Telehealth Treatment for Veterans with Substance Use Disorders

(VetReach Trial)

Recruiting at 1 trial location

Overseen By Deborah A Manderachia, MSW

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Receiving SUD psychotherapy, Mental instability, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 9

Duration: 8 weeks

100 Participants Needed

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. ^{1 2 3 4 5}

Is 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. ^{3 6 7 8 9}

How 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. ^{3 8 10 11 12}

Research Team

Lewei Lin, MD

Principal Investigator

VA Ann Arbor Healthcare System, Ann Arbor, MI

Eligibility 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

Exclusion Criteria

Prior alcohol withdrawal seizures or delirium tremens

Inability to speak or understand English

Receiving SUD psychotherapy

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

Treatment Details

Interventions

• VetReach

Trial Overview 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.

Participant Groups

Group I: MI-CBT Teletx Experimental Treatment 1 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).

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

VA Ann Arbor Healthcare System

Collaborator

Trials

19

Recruited

10,300+

Findings from Research

In early 2021, a study of 370 clients at an outpatient substance use clinic found that 86% of counseling visits were conducted via telehealth, indicating a strong acceptance of this service modality.

However, individuals with unstable housing or serious mental illness were less likely to utilize telehealth, highlighting the need to address barriers for these vulnerable groups as telehealth becomes more integrated into substance use counseling.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patterns & Predictors of Telehealth Utilization Among Individuals Who Use Substances: Implications for the Future of Virtual Behavioral Health Services. Matthews, EB., Lushin, V., Rzewinski, J.[2023]

A survey of 363 substance use disorder organizations in the U.S. revealed that 50% showed high interest in telemedicine applications, particularly in computerized screenings and telephone-based supports, indicating a strong potential for integrating technology in treatment.

There is a significant gap between interest and actual use of certain telemedicine tools, such as texting appointment reminders and mobile apps for recovery, suggesting opportunities for further development and implementation in substance use disorder treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of Telemedicine in Addiction Treatment: Current Practices and Organizational Implementation Characteristics. Molfenter, T., Brown, R., O'Neill, A., et al.[2020]

Veterans were 2.6 times more likely to start substance use disorder treatment when offered telehealth appointments during COVID-19 compared to in-person appointments before the pandemic, indicating that telehealth significantly improves treatment initiation.

While the overall retention in treatment was similar between telehealth and in-person modalities, telehealth showed a higher rate of attendance over time, suggesting that telehealth may enhance ongoing engagement in treatment for veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing substance use treatment initiation and retention between telehealth delivered during COVID-19 and in-person treatment pre-COVID-19. Sistad, RE., Enggasser, J., Livingston, NA., et al.[2023]

Patients with substance use disorders who used telehealth services via video in the first 14 days of treatment had a significantly lower risk of dropout compared to those receiving only in-person services, indicating that telehealth can enhance retention in treatment.

Early engagement in treatment was notably higher for patients using telehealth, both via video and telephone, compared to those receiving in-person care, suggesting that telehealth may improve initial treatment uptake for individuals seeking help.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Telehealth on Dropout and Retention in Care among Treatment-Seeking Individuals with Substance Use Disorder: A Retrospective Cohort Study. Gainer, DM., Wong, C., Embree, JA., et al.[2023]

A study of 100 patients compared telepsychiatry and face-to-face buprenorphine medication-assisted treatment (MAT) for opioid use disorder, finding no significant differences in additional substance use or time to achieve 30 and 90 days of abstinence.

Both treatment methods showed similar retention rates at 90 and 365 days, suggesting that telepsychiatry is as effective as in-person treatment for managing opioid use disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment Outcome Comparison Between Telepsychiatry and Face-to-face Buprenorphine Medication-assisted Treatment for Opioid Use Disorder: A 2-Year Retrospective Data Analysis. Zheng, W., Nickasch, M., Lander, L., et al.[2022]

A pharmacist-led clinical video telehealth (CVT) clinic effectively increased access to opioid overdose education and naloxone distribution for at-risk patients across both urban and rural areas, prescribing 21% of the health care system's naloxone in just six months.

Patients receiving naloxone through the CVT clinic were more likely to be high-risk due to the concurrent use of opioids and benzodiazepines, highlighting the clinic's focus on those most in need of intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Description of a pharmacist-led clinical video telehealth group clinic for opioid overdose prevention and naloxone education. Jensen, AN., Beam, CM., Douglass, AR., et al.[2020]

In a study of 222 veterans using the VetChange web intervention, alcohol use decreased by 43% over six months, with the most significant reduction occurring in the first month, indicating the intervention's efficacy in promoting alcohol reduction.

