Telehealth Treatment for Veterans with Substance Use Disorders
(VetReach Trial)
Recruiting in Palo Alto (17 mi)
+1 other location
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: VA Office of Research and Development
Disqualifiers: Receiving SUD psychotherapy, Mental instability, others
No Placebo Group
Trial Summary
What is the purpose of this trial?This project will pilot-test and obtain stakeholder input on a telehealth-delivered substance use disorder (SUD) care model (with initial engagement and ongoing MI-CBT treatment) with the goal of increasing treatment utilization and improving outcomes for rural and non-rural Veterans with SUDs.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your healthcare provider.
What data supports the effectiveness of the treatment VetReach for veterans with substance use disorders?
Research shows that telehealth can help veterans with substance use disorders stick with their treatment better. During the COVID-19 pandemic, veterans using telehealth were more likely to start and stay in treatment compared to those who only had in-person care.
12345Is telehealth treatment for veterans with substance use disorders safe?
Research indicates that telehealth treatment, including programs like VetReach, has been used safely to provide care for veterans with substance use disorders, especially during the COVID-19 pandemic. Studies have shown that telehealth can safely increase access to treatment and education, such as opioid overdose prevention, without additional safety concerns.
36789How is the VetReach treatment for veterans with substance use disorders different from other treatments?
VetReach is unique because it uses telehealth technology to provide treatment for veterans with substance use disorders, making it more accessible for those who face barriers like transportation issues or living in rural areas. This approach allows veterans to receive care from home, which can improve treatment attendance and retention compared to traditional in-person methods.
38101112Eligibility Criteria
This trial is for Veterans with Substance Use Disorders who are patients at the Ann Arbor VA Healthcare System. They must have phone access, be able to consent, and have a DSM-5 SUD diagnosis or used substances twice weekly over the past month. It's not for those with severe mental health issues, prior severe alcohol withdrawal symptoms, current SUD therapy, or language barriers.Inclusion Criteria
Veteran patients at the Ann Arbor VA Healthcare System
Telephone access
Able to provide informed consent
+1 more
Exclusion Criteria
Prior alcohol withdrawal seizures or delirium tremens
Inability to speak or understand English
Receiving SUD psychotherapy
+1 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Engagement
Initial 30-60 min phone-delivered session focusing on motivational interviewing to build self-efficacy and motivation
1 week
1 visit (phone)
Treatment
Participants complete up to 8 weekly MI-CBT sessions via videoconference or phone
8 weeks
8 visits (virtual)
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
Participant Groups
The study is testing 'VetReach', a telehealth model designed to improve substance use disorder care for rural Veterans by providing initial engagement and ongoing MI-CBT treatment remotely to increase treatment usage and enhance recovery outcomes.
1Treatment groups
Experimental Treatment
Group I: MI-CBT TeletxExperimental Treatment1 Intervention
The intervention consists of an initial 30-60 min phone-delivered Engagement session that focuses on MI to help participants build self-efficacy and motivation to engage and to empower them to plan change and use Elicit-Provide-Elicit (EPE) to address treatment barriers (e.g., stigma, appeal, accessibility). Participants will then complete up to 8 \~50 minute Teletx weekly sessions via videoconference (or phone if needed). The intervention is highly patient-centered, by meeting and assessing patients where they are including in their unique context (i.e. rural community), helping them identify reasons and motivations for change, and centered around their goals (e.g. substance use reduction or abstinence).
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Ann Arbor VA Medical CenterAnn Arbor, MI
VA Ann Arbor Healthcare System, Ann Arbor, MIAnn Arbor, MI
Who Is Running the Clinical Trial?
VA Office of Research and DevelopmentLead Sponsor
VA Ann Arbor Healthcare SystemCollaborator
References
Patterns & Predictors of Telehealth Utilization Among Individuals Who Use Substances: Implications for the Future of Virtual Behavioral Health Services. [2023]Telehealth dramatically expanded during the COVID-19 pandemic, but there remains a dearth of literature examining how this service modality is utilized by individuals who use substances. This study examined patterns of telehealth use and individual level sources of variation among clients receiving counseling in an outpatient substance use clinic in early 2021 (n = 370). Univariate statistics described the percentage of counseling visits delivered via telehealth. OLS regression explored individual level demographic and clinical characteristics that predicted greater telehealth utilization. Overall, more than two thirds (86%) of counseling visits were conducted via telehealth. Individuals with unstable housing or with a co-occurring serious mental illness used less telehealth. Findings suggest that while telehealth appears to be an acceptable way to deliver substance use counseling, patterns varied among vulnerable subgroups. As telehealth becomes further integrated into behavioral health services delivery, it is critical to uncover sources of this variation and identify potential solutions.
