Publications by authors named "Daniel M Blonigen"

64 Publications

Mobile Mental Health Apps from the National Center for PTSD: Digital Self-Management Tools for Co-Occurring Disorders.

J Dual Diagn 2021 Jun 21:1-12. Epub 2021 Jun 21.

HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Menlo Park, California, USA.

Mobile mental health apps can help bridge gaps in access to care for those with substance use disorders and dual diagnoses. The authors describe a portfolio of free, publicly available mobile mental health apps developed by the National Center for PTSD. The authors also demonstrate how this suite of primarily non-substance use disorder-specific mobile mental health apps may support the active ingredients of substance use disorder treatment or be used for self-management of substance use disorder and related issues. The potential advantages of these apps, as well as limitations and considerations for future app development, are discussed.
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http://dx.doi.org/10.1080/15504263.2021.1939919DOI Listing
June 2021

Trauma-related differences in socio-emotional functioning predict housing and employment outcomes in homeless veterans.

Soc Sci Med 2021 07 2;281:114096. Epub 2021 Jun 2.

Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, 01730, USA.

Rationale: Mental health and substance use disorders are strong risk factors for homelessness. Understanding the role of transdiagnostic factors could help inform efforts to reduce homelessness among veterans with a range of disorders. Homeless veterans have high rates of trauma exposure, which can result in the depletion of social and emotional resources that may contribute to housing and employment stability. In this study, we evaluated the role of problems with emotional lability and interpersonal closeness as transdiagnostic socio-emotional factors that might interfere with efforts to achieve housing and employment stability.

Methods: The sample consisted of 346 homeless veterans with co-occurring disorders that were admitted to a U.S. Department of Veterans Affairs (VA) residential treatment program between 2004 and 2009. Assessments were conducted at treatment entry (baseline) and two follow-up timepoints (6- and 12-months). Variables used in the current analyses included history of interpersonal trauma exposure, emotional lability and interpersonal closeness at baseline and 6-months, and homelessness and employment problems during follow-up. Data were analyzed using structural equation modeling and counterfactually-defined mediation effects.

Results: Veterans exposed to more trauma types experienced more baseline impairment and less improvement during treatment in emotional lability and interpersonal closeness. Problems with interpersonal closeness mediated 73% of the relationship between exposure to multiple traumas and homelessness, and 32%-61% of the relationship between trauma exposure and employment problems. Emotional lability mediated 36% of the relationship between exposure to multiple traumas and employment problems. Decomposition of indirect pathways revealed that indirect effects were primarily transmitted through changes during treatment, and not baseline levels.

Conclusion: Findings support a cumulative effect of trauma on persistence of socio-emotional deficits across treatment, which increased risk of homelessness and employment problems during follow-up. Greater attention and more targeted efforts should be directed at helping trauma-exposed veterans build socio-emotional resources during treatment.
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http://dx.doi.org/10.1016/j.socscimed.2021.114096DOI Listing
July 2021

Relevance of psychopathic traits to therapeutic processes and outcomes for veterans with substance use disorders.

Personal Disord 2021 Feb 18. Epub 2021 Feb 18.

Department of Veterans Affairs.

Psychopathic traits have been routinely associated with poor treatment outcomes in correctional settings. Less is known about how psychopathic traits relate to treatment processes (e.g., perceptions of treatment; adjustment to treatment), particularly in nonforensic settings. The current study tested for relationships between psychopathic traits, as operationalized by the Triarchic Psychopathy Measure (TriPM) and treatment processes and outcomes in a sample of 200 U.S. military veterans enrolled in a residential substance use disorder treatment program at a Veteran's Affairs (VA) medical center. Participants were interviewed using several measurement instruments at 4 time points: treatment entry, 1 month into treatment, treatment discharge, and 12 months post discharge. The TriPM was administered at baseline, and measures of treatment processes/outcomes were measured during treatment and at postdischarge. The TriPM scales exhibited differential associations with treatment processes and outcomes in multivariate analyses. Specifically, higher Boldness was associated with fewer psychiatric symptoms at baseline, but more rule-breaking behaviors and more peer-reported conflicts with other residents in treatment; higher Meanness predicted more negative perceptions of the treatment milieu; and higher Disinhibition predicted poorer substance use outcomes posttreatment. Together, these findings demonstrate associations between psychopathy and therapy processes/outcomes and highlight the potentially unique contribution of psychopathic traits to substance use disorder treatment programming. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000485DOI Listing
February 2021

Recidivism Treatment for Justice-Involved Veterans: Evaluating Adoption and Sustainment of Moral Reconation Therapy in the US Veterans Health Administration.

Adm Policy Ment Health 2021 Jan 30. Epub 2021 Jan 30.

Veterans Justice Programs, Veterans Health Administration, Washington, DC, USA.

