VA Faces Challenges in Providing Substance Use Disorder Services and Is Taking Steps to Improve These Services for Veterans

Substance use disorders (SUD), such as alcohol abuse and drug addiction, are serious health conditions that affect many Americans, including a substantial number of veterans. According to the Department of Veterans Affairs (VA), about 420,000 of the over 5 million veterans receiving health care from VA had SUD diagnoses in fiscal year 2009. Both older veterans and veterans of the current military operations in Iraq and Afghanistan are at risk for SUDs, as veterans may use drugs or alcohol to help cope with the effects of stressful events experienced during deployment or with difficulties they encounter in readjusting from wartime military service to civilian life. The identification and treatment of veterans with SUDs is important, as SUDs can have harmful effects on veterans' physical, psychological, and social well-being if left untreated. VA provides SUD services in a range of settings, including inpatient SUD programs that provide acute in-hospital care, which may include detoxification services; residential rehabilitation treatment programs, which provide intensive treatment and rehabilitation services with supported housing; intensive outpatient programs, which provide at least 3 hours of treatment services 3 days per week; and standard outpatient programs, which provide less-intensive outpatient services. This report provides an overview of: (1) the challenges that VA officials and providers reported facing in their efforts to provide SUD services to veterans who have or are at risk for SUDs; and (2) the national efforts VA has recently undertaken to improve its SUD services for veterans who have or are at risk for SUDs.

VA officials and providers reported facing challenges related to providing SUD services to veterans who have or are at risk for SUDs in three areas--providing access to SUD services, meeting the specific treatment needs of veterans with SUDs, and assessing the effectiveness of SUD treatments. These reported challenges include the following: (1) Challenges related to access to SUD services--Several VA medical centers have faced challenges hiring additional SUD staff to meet veterans' needs for SUD services. In addition, it can be difficult for veterans to access VA residential programs because beds in those programs may not always be immediately available. (2) Challenges related to meeting the specific treatment needs of veterans with SUDs--VA faces challenges increasing the use of pharmacotherapies5 that can assist veterans with SUD recovery. According to VA officials, certain pharmacotherapies are underutilized by VA providers for reasons that could include providers' lack of awareness of or training on pharmacotherapies and reluctance among providers to use them. Implementing additional psychotherapies can also be challenging because training can be time-intensive for both providers and trainers. (3) Challenges related to assessing the effectiveness of SUD treatments--VA officials and providers noted factors that can make it difficult to assess the effectiveness of VA SUD treatments, including a lack of information about veterans after they are discharged from treatment and standardized measures for assessing treatment outcomes. To improve its SUD services, VA has recently begun a number of national efforts, including increasing access to SUD services, promoting evidence-based treatments for SUDs, and assessing SUD services and monitoring treatment effectiveness. According to VA officials, these efforts may address multiple challenges that VA faces in providing SUD services. VA's efforts include the following: (1) Efforts to increase veterans' access to its SUD services--VA is in the process of establishing additional intensive outpatient programs at VA facilities. VA is also hiring SUD specialists to work in non-SUD settings, including non-SUD residential rehabilitation treatment programs and community-based outpatient clinics. (2) Efforts to promote the use of evidence-based SUD treatments--VA is requiring facilities to make certain evidence-based SUD treatments, such as cognitive behavioral therapy for relapse prevention, available to veterans. In addition, VA has implemented training for physicians on the use of pharmacotherapies as part of veterans' SUD treatment. (3) Efforts to assess SUD services and monitor treatment effectiveness--VA is assessing the progress that VA medical centers are making toward implementing the requirements listed in the Handbook related to SUD services. VA is also testing a new data collection tool--the Brief Addiction Monitor--that could be used to monitor treatment effectiveness at the individual patient and VA medical center levels.