Use of Telemedicine in Addiction Treatment: Current Practices and Organizational Implementation Characteristics. [2020]Telemedicine applications offer innovative approaches for treating and reducing the effects of substance use disorders (SUDs). This analysis assessed the interest in and use of 11 telemedicine applications in a sample of 363 SUD organizations in the United States of America. Fifty percent of the organizations expressed high rates of interest in seven of the telemedicine applications, demonstrating the appeal of telemedicine within this field. The top three self-reported telemedicine applications being used were (1) computerized screening/assessments (44.6%), (2) telephone-based recovery supports (29.5%), and (3) telephone-based therapy (28.37%). The greatest gaps between interest and use were for (1) texting appointment reminders (55.2% differential), (2) mobile apps for posttreatment recovery (46.6% differential), and (3) recovery support chats (46.6% differential). A Latent Class Analysis (LCA) of the organizations' telemedicine use behavior identified three groupings: "Innovators" that were using a range of technologies (n = 27, 7.4%); "Technology Traditionalists" that limited their use to telephone, video, and web portal technologies (n = 101, 27.8%); and "Low Tech" that had low overall technology use (n = 235, 64.7%). Future studies should build on how telemedicine could be applied in SUD settings, organizational behaviors towards its adoption, and telemedicine's effect on treatment adherence and clinical outcomes.
Comparing substance use treatment initiation and retention between telehealth delivered during COVID-19 and in-person treatment pre-COVID-19. [2023]A large portion of veterans referred to substance use disorder (SUD) treatment do not attend their first appointment or leave treatment prematurely. Telehealth options may increase access to care and treatment attendance. This study compared treatment initiation and retention between in-person treatment pre-COVID-19 and telehealth treatment during COVID-19 in a VA hospital outpatient alcohol and drug treatment clinic.
Effects of Telehealth on Dropout and Retention in Care among Treatment-Seeking Individuals with Substance Use Disorder: A Retrospective Cohort Study. [2023]Background: During the COVID-19 pandemic, telehealth became a widely used method of delivering treatment for substance use disorders (SUD), but its impact upon treatment engagement and dropout remains unknown. Methods: We conducted a retrospective analysis of adult SUD patients (n = 544) between October 2020 and June 2022 among a cohort of treatment-seeking patients at a nonprofit community behavioral health center in Southwestern Ohio. We estimated the likelihood of treatment dropout using survival curves and Cox proportional hazard models, comparing patients who used telehealth with video, telephone, or solely in-person services within the first 14 days of diagnosis. We also compared the likelihood of early treatment engagement. Results: Patients who received services through telehealth with video in the initial 14 days of diagnosis had a lower hazard of dropout, compared to patients receiving solely in-person services (0.64, 95% CI [0.46, 0.90]), while there was no difference in hazards of dropout between patients who received telephone and in-person services. Early use of telehealth, both via video (5.40, 95% CI [1.92, 15.20]) and telephone (2.12, 95% CI [1.05, 4.28]), was associated with greater odds of treatment engagement compared to in-person care. Conclusion: This study adds to the existing literature related to telehealth utilization and engagement in care and supports the inclusion of telehealth in SUD treatment programs for treatment-seeking individuals.
Treatment Outcome Comparison Between Telepsychiatry and Face-to-face Buprenorphine Medication-assisted Treatment for Opioid Use Disorder: A 2-Year Retrospective Data Analysis. [2022]To retrospectively review clinic records to assess the difference between face-to-face and telepsychiatry buprenorphine medication-assisted treatment (MAT) programs for the treatment of opioid use disorder on 3 outcomes: additional substance use, average time to achieve 30 and 90 consecutive days of abstinence, and treatment retention rates at 90 and 365 days.
Description of a pharmacist-led clinical video telehealth group clinic for opioid overdose prevention and naloxone education. [2020]To achieve the nationwide goal of reducing opioid-related deaths, a clinical pharmacy specialist-led clinical video telehealth (CVT) clinic was created at a Veterans Affairs medical center (VAMC) to deliver opioid overdose prevention and naloxone education to at-risk patients. The purpose of this innovative practice was to improve access to this potentially life-saving intervention to patients across urban and rural areas. This study is a single-center, descriptive analysis of adult patients across 2 VAMC campuses and 4 community-based outpatient clinics from July 11, 2016, through December 31, 2016. The purpose of this innovative practice was to increase access to overdose education and naloxone distribution (OEND) to at-risk patients across urban and rural areas. Patient-specific factors were also examined among those receiving naloxone through the CVT clinic compared to other prescribers. During the first 6 months from the initiation of the clinic, 1 pharmacist prescribed 21% of the health care system's naloxone. These patients identified by the pharmacist-led CVT clinic were more likely to be considered high-risk due to concomitant use of opioids and benzodiazepines. In conclusion, the pharmacist-led CVT group clinic has been an efficient strategy to extend OEND services to high-risk patients beyond central, urban areas.
