Factors Associated With Increased Substance Use Disorder Care in VA PTSD Specialty Outpatient Treatment

Abstract

Objective: Substance use disorders (SUDs) commonly co-occur with posttraumatic stress disorder (PTSD). Understanding PTSD clinics that serve higher percentages of patients with PTSD/SUD is crucial for improving SUD care in clinics with lower percentages of such patients. This study examined the differences between Veterans Affairs (VA) PTSD treatment sites with higher percentages ("High%") and lower percentages ("Low%") of patients with PTSD/SUD as well as exploring the roles of the PTSD/SUD specialists. Methods: The study collected quantitative and qualitative data from 18 clinic directors and 21 specialists from 33 VA PTSD specialty outpatient clinics from 2014 to 2016. The clinics were chosen from the top and bottom quartiles based on two criteria: (1) the percentage of patients with PTSD/SUD and (2) the percentage of patients with PTSD/SUD who completed at least three SUD visits within the first month of their SUD treatment. The interviews sought to identify distinguishing characteristics between the High% and Low% clinics in terms of treatment access and practices for patients with PTSD/SUD. Results: More of the High% clinics reported providing evidence-based, patient-centered, and integrated/concurrent PTSD/SUD treatment and had staff members with more up-to-date knowledge and skills than the Low% clinics. We also found the roles of the PTSD/SUD specialists were demanding and confusing, leading to high turnover rates. Conclusions: The two groups of PTSD clinics differed in three key factors: Resources, knowledge and skills of staff members, and local policies. Future research should focus on addressing resource limitations, knowledge gaps, and local policy disparities in Low% clinics. By emulating the practices of High% clinics, VA PTSD clinics can improve SUD care for patients with PTSD/SUD.

Keywords:

• PTSD
• substance use disorder
• treatment
• comorbidity
• veterans
• qualitative study
• quality improvement

Acknowledgments

The authors wish to thank the directors and PTSD/SUD specialists at the PTSD outpatient clinics who participated in this study.

Disclosure statement

The authors report there are no competing interests to declare. The authors report no financial relationship with commercial interests. The views expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Department of Veterans Affairs. The VA HSR&D had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of manuscript.

Additional information

Funding

This study was partially supported by grant HX001527-01 from the Veterans Affairs Health Services Research and Development (VA HSR&D) awarded to the first author.