What Strategies Have Been Used to Improve Veterans Health?
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Primal Findings
- Co-occurring substance apply disorders and mental wellness disorders are mutual amid post-9/11 veterans, but handling facilities typically specialize in treating one type of disorder or the other.
- Mental health handling facilities often require veterans to abstain from substance use, but veterans may be using substances to manage their mental health symptoms.
- Veterans who receive substance use handling lone may be at gamble for failing to meet their treatment goals if their mental health symptoms are not addressed.
- Integrated, evidence-based approaches that address both substance apply disorders and mental health disorders concurrently and provide ongoing support for recovery tin improve outcomes for this population, just it is critical that veterans are able to access programs and facilities that are equipped to treat the veteran population.
Veterans are at risk for a range of behavioral health problems, including posttraumatic stress disorder (PTSD), depression, and substance use disorders. This take a chance is particularly acute for those who have served in the U.Due south. armed services since September xi, 2001, and oftentimes a outcome of combat experiences or military sexual trauma. These post-9/11 veterans are also more likely than veterans of other eras to be diagnosed with more than one of these disorders (for instance, PTSD alongside a substance employ disorder). This co-occurrence has important implications for handling decisions and veterans' behavioral health outcomes, but available treatment options practice not always encounter these needs of mail-nine/11 veterans with co-occurring disorders.
Veterans who employ substances to alleviate symptoms of PTSD, depression, or another mental health disorder may resist giving up those substances out of a fearfulness of intensified symptoms, particularly if using substances helps them to avoid or alleviate their mental wellness symptoms in the brusque term. Not all treatment facilities are equipped to address these co-occurring problems, and mental health handling facilities oftentimes crave patients to abstain from substances before they can receive care for a mental health disorder. Conversely, veterans who enter substance employ treatment before receiving care for a co-occurring mental health disorder may fail to encounter their substance use treatment goals if they have not nevertheless received treatment to address their mental health symptoms. As a result, there is an increased risk that veterans with co-occurring substance use disorders and mental wellness disorders will drop out of treatment or forgo handling altogether.
The Wounded Warrior Project (WWP), a nonprofit organization established to back up post-9/eleven veterans with pregnant injuries, has a robust program to address the mental health needs of veterans and their families. WWP partnered with the RAND Corporation to help amend access to constructive treatment for post-9/11 veterans with substance utilise disorders and co-occurring PTSD or depression.
A comprehensive review of approaches to treating substance use disorders and co-occurring mental health disorders and data on treatment facilities for veterans, combined with interviews and visits to facilities, informed a series of recommendations to help WWP (and other organizations) aggrandize and heighten treatment opportunities for mail-9/11 veterans with co-occurring disorders. The recommendations address the types of treatments provided to veterans, how treatment facilities tin better meet their needs, and how providers, insurers, and organizations such equally WWP can help support veterans' intendance transitions to help prevent a recurrence of mental health symptoms or substance use relapse.
The Mutual Requirement to Abstain from Substance Use Prior to Receiving Mental Health Care May Pose a Bulwark to Treatment for Veterans with Co-Occurring Disorders
Substance abuse is a common bulwark to treatment for veterans who also have mental health disorders, such as PTSD or depression, because of the following cycle:
- Veterans may apply substances to cope with PTSD or depression
- Forbearance is often required for mental health handling
- Untreated PTSD or depression could exacerbate substance use
- As substance use increases, symptoms of PTSD or low tin can worsen
Standardized, Prove-Based, Integrated Treatments Would Improve Veterans' Outcomes
Traditional models of intendance that separate treatment for substance utilise and treatment for PTSD or depression tin can ultimately cause veterans to oscillate between treatment for their mental wellness disorder and for their substance use disorder, if they agree to treatment at all. In the treatment literature, there are many promising approaches to accost unmarried and co-occurring disorders amid veterans, just, in many cases, further research is needed to strengthen the evidence base.
Providers should select treatments based on the strength of supportive bear witness whenever possible and continually renew their knowledge as new studies identify innovative ways of treating substance use disorders and mental health disorders.
For veterans and nonveterans with co-occurring substance utilize disorders and mental health disorders, integrated treatments, which address both types of disorders concurrently, had a stronger evidence base of operations than approaches that focused on a single disorder or treated the problems sequentially. Two approaches accept shown the greatest efficacy in treating substance use with co-occurring PTSD: integrated cognitive behavioral therapy and Concurrent Treatment of PTSD and Substance Use Disorder Using Prolonged Exposure (COPE). In that location is a need for further enquiry on medication-based approaches to treating co-occurring disorders, simply naltrexone and antidepressants have shown promising results. Finer implementing these types of integrated approaches requires a thorough cess to determine which symptoms a veteran is experiencing and tailoring a treatment plan to address those symptoms concurrently.
However, discussions with providers indicated that prove-based practices and information-driven decisionmaking were not standardized across facilities, and there was a need for consistent information collection and processes, such equally validated self-report and diagnostic measures, for tracking treatment outcomes over time and informing modifications to treatment plans.
Treatment Facilities Could Better Accost Barriers to Care
Treatment facilities specializing in either mental health or substance employ treatment are often non equipped to accost the needs of veterans with co-occurring substance utilize and mental health disorders. Access to these facilities may also pose a bulwark to care, particularly for rural veterans.