Moral Reconation Therapy (MRT), an evidence-based intervention to reduce risk for criminal recidivism among justice-involved adults, was developed and primarily tested in correctional settings. Therefore, a better understanding of the implementation potential of MRT within non-correctional settings is needed. To address this gap in the literature, we evaluated the adoption and sustainment of MRT in the US Veterans Health Administration (VHA) following a national training initiative in fiscal years 2016 and 2017. In February 2019, surveys with 66 of the 78 VHA facilities that participated in the training were used to estimate the prevalence of MRT adoption and sustainment, and qualitative interviews with key informants from 20 facilities were used to identify factors associated with sustainment of MRT groups. Of the 66 facilities surveyed, the majority reported adopting (n = 52; 79%) and sustaining their MRT group until the time of the survey (n = 38; 58%). MRT sustainment was facilitated by strong intra-facility (e.g., between veterans justice and behavioral health services) and inter-agency collaborations (e.g., between VHA and criminal justice system stakeholders), which provided a reliable referral source to MRT groups, external incentives for patient engagement, and sufficient staffing to maintain groups. Additional facilitators of MRT sustainment were adaptations to the content and delivery of MRT for patients and screening of referrals to the groups. The findings provide guidance to clinics and healthcare systems that are seeking to implement MRT with justice-involved patient populations, and inform development of implementation strategies to be formally tested in future trials.
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http://dx.doi.org/10.1007/s10488-021-01113-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847225PMC
January 2021

Personality change during substance use disorder treatment is associated with improvements in abstinence self-efficacy post-treatment among U.S. military veterans.

J Subst Abuse Treat 2021 01 2;120:108187. Epub 2020 Nov 2.

Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA; National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (334-NCPTSD), Menlo Park, CA 94025, USA.

Prior research suggests that personality traits change during substance use disorder (SUD) treatment. However, the extent to which changes in traits during SUD treatment are associated with subsequent improvements in treatment outcomes remains untested. Among U.S. military veterans (n = 200) enrolled in SUD residential treatment, we examined whether changes in the personality factors of positive emotionality (PEM), negative emotionality (NEM), and constraint (CON) during treatment were associated with subsequent changes in abstinence self-efficacy and SUD symptoms. We analyzed data at treatment entry, discharge, and 12-months post-discharge via univariate and bivariate latent change score models. During treatment, PEM, CON, and abstinence self-efficacy increased, while NEM decreased, on average. Changes in NEM and CON were largely sustained, whereas PEM and abstinence self-efficacy significantly decreased post-treatment. SUD symptoms decreased from pre- to post-treatment. In bivariate models, higher levels of NEM at baseline were associated with less improvement in both abstinence self-efficacy during treatment and SUD symptoms pre- to post-treatment. Higher levels of CON at baseline were associated with greater improvement in SUD symptoms pre- to post-treatment, and increases in CON during treatment were associated with greater retention of treatment gains in abstinence self-efficacy post-treatment. Greater improvements in CON during treatment were also associated with greater improvements in SUD symptoms pre- to post-treatment in unadjusted (p = 0.041) but not adjusted models (p = 0.089). Our findings suggest that personality changes marked by improvements in impulse control over the course of SUD treatment may be linked to subsequent improvements in treatment outcomes and may have value as a proximal treatment target among SUD patients during residential care.
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http://dx.doi.org/10.1016/j.jsat.2020.108187DOI Listing
January 2021

Latent variable modeling of item-based factor scales: Comment on Triarchic or septarchic?-Uncovering the Triarchic Psychopathy Measure's (TriPM) Structure, by Roy et al.

Personal Disord 2021 01 1;12(1):16-23. Epub 2020 Oct 1.

Department of Psychology.

We critique Roy et al.'s (2020; this issue) approach to characterizing the item-level factor structure of the three scales of the Triarchic Psychopathy Measure (TriPM), in light of the manner in which the TriPM scales were developed, the purposes they were designed to serve, and the growing body of evidence supporting their construct validity. We focus on three major points: (1) The TriPM scales are item-based factor scales - i.e., item sets designed to index broad factors of larger multi-scale (parent) inventories; (2) item-level structural analysis can be useful for representing broad dimensions tapped by such scales, but it cannot be expected to provide an accurate picture of narrower subdimensions (facets) assessed by their parent inventories; and (3) it is critical to consider the nomological networks of the TriPM scales (and other triarchic scale measures) in appraising their effectiveness as operationalizations of the triarchic model constructs. We illustrate the first and second of these points by applying Roy et al.'s analytic approach to the trait scales of the NEO-FFI, which were developed to index broad personality dimensions of the multi-scale NEO-PI-R. We address the third point with reference to the growing body of literature supporting the construct validity of the TriPM scales and demonstrating their utility for advancing an integrative understanding of psychopathy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000424DOI Listing
January 2021

Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans.

JAMIA Open 2019 Oct 5;2(3):323-329. Epub 2019 Aug 5.

Office of Connected Care/Telehealth Services, Veterans Health Administration.

Background: Video telehealth technology has the potential to enhance access for patients with clinical, social, and geographic barriers to care. We evaluated the implementation of a US Department of Veterans Affairs (VA) initiative to distribute tablets to high-need Veterans with access barriers.

Methods: In this mixed methods implementation study, we examined tablet adoption (ie, facility-level tablet distribution rates and patient-level tablet utilization rates) and reach (ie, sociodemographic and clinical characteristics of tablet recipients) between 5/1/16 and 9/30/17. Concurrently, we surveyed 68 facility telehealth coordinators to determine the most common implementation barriers and facilitators, and then conducted interviews with telehealth coordinators and regional leadership to identify strategies that facilitated tablet distribution and use.

Results: 86 VA facilities spanning all 18 geographic regions, distributed tablets to 6 745 patients. Recipients had an average age of 56 years, 53% lived in rural areas, 75% had a diagnosed mental illness, and they had a mean (SD) of 5 (3) chronic conditions. Approximately 4 in 5 tablet recipients used the tablet during the evaluation period. In multivariate logistic regression, tablet recipients were more likely to use their tablets if they were older and had fewer chronic conditions. Implementation barriers included insufficient training, staffing shortages, and provider disinterest (described as barriers by 59%, 55%, and 33% of respondents, respectively). Site readiness assessments, local champions, licensure modifications, and use of mandates and incentives were identified as strategies that may influence widespread implementation of home-based video telehealth.

