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BACKGROUND/RATIONALE:
Background: Interpersonal violence (IPV) among substance use disorder (SUD) patients is common, undertreated, and costly. SUD patients have high rates of perpetrating IPV. IPV is a risk factor for poor response to SUD treatment. Failure to address IPV among SUD patients interferes with treatment effectiveness and contributes to relapse and higher rates of health services use. Nonetheless, SUD treatment programs typically do not include violence prevention interventions and few studies have examined interventions designed to prevent violence perpetration among SUD patients.
OBJECTIVE(S):
Objectives: This trial will evaluate the effectiveness of an IPV-P intervention among patients entering VA SUD treatment who have perpetrated violence in the past year against another adult. Primary objectives are to test the hypotheses that, compared to patients assigned to usual care (UC), those assigned to IPV-P will (1) improve more on violence and SUD outcomes, and (2) use fewer VA mental health and medical care services, thereby saving costs for VA. Secondary objectives are to (1) test the hypothesis that, compared to patients assigned to UC, those assigned to IPV-P will improve more on anger, legal, and social problems; (2) test a mediational model whereby the improved substance use outcomes associated with IPV-P are mediated in part by reductions in anger and violence; and (3) test whether psychiatric comorbidity, particularly PTSD, moderates treatment effectiveness. Objectives will be examined in a large sample of male veterans. We will also be able to recruit enough female SUD patients to examine the effectiveness of IPV-P for women veterans in a pilot study. The long-term goal is to improve services and treatment outcomes for violence-prone SUD patients and to decrease their use of VA health care services.
METHODS:
Methods: Patients entering VA SUD treatment meeting eligibility criteria (past-year violence; cognitively intact) will be assigned to SUD UC or SUD UC plus an IPV-P intervention. The manual-guided IPV-P intervention, which uses a cognitive-behavioral approach and will be monitored for fidelity, was developed and pilot tested with veterans. Patients will be assessed at baseline and end-of-intervention (4 months post-baseline) and 6 and 12 months post-intervention for primary and secondary outcomes and non-VA healthcare; VA health care will be assessed with VA databases. We will use mixed-effects regression analyses to compare the UC and IPV-P groups on primary and secondary outcomes. We will use the general linear modeling approach to test anger and violence as potential mediators and psychiatric comorbidity, particularly PTSD, as a potential moderator of treatment effectiveness.
FINDINGS/RESULTS:
This project has not yet begun.
IMPACT:
Anticipated Impacts on Veterans' Healthcare: This project will help to specify clinical practices that enhance recovery for VA substance use disorder (SUD) patients who perpetrate interpersonal violence (IPV) against other adults. The IPV-prevention (IPV-P) intervention to be evaluated should be efficient, inexpensive, and generalizable for use by SUD clinicians in and outside VA. Project members serve on SUD-QUERI and collaborate closely with the Program Evaluation and Resource Center (conducting nationwide monitoring of VA SUD care under VA Office of Mental Health Services). We will use these existing channels to discuss project results regarding IPV-P as a component of SUD treatment with the key planners in VACO.
PUBLICATIONS:
None at this time.
DRA:
Mental Illness, Substance Abuse, Addictive Disorders
DRE:
Diagnosis and Prognosis
Keywords:
Addictive Disorders
MeSH Terms:
none
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