Web-based CBT for Substance Misusing and PTSD Symptomatic OEF/OIF Veterans

National Institute on Alcohol Abuse and Alcoholism (NIAA), R01AA020181

9/1/10 – 8/31/15

Andrew Rosenblum, PhD; Stephen Maisto, PhD

Lisa A. Marsch, PhD; Michelle Acosta, PhD; Sarah Moore, PhD; Kyle Possemato, PhD; Paige Ouimette, PhD; Larry Lantinga, PhD; Nichole Mangus, MS; Michael French, PhD; Ned Nunes, MD

More than 1.65 million individuals who have served the US in military efforts in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]) have experienced significant stressors, which may contribute to an array of mental health problems. Of the OEF/OIF veterans referred to a Veterans’ Administration (VA) medical center, over 2/3 (69%) have screened positive for a mental health problem. The most prevalent is post-traumatic stress disorder (PTSD). Substance use problems are also prevalent, particularly among veterans with PTSD symptoms. Despite their mental health needs, OEF/OIF veterans with PTSD are more likely to seek treatment for physical complaints than for mental health concerns. Although behavioral health care has been integrated into primary care in VA medical centers, veterans encounter significant barriers accessing this care. Psychosocial interventions such as cognitive-behavioral therapy (CBT) have been found to be efficacious for the treatment of problematic substance use and PTSD, however, providers in non-specialty care are unlikely to have the time or proper training to deliver this complex intervention.

To address this problem, we are developing and will implement and evaluate a web-based CBT intervention for OEF/OIF veterans with problematic substance use and PTSD symptoms. An interactive, web-based psychosocial intervention has the potential to address the challenges associated with the acceptability and delivery of psychosocial treatment to this population, as it allows for a complex intervention to be delivered with fidelity at a low cost, without increasing demands on providers’ time or training needs and preserving the anonymity of the patient. The planned intervention will be theoretically grounded in a CBT approach and will be delivered via an interactive system that employs informational technologies which are effective in promoting knowledge and skills. Development will be informed by input from expert collaborators and OEF/OIF veterans.

We plan to conduct a controlled trial in two primary care VA treatment centers. Participants will be randomized to: (1) Treatment as Usual (TAU) reflecting the model of treatment provided to most OEF/OIF veterans (n=81) or (2) TAU plus the web-based CBT intervention (n=81). Primary outcomes will be: a) number of heavy drinking days and/or number of days of illicit or non-prescribed drug use in the past 30 days; b) Quality of Life; and c) PTSD symptoms. We also plan to evaluate the cost and cost-effectiveness of the web-based intervention plus TAU relative to TAU alone.

Results of this study have the potential to markedly improve the psychosocial functioning among OEF/OIF veterans with substance use and related disorders and enable rapid and widespread diffusion of a cost-effective, anonymous intervention to this population.