Web-Delivered CBT Reduces Heavy Drinking in OEF-OIF Veterans in Primary Care With Symptomatic Substance Use and PTSD

Abstract

Veterans from conflicts such as the wars in Iraq and Afghanistan commonly return with behavioral health problems, including Post-Traumatic Stress Disorder (PTSD) and hazardous or harmful substance use. Unfortunately, many veterans experience significant barriers to receiving evidence-based treatment, including poor treatment motivation, concerns about stigma, and lack of access to appropriate care. To address this need, the current study developed and evaluated a web-based self-management intervention based on cognitive behavioral therapy (CBT), targeting PTSD symptoms and hazardous substance use in a group of symptomatic combat veterans enrolled in VA primary care. Veterans with PTSD/subthreshold PTSD and hazardous substance use were randomized to primary care treatment as usual (TAU; n=81) or to TAU plus a web-based CBT intervention called Thinking Forward (n=81). Thinking Forward consisted of 24 sections (approximately 20 minutes each), accessible over 12 weeks. Participants completed baseline and 4-, 8-, 12-, 16- and 24-week follow-up assessments. Three primary outcomes of PTSD, alcohol and other drug use, and quality of life were examined. Significant treatment effects were found for heavy drinking, but not for PTSD or quality of life. The effect of the intervention on heavy drinking was mediated by intervening increases in coping, social support, self-efficacy, and hope for the future. These results demonstrate the promise of a web-based, self-management intervention for difficult-to-engage OEF/OIF veterans with behavioral health and substance use concerns.

Digital Mental Health for Alcohol and Substance Use Disorders

“…Acosta et al [56] recruited 162 problem drinking (AUDIT score 9 8/9 7 for men/women) or substance misusing (DAST-10 score ≥ 2) veterans via a Veterans Affairs (VA) primary clinic and randomized them to TAU, entailing usual VA primary care services, or to TAU in combination with unguided internetbased CBT, targeting symptoms of substance use and post-traumatic stress disorder (PTSD). The combined treatment produced significant reductions in heavy drinking but not for other substances, PTSD symptoms, or quality of life.…”

Hospitalization Outcomes and Comorbidities of Bulimia Nervosa: A Nationwide Inpatient Study

“…We used the Statistical Package for the Social Science (SPSS), version 23.0 (IBM SPSS Statistics, Armonk, NY) to conduct a retrospective analysis over the HCUP-NIS database from 2010–2014 [ 11 ]. Descriptive statistics were used to summarize the results.…”

Technological Interventions for the Treatment of Substance Use Disorders

“…Finally, an interesting study by Acosta et al. (2017) recruited via a clinical setting 162 problem drinking (AUDIT score > 8/> 7 for men/women) or substance misusing (DAST-10 score ≥ 2) veterans with subthreshold PTSD and randomized them to either to (a) 12-week unguided web-based CBT plus TAU consisting of veteran affairs primary care services including medical, behavioral health, pharmacy, weight management, and social work services, or (b) TAU-only.…”