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ORIGINAL RESEARCH article

Front. Psychiatry
Sec. Addictive Disorders
Volume 15 - 2024 | doi: 10.3389/fpsyt.2024.1432361

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

Provisionally accepted
Vanessa C. Somohano Vanessa C. Somohano 1*David Cameron David Cameron 1,2Meaghan M. Lewis Meaghan M. Lewis 1Allison O'Neill Allison O'Neill 1Rachel Phillips Rachel Phillips 1Joshua Kaplan Joshua Kaplan 2Maya O'Neil Maya O'Neil 1,2*
  • 1 VA Portland Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Portland, United States
  • 2 Oregon Health and Science University, Portland, Oregon, United States

The final, formatted version of the article will be published soon.

    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), cooccurring 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.

    Keywords: health service utilization, PTSD, substance use disorder, Dual-diagnosis, Veterans, Evidence-based psychotherapy

    Received: 13 May 2024; Accepted: 08 Jul 2024.

    Copyright: © 2024 Somohano, Cameron, Lewis, O'Neill, Phillips, Kaplan and O'Neil. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Vanessa C. Somohano, VA Portland Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Portland, United States
    Maya O'Neil, VA Portland Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Portland, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.