Even though a number of pharmacotherapy and behavioral treatments are effective in treating service members and veterans with substance use disorders, they are less likely to be used than more intensive and expensive options, such as intensive inpatient rehabilitation, said psychologists who spoke at a congressional forum on addiction.
"Very often, it's the less expensive treatments that are as or more effective" than intensive inpatient interventions, said Kathleen M. Carroll, PhD, of Yale University.
And, while medications for alcohol, opioid misuse, smoking and co-morbid psychiatric problems have been tested in veterans and are effective, we should remember they're like "Hamburger Helper in that they work more effectively when we combine them with effective evidence-based behavioral therapies," Carroll said.
A bipartisan group of a dozen senators and members of Congress supported the event on Capitol Hill in July. Many are co-sponsors of the Comprehensive Addiction and Recovery Act (CARA)opens in new window, a bill being considered by both houses of Congress at Monitor press time. It calls for giving up to $80 million in grants to help with prevention and treatment in communities struggling with substance use disorders, a situation that Sen. Kelly Ayotte (R-N.H.), who opened the forum, described as a "devastating public health issue and an epidemic across the country."
Several speakers described how prescription opioids are often gateway drugs to abusing other substances, particularly among veterans and service members who receive them for combat-related injuries. "Our veterans come back with physical pain," said Sen. Sheldon Whitehouse (D-R.I.), another CARA co-sponsor. "They come back with the stress of repeat deployments. They come back to a world of new opioids that are very commonly prescribed and poorly understood as to how they could lead to addiction. You put that combination together and you have a population particularly vulnerable to the risk of addiction."
Daniel Kivlahan, PhD, national mental health program director for addictive disorders in the Veterans Health Administration (VHA), said more research is needed so that clinical practice guideline recommendations are based on sound evidence. In addition, he said, better ways are needed for researchers to access existing clinical data on Medicare and Medicaid patients with substance use disorders.
VHA is stepping up efforts to educate veterans about opioid overdose, while distributing more naloxone, which can reverse the effects of accidental opioid overdose. Social support is important to overcoming the stigma of treatment-seeking, Kivlahan said, adding, "Nothing is more effective than veterans helping veterans to engage in change." To that end, the agency is addressing substance use disorders through a social media campaignopens in new window.
— Stacy Lu