Conclusion: VA's initiative to distribute video telehealth tablets to high-need patients appears to have successfully reached individuals with social and clinical access barriers. Implementation strategies that address staffing constraints and provider engagement may enhance the impact of such efforts.
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http://dx.doi.org/10.1093/jamiaopen/ooz024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952023PMC
October 2019

Using peers to increase veterans' engagement in a smartphone application for unhealthy alcohol use: A pilot study of acceptability and utility.

Psychol Addict Behav 2020 Jun 29. Epub 2020 Jun 29.

Department of Clinical and Community Psychology, University of Alaska Anchorage.

Mobile apps can only increase access to alcohol treatment if patients actively engage with them. Peers may be able to facilitate such engagement by providing supportive accountability and instruction and encouragement for app use. We developed a protocol for peers to support engagement in the Stand Down app for unhealthy alcohol use in veterans and tested the acceptability and utility of the protocol. Thirty-one veteran primary care patients who screened positive for unhealthy alcohol use and were not currently in addiction treatment were given access to Stand Down for four weeks and concurrently received weekly phone support from a Department of Veterans Affairs peer specialist to facilitate engagement with the app. App usage was extracted daily, and pre/post treatment assessments measured changes in drinking patterns, via the Timeline Followback interview, and satisfaction with care, via quantitative and qualitative approaches. A priori benchmarks for acceptability were surpassed: time spent in the app (M = 93.89 min, SD = 92.1), days of app use (M = 14.05, SD = 8.0), and number of daily interviews completed for tracking progress toward a drinking goal (M = 12.64, SD = 9.7). Global satisfaction, per the Client Satisfaction Questionnaire, was high (M = 26.4 out of 32, SD = 4.5). Pre to post, total standard drinks in the prior 30 days (MPre = 142.7, MPost = 85.6), Drinks Per Drinking Day (MPre = 5.4, MPost = 4.0), and Percent Heavy Drinking Days (MPre = 35.3%, MPost = 20.1%) decreased significantly (ps < .05). Findings indicate that Peer-Supported Stand Down is highly acceptable to veteran primary care patients and may help reduce drinking in this population. A larger controlled trial of this intervention is warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/adb0000598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769861PMC
June 2020

Criminal recidivism among justice-involved veterans following substance use disorder residential treatment.

Addict Behav 2020 07 15;106:106357. Epub 2020 Feb 15.

Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94304, USA.

Veterans in treatment for substance use disorders (SUD) often report past criminal offending. However, the rate of criminal recidivism in this population is unknown. Further, prior research in veterans has not examined personality factors as predictors of recidivism, despite the prominence of such factors in leading models of recidivism risk management. We examined these issues in a secondary data analysis of 197 military veterans with a history of criminal offending who were enrolled in an SUD residential treatment program. Participants were interviewed using several measurement instruments at treatment entry, one month into treatment, treatment discharge, and 12 months post-discharge. Most veterans (94%) had a history of multiple charges, and 53% had recent involvement in the criminal justice system at the time of treatment entry. In the 12 months post-discharge, 22% reported reoffending. In addition, 30% of patients who had been recently involved in the criminal justice system at treatment entry reoffended during follow-up. Higher friend relationship quality (OR = 2.32, 95% CI [1.03, 5.21]) at treatment entry and higher staff ratings of patients' relationship quality with other residents during treatment (OR = 2.76, 95% CI [1.40, 5.41]) predicted lower odds of recidivism post-discharge. After accounting for these factors, smaller reductions during treatment in the personality trait of Negative Emotionality predicted an increased risk for criminal recidivism post-discharge (OR = 1.13, 95% CI [1.01, 1.26]). Results support augmenting the curriculum of SUD programs for veterans with services aimed at reducing risk for criminal recidivism, with a focus on interventions that directly target patients' social support networks and tendencies towards negative emotionality.
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http://dx.doi.org/10.1016/j.addbeh.2020.106357DOI Listing
July 2020

Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets.

Psychiatr Serv 2019 11 5;70(11):976-982. Epub 2019 Aug 5.

U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling).

Objective: In 2016, the Veterans Health Administration (VHA) began distributing video-enabled tablets to veterans with access barriers. This study evaluated the implementation of this initiative for veterans with mental health conditions, including the impact of tablet receipt on access to and continuity of mental health care, missed opportunities for care, and use of urgent care.

Methods: A retrospective matched cohort study was conducted, matching tablet recipients with diagnoses of mental disorders (N=728) to a comparison group (N=1,020) on the basis of sociodemographic characteristics, mental health utilization and diagnoses, and wireless coverage. A difference-in-differences approach was used to compare 6-month pre-post changes in number of psychotherapy and medication management visits, continuity of psychotherapy based on VHA's quality metric for mental health care continuity, missed opportunity rate (i.e., the proportion of mental health appointments that were missed or canceled), and probability of any and number of emergency department (ED) or urgent care visits.