Changes in alcohol use, PTSD hyperarousal symptoms, and intervention dropout following veterans' use of VetChange. [2022]Veterans of Iraq and Afghanistan conflicts report high rates of drinking, PTSD, and low rates of treatment engagement. Web interventions may help address unmet treatment need; unfortunately, little is known regarding outcomes or adherence to these interventions. In this study, we examined VetChange treatment outcomes and downstream effects of alcohol reduction on PTSD symptoms and intervention dropout rates over six months.
Community Treatment for Opioid Use Disorders in Urban and Rural Veterans. [2021]Label="PURPOSE">The recent opioid crisis is characterized by a relatively greater increase in opioid use disorder and related mortality in rural populations when compared with urban populations.1-5 As almost a quarter of our nation's veterans reside in rural settings, the United States Veterans Health Administration (VHA) is interested in the impact of this epidemic on rural veterans. This study aims to develop a comprehensive understanding of the trends in substance use disorders (SUD) in veterans seeking treatment from community, non-VHA providers.
The COVID-19 pandemic and opioid use disorder: Expanding treatment with buprenorphine, and combining safety precautions with telehealth. [2022]This study investigated the efficacy and safety of providing medication for opioid use disorder (MOUD) and individualized telehealth in Kentucky, a state severely impacted simultaneously by the opioid epidemic and the COVID-19 pandemic.
Development of an in-home telehealth program for outpatient veterans with substance use disorders. [2019]A variety of obstacles (e.g., lack of transportation, less availability of treatment in rural districts) contribute to underutilization of treatment among patients with substance use disorders, warranting the need to develop innovative strategies for enhancing access to treatment for these patients. The telehealth in-home-messaging-device is a small message-delivering and monitoring device connected via landline phone to a secure server that provides assessment and disease self-management education to patients in their homes. We describe the development of a Substance Use Disorder telehealth management program (SUD program) for use on this device and a feasibility pilot of the program with six outpatient veterans with substance use disorders referred by their primary medical care providers. These patients indicated that the SUD program was acceptable, easy to use, and helpful toward addressing their substance use problems. Home telehealth technology may be an innovative and feasible approach for providing substance abuse evidence-based treatment either as an adjunct to specialty treatment for substance use disorders or as a stand-alone intervention within primary care for a larger number of patients who may otherwise not access traditional treatment services.
Impact of VA's video telehealth tablets on substance use disorder care during the COVID-19 pandemic. [2023]Telehealth has the potential to improve health care access for patients but it has been underused and understudied for examining patients with substance use disorders (SUD). VA began distributing video-enabled tablets to veterans with access barriers in 2016 to facilitate participation in home-based telehealth and expanded this program in 2020 due to the coronavirus COVID-19 pandemic.
Increasing Use of Video Telehealth Among Veterans Experiencing Homelessness with Substance Use Disorder: Design of A Peer-Led Intervention. [2023]Telehealth offers promising opportunities, but also challenges, for veterans experiencing homelessness - during the COVID-19 pandemic and beyond. Recent research found low utilization of clinical video visits among homeless veterans receiving a VA tablet, and having a substance use disorder (SUD) further reduced visit likelihood. Hence, this study sought to identify unique barriers to telehealth use among veterans experiencing homelessness with a SUD and design an intervention to promote adoption. This qualitative study was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The study's three phases included veteran interviews (N = 28) to identify barriers and facilitators to video telehealth use and propose intervention candidates, a provider expert panel to obtain feedback on interventions, and a focus group with veterans to complete the intervention. Finally, a prototype was designed using the intervention mapping approach. Veteran interviews revealed that barriers to video telehealth included complex physical and mental health issues, lack of digital literacy, and insufficient technical support. Together, veterans and experts proposed five intervention candidates. In the end, a veteran focus group combined two candidates, peer-led digital training and motivational interviewing. Intervention mapping was used to design a "stepped care" intervention that trains and activates veterans at all skill levels. This study demonstrates how inclusion of expert and veteran views led to development of a novel intervention to support and sustain video telehealth use among veterans experiencing homeless with SUD.