Engaging Younger Veterans Struggling with Addictions

Kellie Rollins, Psy.D.Psychologist, Substance Abuse Programs

San Francisco VA Medical CenterAssistant Clinical Professor

University of California, San Francisco

Disclosures: No Commercial Interest

No Financial relationshipsNo Relevant financial relationships

No Conflict of Interest

Overview• Profile of OEF/OIF/OND Veterans– Addiction prevalence

• Best Practices Summary– For SUD w/in the VA

• Opioid Replacement Treatment Clinic (ORT)- San Francisco VA Medical Center

• Young Adults Recovery Group• Q&A

“The 9/11 Generation”- Barack Obama

OEF - Operation Enduring FreedomOctober 7, 2011 – present.

OIF - Operation Iraqi Freedom March 30, 2003 - redesignated.

OND - Operation New Dawn

September 1, 2010 - present.

OEF / OIF / OND • Over 5 million American men and

women served in the ranks of the US armed forces since 9/11/2001.

• Over 2 million US Troops deployed to Iraq & Afghanistan since 09/11.

• 1.6 million active duty.

OEF / OIF / OND• 1/3 have mental health diagnoses or

serious psychosocial problems • 1/5 dx with SUD• 15% unemployment• 78% divorce rate • Significant homelessness• Elevated risk of suicide

Scope of the SUD problem

• Alcohol Dependence rate doubled in the last 5 years (US Army figure).

• 27% of Army active duty misuse alcohol (Santiago et al., 2010).

• Youngest service members at highest risk (Bray et al., 2009; Jacobson et al., 2008).

• High correlation between substance misuse and PTSD (Jacobson et al., 2008).

Veterans vs Non-Veterans – % of SUD by age

18-25 26-54 55 or older0

5

10

15

20

25

30 29

14.4

3.9

27

13.3

3.2

VeteransNonveterans

NSDUH, November 2004

Serious Psychological Distress (SPD), SUD, and Co-Occurring SPD and SUD in the Past Year among

Veterans, by Age: 2004 to 2006

SPD SUD Co-occurring0

5

10

15

20

25

30

20.9

25

8.411.2 11.3

2.74.3 4.4

0.7

Aged 18-25Aged 26-54Aged 55 or older

SAMHSA, 2004, 2005 and 2006 NSDUHs

Prevalence of SPD, SUD, SPD/SUD past year among Veterans, by gender: 2004-2006

SAMHSA, 2004, 2005 and 2006 NSDUHs

Disorder Males Females

SPD 6.5% 14.5%

SUD 7.2% 5.8%

SPD/SUD 1.5% 2.0%

Rx Drug Use/Abuse

• Doubled from 2002-2005

• Tripled from 2005-2008

Increasing rates of opioid use for pain among Veterans aged 18-30.

NIDA Brief, April, 2011

Co-occurring Triad

VAMCs with Onsite OTP and/or Buprenorphine Treatment (BT)

20%

26%51%

3% VAMCs with both OTP and BT (28/139)

VAMCs with Neither OTP or BT (36/139)

VAMCs with BT Only (71/139)

VAMCs with only OTP (4/139)

San Francisco Veterans AffairsMedical Center

Opioid Replacement Treatment Clinic(ORT)

Methadone &Buprenorphine

Interdisciplinary Treatment Team

SFVAMC ORT Best Practices

Young Adults Recovery Group SFVAMC, Substance Abuse Programs

Group Themes

No Script for Treating Younger Veterans

NO Rx

“Younger veterans are difficult to engage! They have life

on their minds.”Dr. Sam Wan, 2010, 2011, 2012

Q & A