Results: Compared with the matched control group, tablet recipients experienced an increase of 1.94 (p<0.001) psychotherapy encounters, an increase of 1.05 (p<0.001) medication management visits, an 18.54 percentage point (p<0.001) increase in their likelihood of receiving recommended mental health care necessary for continuity of care, and a 20.24 percentage point (p<.001) decrease in their missed opportunity rate in the 6-month period following receipt of tablets (or the index date for the matched sample). No significant differences in ED or urgent care use were found.

Conclusions: Distributing video-enabled tablets to veterans with mental health conditions appeared to improve access to and continuity of mental health services while also improving clinical efficiency by decreasing missed opportunities for care.
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http://dx.doi.org/10.1176/appi.ps.201900104DOI Listing
November 2019

Customizing a clinical app to reduce hazardous drinking among veterans in primary care.

Psychol Serv 2019 May 8;16(2):250-254. Epub 2018 Nov 8.

Department of Clinical and Community Psychology, University of Alaska-Anchorage.

Within the Veterans Health Administration (VHA), 15-30% of patients seen in primary care are identified as hazardous drinkers, yet the vast majority of these patients receive no intervention. Time constraints on providers and patient-level barriers to in-person treatment contribute to this problem. The scientific literature provides a compelling case that mobile-based interventions can reduce hazardous drinking and underscores the role of peer support in behavioral change. Here, we describe the benefits of using a clinical app-Step Away-to treat hazardous drinking among VHA primary care patients as well as an approach to customizing the app to maximize its engagement and effectiveness with this population. We highlight the value of integrating use of Step Away with telephone support from a trained VHA peer support specialist. This type of integrated approach may provide the key therapeutic components necessary to generate an effective and easily implemented alcohol use intervention that can be made available to VHA primary care patients who screen positive for hazardous drinking but are unwilling or unable to attend in-person treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/ser0000300DOI Listing
May 2019

Evaluating the structure of psychopathic personality traits: A meta-analysis of the Psychopathic Personality Inventory.

Psychol Assess 2018 06;30(6):707-718

Health Services Research and Development (HSR&D) Center for Innovation.

Which core traits exemplify psychopathic personality disorder is a hotly debated question within psychology, particularly regarding the role of ostensibly adaptive traits such as stress immunity, social potency, and fearlessness. Much of the research on the interrelationships among putatively adaptive and more maladaptive traits of psychopathy has focused on the factor structure of the Psychopathic Personality Inventory (PPI) and its revision, the Psychopathic Personality Inventory-Revised (PPI-R). These instruments include content scales that have coalesced to form 2 higher order factors in some (but not all) prior studies: Fearless Dominance and Self-Centered Impulsivity. Given the inconsistencies in prior research, we performed a meta-analytic factor analysis of the 8 content scales from these instruments (total N > 18,000) and found general support for these 2 dimensions in community samples. The structure among offender samples (e.g., prisoners, forensic patients) supported a 3-factor model in which the Fearlessness content scale loaded onto Self-Centered Impulsivity (rather than Fearless Dominance). There were also indications that the Stress Immunity content scale had different relations to the other PPI scales in offender versus community samples. We discuss the theoretical and diagnostic implications of these differing factor structures for the field of psychopathy research. (PsycINFO Database Record
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http://dx.doi.org/10.1037/pas0000520DOI Listing
June 2018

Study protocol: a hybrid effectiveness-implementation trial of Moral Reconation Therapy in the US Veterans Health Administration.

BMC Health Serv Res 2018 03 7;18(1):164. Epub 2018 Mar 7.

Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.

Background: Moral Reconation Therapy (MRT) is a cognitive-behavioral intervention aimed at reducing risk for criminal recidivism by restructuring antisocial attitudes and cognitions (i.e., "criminogenic thinking"). MRT has empirical support for reducing risk for criminal recidivism among civilian offenders. Recently, a version of MRT was developed for military veterans; however, no randomized controlled trials (RCT) have been conducted with the veteran-specific protocol, and the effectiveness and implementation potential of MRT outside of correctional settings has not been established.

Methods: Using a Hybrid Type 1 RCT design, this study will test the effectiveness of MRT to reduce risk for criminal recidivism and improve health-related outcomes among justice-involved veterans entering mental health residential treatment at three US Veterans Health Administration (VHA) Medical Centers. Upon admission to the treatment program, justice-involved veterans will complete a baseline assessment, be randomized to usual care (UC) or UC + MRT, and be followed 6 and 12 months post-baseline. A process evaluation will also be conducted to identify barriers and facilitators to implementation of MRT in residential treatment.

Discussion: The primary aim of this study is to evaluate the effectiveness of MRT with justice-involved veterans. If MRT proves effective in this trial, the findings can provide large healthcare systems that serve veterans with an evidence-based intervention for addressing criminogenic thinking among justice-involved adults, as well as guidance on how to facilitate future implementation of MRT in non-correctional settings.

Trial Registration: This trial is funded by the VA Health Services Research & Development Program (IIR 14-081) and is registered with ClinicalTrials.gov (ID: NCT02524171 ).
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http://dx.doi.org/10.1186/s12913-018-2967-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842602PMC
March 2018

Reducing Frequent Utilization of Psychiatric Emergency Services Among Veterans While Maintaining Quality of Care.

Psychiatr Serv 2018 04 1;69(4):438-447. Epub 2018 Feb 1.

