Telehealth Treatment for Veterans with Substance Use Disorders

(VetReach Trial)

Not currently 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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to test a telehealth treatment called VetReach for veterans dealing with substance use disorders. The goal is to determine if remote sessions can help veterans adhere to their treatment and improve outcomes. Sessions begin with a phone call to boost motivation, followed by weekly videoconference sessions focused on personal goals like reducing or quitting substance use. Veterans with a substance use disorder who use substances at least twice a week and can access a phone might be a good fit. As an unphased trial, this study offers veterans the opportunity to access innovative telehealth support tailored to their needs.

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 prior data suggests that this telehealth care model is safe for veterans with substance use disorders?

Research has shown that telehealth programs like VetReach can safely facilitate treatment for substance use disorders (SUDs) without increasing safety risks. Specifically, telehealth has proven safe for preventing opioid overdoses and other treatments.

VetReach employs a method called MI-CBT, which stands for Motivational Interviewing and Cognitive Behavioral Therapy. This approach has shown promise in reducing substance use and related issues. It helps individuals find the motivation to change and provides tools to overcome treatment obstacles.

Overall, studies suggest that telehealth treatments for SUDs are well-received and can be a safe option for many veterans. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about VetReach because it offers a unique telehealth approach for treating substance use disorders in veterans. Unlike traditional in-person therapy, which can be hard to access for veterans in rural areas, VetReach delivers Motivational Interviewing and Cognitive Behavioral Therapy sessions over the phone or video. This method not only makes treatment more accessible but also focuses on empowering veterans by addressing personal barriers like stigma and motivation. By tailoring the therapy to the individual's goals and context, VetReach has the potential to significantly improve engagement and outcomes.

What evidence suggests that this telehealth treatment is effective for substance use disorders?

Research has shown that telehealth treatments like VetReach, which participants in this trial will receive, can safely assist veterans with substance use problems. VetReach employs motivational interviewing (MI) and cognitive behavioral therapy (CBT) through phone or video calls to help veterans build motivation and plan changes. Early studies found that telehealth can increase veterans' satisfaction and enhance their understanding of treatment compared to traditional methods. This telehealth model personalizes care, making it easier for veterans, especially those in rural areas, to access the help they need. Overall, VetReach aims to improve access to treatment and outcomes for veterans dealing with substance use issues. ^{1 5 6 7 8}

Who Is on the Research Team?

Lewei Lin, MD

Principal Investigator

VA Ann Arbor Healthcare System, Ann Arbor, MI

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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]

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]

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 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]

Citations

1. withpower.com withpower.com/trial/phase-substance-use-disorders-sud-4-2022-6c84e

Telehealth Treatment for Veterans with Substance Use Disorders ... Research indicates that telehealth treatment, including programs like VetReach, has been used safely to provide care for veterans with substance use disorders, ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT04768920

Study Details | NCT04768920 | Examining Feasibility and ... TeleTx consists of up to 8 ~30-50 minute psychosocial sessions delivered via phone or videoconference platform (e.g. Zoom etc). Intervention/Treatment ...

3. ctv.veeva.com ctv.veeva.com/study/developing-a-telehealth-model-to-improve-treatment-access-for-rural-veterans-with-substance-use-diso

Developing a Telehealth Model to Improve Treatment Access ... This project will pilot-test and obtain stakeholder input on a telehealth-delivered substance use disorder (SUD) care model (with initial ...

4. withpower.com withpower.com/trial/phase-substance-related-disorders-2-2021-dc6fa

Telemedicine-Based Therapy for Substance Abuse Participants using CBT4CBT reported higher satisfaction and better understanding of cognitive and behavioral concepts than those receiving traditional clinician ...

5. clinicaltrials.gov clinicaltrials.gov/study/NCT05348317?tab=table

Developing a Telehealth Model to Improve Treatment Access for ... This project will pilot-test and obtain stakeholder input on a telehealth-delivered substance use disorder (SUD) care model (with initial engagement and ongoing ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5587184/

Substance use disorders in military veterans: prevalence and ... Substance use disorders (SUDs) are a significant problem among military veterans and are associated with numerous deleterious effects.

7. hsrd.research.va.gov hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141700803

IIR 09-333 – HSR Study - VA Health Systems Research The preliminary results show some reductions in violence and substance use for all groups, with some evidence that those receiving MI-CBT+CC showed significant ...

8. ihpi.umich.edu ihpi.umich.edu/news-events/news/fewer-deaths-seen-among-veterans-incentive-based-drug-recovery

Fewer deaths seen among veterans in incentive-based drug ... Veterans in incentive-based recovery had a 41% lower risk of death, a 33% reduction in overdose risk, and a 42% reduction in stimulant-related ...