Predictors of evidence-based psychotherapy initiation among veterans with co-occurring PTSD and substance use disorder

Vanessa C Somohano; David Cameron; Meaghan M Lewis; Allison O'Neill; Rachel Phillips; Joshua Kaplan; Maya E O'Neil

doi:10.3389/fpsyt.2024.1432361

Predictors of evidence-based psychotherapy initiation among veterans with co-occurring PTSD and substance use disorder

Front Psychiatry. 2024 Aug 16:15:1432361. doi: 10.3389/fpsyt.2024.1432361. eCollection 2024.

Authors

Vanessa C Somohano¹, David Cameron^{1

2}, Meaghan M Lewis¹, Allison O'Neill¹, Rachel Phillips¹, Joshua Kaplan³, Maya E O'Neil^{1

2

4}

Affiliations

¹ Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, United States.
² Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.
³ Integrative Neurology and Intraoperative Neuromonitoring, Oregon Health & Science University, Portland, OR, United States.
⁴ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States.

Abstract

Objective: To compare initiation of PTSD evidence-based psychotherapy (EBP) between Veterans with and without a co-occurring substance use disorder (SUD), and identify factors associated with EBP initiation among Veterans with PTSD-SUD.

Method: A national sample of Veterans with PTSD (n = 301,872) and PTSD-SUD (n = 94,515) were identified from VA Electronic Health Record data. Treatment initiation was defined as having at least one mental health encounter associated with Cognitive Processing Therapy or Prolonged Exposure therapy. Generalized estimating equations were used to compare EBP initiation between Veterans with and without co-occurring SUD, and to identify patient- and facility characteristics associated with EBP initiation among Veterans with PTSD-SUD.

Results: The majority of Veterans were 30 - 44 years old, male sex, and Non-Hispanic White. No significant differences were observed in EBP initiation between Veterans with and without a co-occurring SUD (OR=1.00, p=0.985). Among Veterans with PTSD-SUD, co-occurring bipolar disorder (OR=0.83, p=.000), co-occurring psychotic disorder (OR=0.69, p=.000), service connection (OR=0.94, p=.001), female sex (OR=0.87, p=.000), and being 60 years or older (OR=0.57, p=.000) were associated with a reduced likelihood of initiating a PTSD EBP. Having a co-occurring anxiety disorder (OR=1.06, p=.020), MST history (OR=1.95, p=.000), and high risk for suicide (OR=1.15, p=.000) were associated with an increased likelihood of initiating EBP.

Discussion: These findings support VA provision of EBP for Veterans with PTSD regardless of the presence of co-occurring SUD. Identifying characteristics that increase or reduce the likelihood of EBP initiation may provide insight into treatment pathways and subgroups warranting augmented outreach.

Keywords: PTSD; dual-diagnosis; evidence-based psychotherapy; health service utilization; substance use disorder; veterans.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This material was based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and funded by a grant to VS from Health Systems Research Small Award Initiative for Impact (HSR SWIFT; SWI-21-002). MO’N is supported by a VA Rehabilitation Research Development (RR&D) Career Development Award 1 IK2 RX002762. MO’N and VS were also supported by the NW Mental Illness Research, Education, and Clinical Centers (MIRECC), and the Center to Improve Veteran Involvement in Care (CIVIC), the VA Portland Health Care System’s HSR Center of Innovation. The opinions herein are those of the authors and not necessarily those of the US Department of Veterans Affairs (VA) or the United States government. The VA did not have any role in the design, analysis, interpretation, or publication of this study.