Apart from Dr. Bi, the authors are with the Center for Innovation to Implementation, U.S. Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California. Dr. Blonigen, Ms. Suarez, Dr. Vashi, Dr. Timko, and Dr. Wagner are also with the Stanford University School of Medicine, where Dr. Blonigen and Dr. Timko are with the Department of Psychiatry and Behavioral Sciences, Ms. Suarez is with the Department of Neurosurgery, Dr. Vashi is with the Department of Emergency Medicine, and Dr. Wagner is with the Department of Surgery. Dr. Heinz is also with the National Center for PTSD, VA Palo Alto Health Care System. Dr. Bi is with Anthem, Inc., San Jose, California.

Objective: Use of psychiatric emergency services in emergency departments (EDs) and inpatient psychiatry units contributes substantially to the cost of mental health care. Among patients who utilize psychiatric emergency services, a small percentage ("high utilizers") contributes a disproportionate share of the total cost, yet little is known about the context of care for these patients. This study employed qualitative methods to identify barriers to and facilitators of reducing use of psychiatric emergency services among high utilizers.

Methods: Semistructured phone interviews were conducted with 31 directors of mental health services and providers of psychiatric emergency services across 22 Veterans Health Administration medical centers. The Consolidated Framework for Implementation Research was used to guide the interviews to evaluate the context of care for high utilizers. Thematic coding was used to identify barriers to and facilitators of reducing utilization.

Results: Barriers emerged at the patient level (for example, treatment nonadherence and transiency), provider level (for example, stigma toward high utilizers and lack of expertise and training in the management of psychiatric issues among ED staff), and system level (for example, lack of specialized services to address short- and long-term care needs). Facilitators included recovery-oriented care; interdisciplinary care coordination and case management, with emphasis on the role of psychiatric social workers; and predictive analytics to flag high utilizers.

Conclusions: The findings lay the groundwork for the design of novel approaches to care for high utilizers of psychiatric emergency services while limiting provider burnout, managing costs, and optimizing treatment outcomes.
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http://dx.doi.org/10.1176/appi.ps.201700288DOI Listing
April 2018

Criminogenic Needs, Substance Use, and Offending among Rural Stimulant Users.

Rural Ment Health 2017 Apr;41(2):110-122

Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205 USA.

There is a need to understand the determinants of both substance use and criminal activity in rural areas in order to design appropriate treatment interventions for these linked problems. The present study drew on a predominant model used to assess and treat offenders -- the Risk-Need-Responsivity (RNR) model -- to examine risk factors for substance use and criminal activity in a rural drug using sample. This study extends the RNR model's focus on offenders to assessing rural-dwelling individuals using stimulants (N=462). We examined substance use and criminal justice outcomes at 6-month (91%) and 3-year (79%) follow-ups, and used Generalized Estimating Equations to examine the extent to which RNR criminogenic need factors at baseline predicted outcomes at follow-ups. Substance use and criminal justice outcomes improved at six months, and even more at three years, post-baseline. As expected, higher risk was associated with poorer outcomes. Antisocial personality patterns and procriminal attitudes at baseline predicted poorer legal and drug outcomes measured at subsequent follow-ups. In contrast, less connection to antisocial others and fewer work difficulties predicted lower alcohol problem severity, but more frequent alcohol use. Engagement in social-recreational activities was associated with fewer subsequent arrests and less severe alcohol and drug problems. The RNR model's criminogenic need factors predicted drug use and crime-related outcomes among rural residents. Services adapted to rural settings that target these factors, such as telehealth and other technology-based resources, may hasten improvement on both types of outcomes among drug users.
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http://dx.doi.org/10.1037/rmh0000065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642975PMC
April 2017

Interpersonal styles, peer relationships, and outcomes in residential substance use treatment.

J Subst Abuse Treat 2017 10 20;81:17-24. Epub 2017 Jul 20.

Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, United States; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States; Palo Alto University, United States.

Interpersonal relationships play a key role in recovery from substance use disorders (SUDs). We examined the associations between problematic interpersonal styles, peer relationships, and treatment outcomes in a sample of U.S. military veterans in residential SUD treatment. Participants were 189 veterans enrolled in a residential SUD treatment program at a Department of Veterans Affairs medical center. Participants were interviewed at the time of treatment entry (baseline), one month into treatment, and 12months following discharge from treatment. More problematic interpersonal styles at treatment entry, measured by the Inventory of Interpersonal Problems-Circumplex (IIP-C), predicted more SUD symptoms 12months post-discharge (r=0.29, P<0.01). Results of a principal components analysis of the IIP-C subscales revealed three main factors of interpersonal styles: Passive, Cruel/Aloof, and Controlling. With the exception of the Passive factor, the relationship between these interpersonal styles and SUD symptoms 12months after discharge was mediated by relationship quality with peers one month in treatment: i.e., more problematic interpersonal styles at baseline predicted poorer relationship quality with peers at 1month, which in turn predicted more SUD symptoms at 12months. Results demonstrate the importance of assessing interpersonal styles among patients in residential SUD treatment, as well as potentially augmenting existing evidence-based psychosocial treatments with a focus on interpersonal styles.
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http://dx.doi.org/10.1016/j.jsat.2017.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657574PMC
October 2017

Cognitive-behavioral treatments for criminogenic thinking: Barriers and facilitators to implementation within the Veterans Health Administration.

Psychol Serv 2018 Feb 18;15(1):87-97. Epub 2017 May 18.

HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System.

