Encouraging the use of the Veterans Crisis Line among high-risk Veterans: A randomized trial of a Crisis Line Facilitation intervention.

The Veterans Crisis Line (VCL) is a core component of VA's suicide prevention strategy. Despite the availability and utility of the VCL, many Veterans do not utilize this resource during times of crisis. A brief, psychoeducational behavioral intervention (termed Crisis Line Facilitation [CLF]) was developed to increase utilization of the VCL and reduce suicidal behaviors in high-risk Veterans. The therapist-led session includes educational information regarding the VCL, as well as a chance to discuss the participant's perceptions of contacting the VCL during periods of crisis. The final component of the session is a practice call placed to the VCL by both the therapist and the participant. The CLF intervention was compared to Enhanced Usual Care (EUC) during a multi-site randomized clinical trial for 307 Veteran participants recently hospitalized for a suicidal crisis who reported no contact with the VCL in the prior 12 months. Initial analyses indicated that participants randomized to the CLF intervention were less likely to report suicidal behaviors, including suicide attempts compared to participants randomized to receive EUC over 12-months of follow-up (χ2 = 18.48/p < 0.0001), however this effect was not sustained when analyses were conducted on an individual level. No significant differences were found between conditions on VCL utilization. Initial evidence suggests a brief CLF intervention has an impact on preventing suicidal behaviors in Veterans treated in inpatient mental health programs; however, it may not change use of the VCL. This brief intervention could be easily adapted into clinical settings to be delivered by standard clinical staff.

Pain acceptance and opiate use disorders in addiction treatment patients with comorbid pain.

OBJECTIVES: Studies from pain treatment settings indicate that poor acceptance of pain may be an important and modifiable risk factor for higher severity of opioid use. However, the degree to which pain acceptance relates to opioid use severity in the addiction treatment population is unknown. In this study of addiction treatment patients with co-morbid pain, we examined correlates of severity of opiate (heroin and prescription opioid) use, with a particular focus on the role of pain acceptance. METHODS: Patients in residential addiction treatment with comorbid pain (N=501) were stratified into low, moderate and high severity of opiate use. Demographic and clinical characteristics were compared across opiate severity categories. RESULTS: 72% (N=360) of the participants had symptoms that were consistent with an opiate use disorder. Younger age, Caucasian race, female gender, cocaine use and lower pain acceptance were associated with higher severity of opiate use, whereas pain intensity was not. Controlling for demographic and other risk factors, such as substance use and pain intensity, higher pain acceptance was associated with lower odds of severe prescription opioid (AOR 0.50, 95% CI 0.38-0.68 for a one SD increase in pain acceptance) and heroin use (AOR 0.57, 95% CI 0.44-0.75 for a one SD increase in pain acceptance). CONCLUSIONS: Problematic opiate use is common in addictions treatment patients with chronic pain. Lower pain acceptance is related to greater opiate use severity, and may be an important modifiable target for interventions to successfully treat both pain and opiate use disorders.

Self-efficacy to avoid suicidal action: factor structure and convergent validity among adults in substance use disorder treatment.

Individuals with substance use disorders (SUDs) are at high risk of suicidal behaviors, highlighting the need for an improved understanding of potentially influential factors. One such domain is self-efficacy to manage suicidal thoughts and impulses. Psychometric data about the Self-Efficacy to Avoid Suicidal Action (SEASA) Scale within a sample of adults seeking SUD treatment (N = 464) is provided. Exploratory factor analysis supported a single self-efficacy construct. Lower SEASA scores, or lower self-efficacy, were reported in those with more severe suicidal ideation and those with more suicide attempts, providing evidence for convergent validity. Implications of measuring self-efficacy in the context of suicide risk assessment are discussed.

Substance use disorders and homicide death in veterans.

OBJECTIVE: The present study examined the association between a diagnosis of an alcohol use disorder or a drug use disorder and death by homicide over the course of 6 years. METHOD: This was a cohort study that included all patients seen for medical treatment by the Veterans Health Administration during fiscal year (FY) 2001. Treatment records were used to identify all patients with a diagnosis of a substance use disorder in FY01 (n = 3,942,932). The National Death Index data provided information on the timing and cause of death between FY02 and the end of 2007. Analyses examined the association between substance use disorders and the time to homicide, after controlling for age and gender. RESULTS: Veterans Health Administration patients who were diagnosed with an alcohol use disorder were more likely to die by homicide than those without a substance use disorder (hazard ratio [HR] = 3.3, 95% CI [2.6,4.1]). This finding also was true for those with drug use disorders (HR = 4.3, 95% CI [3.4, 5.4]) and for those with both an alcohol use disorder and a drug use disorder (HR = 4.6, 95% CI [3.9, 5.4]), compared with those without a substance use disorder. CONCLUSIONS: In this observational study of veterans, a diagnosis of a substance use disorder was significantly associated with death by homicide. Alcohol and drug treatment programs may have an important role to play in reducing the burden of homicide as a public health problem.

Prevalence and correlates of nonmedical use of prescription opioids in patients seen in a residential drug and alcohol treatment program.

Population-based data indicate that rates of nonmedical use of prescription opioids (POs) have increased dramatically over the past decade. However, data are lacking on nonmedical use of POs in individuals seeking treatment for substance use disorders. Patients (N = 351) seeking treatment from a residential drug and alcohol treatment program were assessed for nonmedical use of POs prior to treatment entry. Approximately 68% (65% men and 78% women) of patients reported at least some nonmedical PO use in the 30 days prior to treatment. Our results indicate that nonmedical PO use was more common in those with higher levels of depressive symptoms and pain intensity and in those with lower physical functioning. Treatment programs should consider actively screening participants for nonmedical PO use and consider how nonmedical use of pain medications might influence their treatment planning for patients.

Longitudinal predictors of addictions treatment utilization in treatment-naïve adults with alcohol use disorders.

BACKGROUND: Despite the substantial prevalence of alcohol use disorders (AUDs), prior research indicates that most people with AUDs never utilize either formal or informal treatment services. Several prior studies have examined the characteristics of individuals with AUDs who receive treatment; however, limited longitudinal data are available on the predictors of receiving AUD services in treatment-naive individuals with AUDs. METHODS: This study utilized data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to identify adults in Wave 1 who met criteria for an AUD within the last 12 months and reported no prior lifetime alcohol treatment (N = 2760). These individuals were surveyed again at Wave 2, approximately 3-4 years later (N = 2170). This study examined the Wave 1 demographic and psychiatric conditions that were associated with receipt of AUD treatment services between Waves 1 and 2. RESULTS: In multivariable analyses, use of AUD treatment services between Waves 1 and 2 was significantly more likely among those who were male, non-Caucasian, younger, had lower income, and who had health insurance. Additionally, those who met criteria for a baseline drug use disorder, anxiety disorder or a personality disorder were more likely to receive AUD treatment. CONCLUSIONS: Treatment was more often utilized in those who had more severe baseline psychopathology and in those with fewer economic resources. These findings highlight the need to broaden the types of care available to individuals with AUDs to increase the appeal of AUD services.