Journal Article

Brief Counseling for Veterans with Musculoskeletal Disorder, Risky Substance Use, and Service Connection Claims

Black, Anne C, Rosen, Marc I, Edens, Ellen L, Kerns, Robert D, Becker, William C, Martino, Steve

2019

Overview

Abstract Objective High proportions of post-9/11 veterans have musculoskeletal disorders (MSDs), but engaging them in care early in their course of illness has been challenging. The service connection application is an ideal point of contact for referring veterans to early interventions for their conditions. Design Among MSD claimants who reported risky substance use, we pilot-tested a counseling intervention targeting pain and risky substance use called Screening Brief Intervention and Referral to Treatment–Pain Module (SBIRT-PM). Veterans were randomly assigned in a 2:1:1 ratio to SBIRT-PM, Pain Module counseling only, or treatment as usual (TAU). Methods Participants assigned to either counseling arm were offered a single meeting with a study therapist with two follow-up telephone calls as needed. Participants completed outcome assessments at four and 12 weeks after randomization. Results Of 257 veterans evaluated, 101 reported risky substance use and were randomized. Counseling was attended by 75% of veterans offered it and was well received. VA pain-related services were used by 51% of participants in either of the pain-focused conditions but only by 27% in TAU (P < 0.04). Starting with average pain severity ratings of 5.1/10 at baseline, only minimal changes in mean pain severity were noted regardless of condition. Self-reported risky substance use was significantly lower over time in the SBIRT-PM condition relative to the two other conditions (P < 0.02). At week 12, proportions of veterans reporting risky substance use were 0.39, 0.69, and 0.71 for the SBIRT-PM, Pain Module counseling, and TAU conditions, respectively. Conclusions SBIRT-PM shows promise as a way to engage veterans in pain treatment and reduce substance use.

• Publisher: Oxford University Press
• Subject: Adult / Care and treatment / Chronic pain / Clinical trials / Counseling / Counseling - methods / Drug abuse / Drug use / Evidence-based medicine / Female / Health behavior / Health counseling / Humans / Male / Methods / MUSCULOSEKELTAL SECTION / Musculoskeletal diseases / Musculoskeletal Diseases - complications / Musculoskeletal Diseases - psychology / Pain / Pain - etiology / Pain - psychology / Pain management / Pain Management - methods / Patient compliance / Pilot Projects / Psychological aspects / Substance abuse / Substance use / Substance-Related Disorders - psychology / United States / Veterans