Cognitive-behavioral treatments for criminogenic thinking (i.e., antisocial cognitions, attitudes, and traits) are regarded as best practices for reducing criminal recidivism among justice-involved adults. However, the barriers and facilitators to implementation of these treatments within large health care systems such as the Veterans Health Administration (VHA) are largely unknown. To address this gap, we conducted qualitative interviews with 22 Specialists from the VHA's Veterans Justice Programs who had been trained in a cognitive-behavioral treatment for criminogenic thinking (i.e., Moral Reconation Therapy [MRT], Thinking for a Change [T4C]). The time-intensiveness of these treatments emerged as a barrier to implementation. Potential solutions identified were patient incentives for treatment engagement, streamlining the curriculum, and implementing the treatments within long-term/residential programs. At the program level, providers' stigma/bias toward patients with antisocial tendencies was seen as a barrier to implementation, as were time/resource constraints on providers. To address the latter, use of peer providers to deliver the treatments and partnerships between justice programs and behavioral health services were suggested. At the system level, lack of recognition of criminogenic treatments as evidence based, and uncertainty of sustained funds to support ongoing costs of these treatments emerged as implementation barriers. To address the latter, a train-the-trainers model was suggested. Our findings serve as a guide for implementation of criminogenic treatments for providers and policymakers in VHA and other large health care systems, which are increasingly called upon to provide care to justice-involved adults in the community. (PsycINFO Database Record
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http://dx.doi.org/10.1037/ser0000128DOI Listing
February 2018

Institutional Incentives for Mentoring at the U.S. Department of Veterans Affairs and Universities: Associations With Mentors' Perceptions and Time Spent Mentoring.

Acad Med 2017 04;92(4):521-527

N.C. Maisel is a social science research professional, Institute for Research in the Social Sciences, Stanford University, Stanford, California, and research health science specialist, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.M.A. Halvorson is a graduate student, Department of Psychology, University of Washington, Seattle, Washington, and research health science specialist, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.J.W. Finney is research health science specialist (WOC), Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, and consulting professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.X. Bi is analytics and research manager, American Academy of Ophthalmology, San Francisco, California.K.P. Hayashi is a biostatistician, Impax Laboratories, Hayward, California.D.M. Blonigen is research health science specialist, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, and adjunct professor, Palo Alto University, Palo Alto, California.J.C. Weitlauf is director, Women's Mental Health and Aging Core, VISN 21 Mental Illness, Research, Education and Clinical Center, and center investigator, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, as well as clinical professor (affiliated) of psychiatry and behavioral sciences, Stanford University School of Medicine, Stanford, California.C. Timko is senior research career scientist, VA Health Services Research and Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, and consulting professor, Stanford University School of Medicine, Stanford, California.R.C. Cronkite is research health science specialist, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, as well as consulting professor, Department of Sociology, and affiliate, Center for Primary Care and Outcomes Research, Stanford University, Stanford, California.

Purpose: Limited empirical attention to date has focused on best practices in advanced research mentoring in the health services research domain. The authors investigated whether institutional incentives for mentoring (e.g., consideration of mentoring in promotion criteria) were associated with mentors' perceptions of mentoring benefits and costs and with time spent mentoring.

Method: The authors conducted an online survey in 2014 of a national sample of mentors of U.S. Department of Veterans Affairs (VA) Health Services Research and Development Service (HSR&D) mentored career development award recipients who received an award during 2000-2012. Regression analyses were used to examine institutional incentives as predictors of perceptions of benefits and costs of mentoring and time spent mentoring.

Results: Of the 145 mentors invited, 119 (82%) responded and 110 (76%) provided complete data for the study items. Overall, mentors who reported more institutional incentives also reported greater perceived benefits of mentoring (P = .03); however, more incentives were not significantly associated with perceived costs of mentoring. Mentors who reported more institutional incentives also reported spending a greater percentage of time mentoring (P = .02). University incentives were associated with perceived benefits of mentoring (P = .02), whereas VA incentives were associated with time spent mentoring (P = .003).

Conclusions: Institutional policies that promote and support mentorship of junior investigators, specifically by recognizing and rewarding the efforts of mentors, are integral to fostering mentorship programs that contribute to the development of early-career health services researchers into independent investigators.
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http://dx.doi.org/10.1097/ACM.0000000000001507DOI Listing
April 2017

Factors associated with emergency department useamong veteran psychiatric patients.

Psychiatr Q 2017 Dec;88(4):721-732

HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.

Frequent utilization of emergency department (ED) services contributes substantially to the cost of healthcare nationally and is often driven by psychiatric factors. Using national-level data from the Veterans Health Administration (VHA), the present study examined patient-level factors associated with ED use among veteran psychiatric patients. Veterans who had at least one ED visit with a psychiatric diagnosis in fiscal years 2011-2012 (n = 226,122) were identified in VHA administrative records. Andersen's behavioral model of healthcare utilization was used to identify need, enabling, and predisposing factors associated with frequency of ED use (primary outcome) in multivariate regression models. Greater ED use was primarily linked with need (psychotic, anxiety, personality, substance use, and bipolar disorders) and enabling (detoxification-related service utilization and homelessness) factors. Chronic medical conditions, receipt of an opioid prescription, and predisposing factors (e.g., younger age) were also linked to greater ED use; however, the effect sizes for these factors were markedly lower than those of most psychiatric and psychosocial factors. The findings suggest that intensive case management programs aimed reducing frequent ED use among psychiatric patients may require greater emphasis on homelessness and other psychosocial deficits that are common among these patients, and future research should explore cost-effective approaches to implementing these programs.
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http://dx.doi.org/10.1007/s11126-017-9490-2DOI Listing
December 2017

Dually Diagnosed Patients with Arrests for Violent and Nonviolent Offenses: Two-Year Treatment Outcomes.