However, over half of the participants (52.3%) dropped out by the end of the first month, and hyperarousal symptoms were linked to higher dropout rates, suggesting a need for tailored content in online interventions to better address varying PTSD symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in alcohol use, PTSD hyperarousal symptoms, and intervention dropout following veterans' use of VetChange. Livingston, NA., Mahoney, CT., Ameral, V., et al.[2022]

Rural veterans showed slightly higher rates of treatment admissions for opioid use disorder and injectable drug use compared to urban veterans, indicating a significant need for targeted interventions in these populations.

From 2011 to 2016, both urban and rural veterans experienced an increase in admissions for opioid, heroin, and injectable drug use disorders, highlighting a growing trend in substance use disorders among veterans seeking treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Community Treatment for Opioid Use Disorders in Urban and Rural Veterans. Turvey, CL., Lund, BC., Jones, D., et al.[2021]

The study of 191 buprenorphine outpatients in Kentucky found that despite the challenges posed by the COVID-19 pandemic, there were no significant changes in drug use, indicating that medication for opioid use disorder (MOUD) remained effective during this time.

Patients reported significant barriers to treatment, such as loss of housing and transportation, but telehealth was viewed as a helpful supplement to in-person care, suggesting that a hybrid model can effectively support ongoing treatment for opioid use disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The COVID-19 pandemic and opioid use disorder: Expanding treatment with buprenorphine, and combining safety precautions with telehealth. Cales, RH., Cales, SC., Shreffler, J., et al.[2022]

The telehealth in-home-messaging-device was developed to enhance access to treatment for patients with substance use disorders, addressing barriers like transportation and treatment availability in rural areas.

A pilot study with six outpatient veterans showed that the Substance Use Disorder telehealth management program was well-received, being considered acceptable, easy to use, and helpful in managing their substance use issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of an in-home telehealth program for outpatient veterans with substance use disorders. Santa Ana, EJ., Stallings, DL., Rounsaville, BJ., et al.[2019]

The distribution of video-enabled tablets by the VA significantly increased engagement in mental health services for veterans with substance use disorders, leading to more psychotherapy and group therapy visits.

Patients with these tablets experienced an 18% increase in SUD psychotherapy visits and a 10% increase in group therapy visits, demonstrating that telehealth can enhance access to care, especially during the COVID-19 pandemic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of VA's video telehealth tablets on substance use disorder care during the COVID-19 pandemic. Gujral, K., Van Campen, J., Jacobs, J., et al.[2023]

A qualitative study involving 28 veterans identified key barriers to telehealth use among homeless veterans with substance use disorders, including complex health issues, lack of digital literacy, and insufficient technical support.

The study led to the development of a novel 'stepped care' intervention that combines peer-led digital training and motivational interviewing to enhance video telehealth adoption among this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing Use of Video Telehealth Among Veterans Experiencing Homelessness with Substance Use Disorder: Design of A Peer-Led Intervention. Garvin, LA., Greenan, MA., Edelman, EJ., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Patterns & Predictors of Telehealth Utilization Among Individuals Who Use Substances: Implications for the Future of Virtual Behavioral Health Services. [2023]

2. Egypt pubmed.ncbi.nlm.nih.gov

Use of Telemedicine in Addiction Treatment: Current Practices and Organizational Implementation Characteristics. [2020]

3. England pubmed.ncbi.nlm.nih.gov

Comparing substance use treatment initiation and retention between telehealth delivered during COVID-19 and in-person treatment pre-COVID-19. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Effects of Telehealth on Dropout and Retention in Care among Treatment-Seeking Individuals with Substance Use Disorder: A Retrospective Cohort Study. [2023]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Treatment Outcome Comparison Between Telepsychiatry and Face-to-face Buprenorphine Medication-assisted Treatment for Opioid Use Disorder: A 2-Year Retrospective Data Analysis. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Description of a pharmacist-led clinical video telehealth group clinic for opioid overdose prevention and naloxone education. [2020]

7. England pubmed.ncbi.nlm.nih.gov

Changes in alcohol use, PTSD hyperarousal symptoms, and intervention dropout following veterans' use of VetChange. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Community Treatment for Opioid Use Disorders in Urban and Rural Veterans. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

The COVID-19 pandemic and opioid use disorder: Expanding treatment with buprenorphine, and combining safety precautions with telehealth. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Development of an in-home telehealth program for outpatient veterans with substance use disorders. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

Impact of VA's video telehealth tablets on substance use disorder care during the COVID-19 pandemic. [2023]

12. Switzerland pubmed.ncbi.nlm.nih.gov

Increasing Use of Video Telehealth Among Veterans Experiencing Homelessness with Substance Use Disorder: Design of A Peer-Led Intervention. [2023]