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Military and Veterans Psychology

(PS6-D81) VA Coordinated Anxiety Learning and Management for Transdiagnostic Treatment of Co-occurring Anxiety and Substance Use: A Pilot Randomized Controlled Trial

Friday, November 17, 2023
4:00 PM – 5:00 PM PST
Location: Regency Ballroom, Level 7
Nearly 1.5 million US military veterans are diagnosed with a substance use disorder (SUD; SAMHSA, 2015) and nearly 300,000 veterans receive a new anxiety disorder diagnosis (Barrera et al., 2014). SUD commonly co-occurs with anxiety disorders (Kessler et al., 2005) and individuals with anxiety disorders are 7 times more likely to develop SUD compared to persons without an anxiety disorder (Buckner et al., 2008). Unfortunately, many Veterans living in rural areas do not receive evidence-based treatment for anxiety disorders or SUD, in part due to lack of providers with training in treatments for these disorders (Barrera et al., 2014; Halvorson et al., 2014; Mott et al., 2014). Tools are needed to increase providers’ ability to deliver high quality evidence-based treatments such cognitive-behavioral therapy (CBT). The VA Coordinated Anxiety Learning and Management (CALM) program is a computer-assisted tool, adapted for VHA, that helps providers deliver CBT for anxiety disorders (Cucciare et al., 2021). CALM has been shown to be effective for treating anxiety disorders in primary care clinics (Craske et al., 2011; Roy-Byrne et al., 2010). CALM has been used to successfully treat anxiety in SUD intensive outpatient treatment programs (Wolitzky-Taylor et al., 2018), however VA CALM does not currently include CBT components for treating co-occurring substance use in a transdiagnostic package. This package could help rural providers efficiently address the care needs of this high-need population. To address this care gap, our team adapted VA CALM to treat co-occurring anxiety and SUD using an integrated, transdiagnostic format (VA CALM-S). The current study, still ongoing, aims to examine the feasibility, acceptability, and preliminary effectiveness of VA CALM-S in a pilot randomized controlled trial. In this ongoing trial, 16 Veterans (Mage = 49.88, 18.5% Women), were recruited from rural-serving community-based outpatient clinics and randomized to receive VA CALM-S (n = 8) or usual care (UC, n = 8). Participants completed assessments at baseline, 3 months post baseline, and 6 months post baseline. Participants also completed qualitative interviews post-treatment to provide feedback on their experience with VA CALM-S or UC. To illustrate initial feasibility and acceptability, 100% of participants who started treatment completed all modules within 10-12 sessions. Participants completed measures of anxiety (Overall Anxiety Severity and Impairment Scale; OASIS) and substance use quantity/frequency (Brief Addiction Monitor-Revised, consumption items; BAM-R) at each session. Across these participants over the course of 10-12 weekly sessions, OASIS scores reduced from a mean of 9.16 (SD = 3.71) to mean of 4.33 (SD = 3.27), and BAM-R scores reduced from 33.33 (SD = 18.36) to mean of 20.33 (SD = 12.21). Preliminary qualitative feedback from veterans indicated that the program was easy to use and helpful for participants in learning skills to manage their substance use while reducing avoidance and engaging in meaningful activities. Data from this pilot study suggest that VA CALM-S has the potential to be a feasible, acceptable, and effective tool to help Veterans manage anxiety and substance use simultaneously.