J Addict 2016 28;2016:6793907. Epub 2016 Mar 28.

Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA 94304, USA; Palo Alto University, Palo Alto, CA 94304, USA.

The purpose of this study was to examine the history of arrests among dually diagnosed patients entering treatment, compare groups with different histories on use of treatment and mutual-help groups and functioning, at intake to treatment and six-month, one-year, and two-year follow-ups, and examine correlates and predictors of legal functioning at the study endpoint. At treatment intake, 9.2% of patients had no arrest history, 56.3% had been arrested for nonviolent offenses only, and 34.5% had been arrested for violent offenses. At baseline, the violent group had used the most outpatient psychiatric treatment and reported poorer functioning (psychiatric, alcohol, drug, employment, and family/social). Both arrest groups had used more inpatient/residential treatment and had more mutual-help group participation than the no-arrest group. The arrest groups had higher likelihood of substance use disorder treatment or mutual-help group participation at follow-ups. Generally, all groups were comparable on functioning at follow-ups (with baseline functioning controlled). With baseline arrest status controlled, earlier predictors of more severe legal problems at the two-year follow-up were more severe psychological, family/social, and drug problems. Findings suggest that dually diagnosed patients with a history of arrests for violent offenses may achieve comparable treatment outcomes to those of patients with milder criminal histories.
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http://dx.doi.org/10.1155/2016/6793907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826919PMC
April 2016

Factors Associated With Veterans' Access to Permanent Supportive Housing.

Psychiatr Serv 2016 08 1;67(8):870-7. Epub 2016 Apr 1.

Dr. Montgomery and Ms. Cusack are with the National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), Philadelphia (e-mail: ). Dr. Blonigen is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, and Palo Alto University, Palo Alto, California. Dr. Gabrielian is with the Department of Psychiatry, Greater Los Angeles VA, and the Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles. Dr. Marsh is with the Mental Health Care Line, Michael E. DeBakey VA Medical Center, and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas. Dr. Fargo is with the Department of Psychology, Utah State University, and the VA Salt Lake City Health Care System, Salt Lake City.

Objective: The objective of this study was to identify individual- and program-level characteristics associated with veterans' ability to move into permanent housing following receipt of a housing voucher and to identify factors associated with more rapid placement into housing.

Methods: This study used secondary quantitative and primary quantitative and qualitative data collected from veterans participating in the U.S. Department of Housing and Urban Development and U.S. Department of Veterans Affairs Supportive Housing program at four locations between 2008 and 2014 (N=9,967). Interviewers conducted in-person surveys with a subsample of the cohort (N=508). The study assessed two outcomes: whether a veteran accessed permanent supportive housing and the number of days required for veterans to move in. A logistic regression analysis identified predictors of becoming housed and a multiple regression model determined factors that influenced the time required for veterans to move into housing after admission to the program.

Results: Most (85%) veterans who received a permanent housing subsidy identified and moved into permanent housing. Receipt of outpatient behavioral health care in the 90 days before program admission and use of outpatient medical, behavioral health, or substance use care in the 90 days after increased the odds of becoming housed.

Conclusions: Program-level policies may contribute to enhanced access to housing among veterans seeking permanent supportive housing, specifically a holistic approach to the frequent provision of supportive services-including both health care and case management-immediately after program admission.
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http://dx.doi.org/10.1176/appi.ps.201500248DOI Listing
August 2016

Personality trait change across late childhood to young adulthood: Evidence for nonlinearity and sex differences in change.

Eur J Pers 2016 Jan-Feb;30(1):31-44. Epub 2015 Sep 14.

University of Minnesota.

We explored patterns of self-reported personality trait change across late childhood through young adulthood in a sample assessed up to 4 times on the lower-order facets of Positive Emotionality (PEM), Negative Emotionality (NEM), and Constraint (CON). Multilevel modeling analyses were used to describe both group- and individual-level change trajectories across this time span. There was evidence for nonlinear age-related change in most traits, and substantial individual differences in change for all traits. Gender differences were detected in the change trajectories for several facets of NEM and CON. Findings add to the literature on personality development by demonstrating robust nonlinear change in several traits across late childhood to young adulthood, as well as deviations from normative patterns of maturation at the earliest ages.
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http://dx.doi.org/10.1002/per.2013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795480PMC
September 2015

The Availability and Utility of Services to Address Risk Factors for Recidivism among Justice-Involved Veterans.

Crim Justice Policy Rev 2017 10 10;28(8):790-813. Epub 2016 Feb 10.

HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Stanford University School of Medicine, Palo Alto, CA.

The availability and utility of services to address recidivism risk factors among justice-involved veterans is unknown. We explored these issues through qualitative interviews with 63 Specialists from the Department of Veterans Affairs' (VA) Veterans Justice Programs. To guide the interviews, we utilized the Risk-Need-Responsivity (RNR) model of offender rehabilitation. Specialists reported that justice-involved veterans generally have access to services to address most RNR-based risk factors (substance abuse; lack of positive school/work involvement; family/marital dysfunction; lack of prosocial activities/interests), but have less access to services targeting risk factors of antisocial tendencies and associates and empirically-based treatments for recidivism in VA. Peer-based services, motivational interviewing/cognitive-behavioral therapy, and Veterans Treatment Courts were perceived as useful to address multiple risk factors. These findings highlight potential gaps in provision of evidence-based care to address recidivism among justice-involved veterans, as well as promising policy-based solutions that may have widespread impact on reducing recidivism in this population.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765911PMC
http://dx.doi.org/10.1177/0887403416628601DOI Listing
October 2017

Further Validation of Triarchic Psychopathy Scales From the Multidimensional Personality Questionnaire: Setting the Stage for Large-Sample Etiological Studies.

