological Services. 2016 Aug 1; 13(3):317-21.
  2. Tiet QQ, Leyva YE, Blau K, Turchik JA, Rosen CS. Military sexual assault, gender, and PTSD treatment outcomes of U.S. Veterans. Journal of traumatic stress. 2015 Apr 1; 28(2):92-101.


DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction
DRE: Treatment - Comparative Effectiveness
Keywords: QUERI Implementation
MeSH Terms: none