PORTLAND, OR — Is it beneficial for VA to provide evidence-based psychotherapy (EBP) to veterans with post-traumatic stress disorder and co-occurring substance use disorder?
That was the question addressed in a recent study from the VA Portland Healthcare System. Researchers sought to compare initiation of PTSD EBP between veterans with and without a co-occurring substance-use disorder (SUD) and identify factors associated with EBP initiation among veterans with PTSD-SUD.
To do that, the study team analyzed a national sample of nearly 302,000 veterans with PTSD and nearly 95,000 with co-morbid SUD, identified from VA Electronic Health Record data. Treatment initiation was defined as having at least one mental health encounter associated with Cognitive Processing Therapy or Prolonged Exposure therapy. Most of the veterans were 30–44 years old, male sex, and non-Hispanic white.
The authors reported in Frontiers in Psychology that no significant differences were observed in EBP initiation between veterans with and without a co-occurring SUD (OR=1.00, p=0.985). Among veterans with PTSD-SUD, reduced likelihood of initiating a PTSD EBP were associated with:1
- co-occurring bipolar disorder (OR=0.83, p=0.000),
- co-occurring psychotic disorder (OR=0.69, p=0.000),
- service connection (OR=0.94, p=0.001),
- female sex (OR=0.87, p=0.000), and
- being 60 years or older (OR=0.57, p=0.000).
On the other hand, they wrote, having a co-occurring anxiety disorder (OR=1.06, p=0.020), MST history (OR=1.95, p=0.000) and high risk for suicide (OR=1.15, p=0.000) were associated with an increased likelihood of initiating EBP.
These findings support VA provision of EBP for veterans with PTSD, regardless of the presence of co-occurring SUD. Identifying characteristics that increase or reduce the likelihood of EBP initiation may provide insight into treatment pathways and subgroups warranting augmented outreach.
- Somohano VC, Cameron D, Lewis MM, O’Neill A, Phillips R, Kaplan J, O’Neil ME. Predictors of evidence-based psychotherapy initiation among veterans with co-occurring PTSD and substance use disorder. Front Psychiatry. 2024 Aug 16;15:1432361. doi: 10.3389/fpsyt.2024.1432361. PMID: 39220182; PMCID: PMC11363902.