The Substance Corruption and Mental Health Services Administration, part of the U.S. Department of Health and Human Services, tracks the availability of licensed mental health and substance apply handling facilities nationwide. RAND'due south written report focused on facilities that offered (1) specialized programs for veterans and (2) specialized programs for veterans with substance utilise disorders and co-occurring mental wellness disorders—specifically, PTSD and depression.
Using WWP survey data, RAND researchers were able to calculate the average drive time from where veterans resided to mental health and substance use handling facilities. U.South. Department of Veterans Affairs (VA) standards for access to care imply that a treatment facility should be within a threescore-minute drive time but, ideally, attainable within xxx minutes. This analysis found that the boilerplate veteran lived well within a 60-minute bulldoze of the nearest mental health or substance utilize handling facility with a specialized treatment programme for co-occurring disorders that too served veterans—and inside a 30-minute bulldoze of a mental wellness provider. However, VA medical centers and VA-affiliated facilities were substantially farther away, about a 60-infinitesimal drive, on average. Although the results suggest that veterans more often than not have reasonable geographic access to facilities that come across their needs, they could face up other barriers to intendance, such as transportation limitations or childcare needs. Moreover, although veterans have admission to care, the quality of the care or the types of evidence-based treatments available at these facilities could vary.
One advantage to receiving treatment at a VA medical center or VA-affiliated facility is providers' familiarity with war machine and veteran civilization. Studies accept shown that veterans prefer a provider who understands the military machine and the veteran feel. Additional training to improve the military machine cultural competence of providers in non-VA facilities would help amend run into the needs of veterans.
Veterans may also have specific preferences regarding their treatment options; for example, they prefer to participate in group therapy aslope other veterans or with a mix of veterans and nonveterans. Some might adopt a demographic-specific group, such as all women. In that location was no compelling evidence to conclude that ane mix of group therapy participants leads to better outcomes than some other. However, given that veterans may accept difficulty engaging with intendance, accommodating these types of preferences may better treatment outcomes, if resources are available.
Cost is a significant barrier for veterans who do non have access to care through VA or are eligible for Medicaid. To reduce costs, facilities often modify prove-based protocols or shorten treatment elapsing; these modifications may weaken their effectiveness. Therefore, payment models that prioritize the commitment of evidence-based treatments with fidelity are essential to ensuring that veterans have an opportunity to achieve recovery, decreasing the overall costs to club, and increasing treatment chapters and quality.
Veterans Need Extra Support During Care Transitions
Prevention and early intervention in chief and specialty intendance settings—engaging veterans before long afterwards discharge from active duty or shortly after symptoms manifest—can prevent heavy alcohol or other substance use from developing into a disorder and amend subsequent treatment initiation and retention.
Transitions post-obit care can be precarious for veterans with co-occurring disorders. Later intensive treatment concludes, it is imperative that veterans have admission to aftercare programs that provide ongoing support and reinforce the treatment they have received.
WWP and other veterans' organizations offer outreach programs that can help veterans place behavioral wellness concerns outside of formal care settings and connect veterans with providers. Such efforts can exist particularly useful in reaching women and racial/ethnic minority veterans, who may be less likely to receive substance utilize and mental health treatment.
Recommendations
The study'due south findings point to several recommendations to guide providers, handling facilities, and policymakers, along with directions for time to come research, to assist improve access and quality of intendance for mail-9/11 veterans.
Increment the Adoption of Prove-Based, Patient-Centered Handling for Co-Occurring Disorders
Almost treatment facilities and providers specialize in either substance apply or mental health treatment; these facilities and their providers would better serve veterans with co-occurring disorders by implementing the following changes:
- Screen veterans for co-occurring disorders and offering treatment programs and evidence-based, integrated approaches that address both types of disorders.
- Evaluate both substance use and mental health outcomes regularly over the course of handling to ensure that both are being addressed adequately.
- Comprise and accommodate veterans' treatment preferences into handling decisions and provide intendance in a way that is sensitive to military and veteran civilization.
- Provide patients with a clear aftercare plan focused on relapse prevention.
Aggrandize Handling Availability and Accessibility
Improving availability and admission to treatment for veterans with co-occurring substance use disorders and mental health disorders volition require a coordinated try across the treatment community:
- Consider policies to aggrandize the capacity of VA medical centers and VA-affiliated facilities, and heighten access to facilities offering programs for veterans with co-occurring disorders.
- Subtract barriers to accessing intendance, and provide incentives for treatment facilities to offer evidence-based treatments.
- To address challenges that veterans may face up to receiving in-person care, support farther enquiry on the effectiveness of telehealth programs.
- Increase early prevention and intervention, including outreach to veterans outside of handling settings.
Despite federal and community efforts to improve the quality and availability of intendance for veterans, veterans remain at loftier take chances of developing both substance use disorders and mental wellness disorders, and their treatment outcomes are poorer when these disorders co-occur. Boosted research on the quality of care available to veterans and their curt- and long-term treatment outcomes would farther inform efforts to address the complex challenges to treating post-ix/11 veterans with co-occurring disorders.
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