Assessment 2017 Jul 18;24(5):575-590. Epub 2015 Dec 18.

1 Florida State University, Tallahassee, FL, USA.

Psychopathy as conceptualized by the triarchic model encompasses three distinct dispositional constructs: boldness, meanness, and disinhibition. The current study sought to further validate triarchic (Tri) construct scales composed of items from the Multidimensional Personality Questionnaire (MPQ) as a foundation for advancing research on the etiology of psychopathy using existing large-scale longitudinal studies. MPQ-Tri scales were examined in three samples: mixed-gender undergraduate students ( N = 346), male offenders from a residential substance abuse treatment facility ( N = 190), and incarcerated female offenders ( N = 216). Across these three samples, the MPQ-Tri scales demonstrated high internal consistency and clear convergent and discriminant associations with criterion measures of psychopathy and other psychopathology outcomes. Gender comparisons revealed relatively few differences in relationships with criterion measures. Findings are discussed in terms of their implications for further investigation of the causal bases of psychopathy and other forms of psychopathology utilizing data from large etiologically informative studies.
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http://dx.doi.org/10.1177/1073191115621790DOI Listing
July 2017

Internalizing and externalizing personality subtypes predict differences in functioning and outcomes among veterans in residential substance use disorder treatment.

Psychol Assess 2016 10 30;28(10):1186-1197. Epub 2015 Nov 30.

Veterans Affairs Palo Alto Health Care System.

There is a long history of using personality to subtype patients in treatment for substance use disorders (SUD). However, no one has validated a typology of SUD patients using a structural model of normal-range personality, particularly indicating whether subtypes differ on treatment processes and outcomes. We developed a personality-based typology among 196 military veterans enrolled in residential SUD treatment at a Veterans Affairs medical center. Patients were assessed at treatment entry, 1 month into treatment, and at discharge from treatment. Personality was assessed using the Multidimensional Personality Questionnaire-Brief Form at treatment entry. Latent profile analyses identified a 3-group solution consisting of low pathology, internalizing, and externalizing groups. The internalizing group scored lowest on measures of functioning at treatment entry, whereas the externalizing group scored more poorly on treatment processes and outcomes over the course of their residential stay (e.g., more stressful relationships with other residents, lower program alliance). These findings support a clinically meaningful typology of SUD patients based on a 3-factor model of personality and can serve as a guide for future efforts aimed at developing targeted interventions that can address the individual differences of patients in this population. (PsycINFO Database Record
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http://dx.doi.org/10.1037/pas0000250DOI Listing
October 2016

Alcohol use initiation is associated with changes in personality trait trajectories from early adolescence to young adulthood.

Alcohol Clin Exp Res 2015 Nov 30;39(11):2163-70. Epub 2015 Sep 30.

Department of Psychology, University of Minnesota, Minneapolis, Minnesota.

Background: Recent work has demonstrated the codevelopment of personality traits and alcohol use characteristics from early adolescence to young adulthood. Few studies, however, have tested whether alcohol use initiation impacts trajectories of personality over this time period. We examined the effect of alcohol use initiation on personality development from early adolescence to young adulthood.

Methods: Participants were male (nmen = 2,350) and female (nwomen = 2,618) twins and adoptees from 3 community-based longitudinal studies conducted at the Minnesota Center for Twin and Family Research. Data on personality traits of Positive Emotionality (PEM; Well-being), Negative Emotionality (NEM; Stress Reaction, Alienation, and Aggression), and Constraint (CON; Control and Harm Avoidance)-assessed via the Multidimensional Personality Questionnaire (MPQ)-and age of first drink were collected for up to 4 waves spanning ages 10 to 32.

Results: Alcohol use initiation was associated with significant decreases in levels of Well-being and CON traits, most notably Control; and significant increases in levels of all NEM traits, particularly Aggression. In general, the effects of alcohol use initiation on personality traits were moderated by gender and enhanced among those with earlier age of first drink.

Conclusions: From early adolescence to young adulthood, alcohol use initiation predicts deviations from normative patterns of personality maturation. Such findings offer a potential mechanism underlying the codevelopment of personality traits and alcohol use characteristics during this formative period of development.
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http://dx.doi.org/10.1111/acer.12878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662053PMC
November 2015

Health Care Utilization Patterns Among High-Cost VA Patients With Mental Health Conditions.

Psychiatr Serv 2015 Sep 1;66(9):952-8. Epub 2015 May 1.

Ms. Hunter is a medical student at Stanford University School of Medicine, Stanford, California, where Dr. Zulman and Dr. Asch are with the Division of General Medical Disciplines. Dr. Zulman and Dr. Asch are also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, where Dr. Blonigen is affiliated. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System. Send correspondence to Dr. Zulman (e-mail: ). This work was presented at the annual research meeting of AcademyHealth, San Diego, June 8-10, 2014, and at the regional meeting of the Society for General Internal Medicine, Stanford, California, January 31, 2014.

Objective: To inform development of intensive management programs for high-cost patients, this study investigated the relationship between psychiatric diagnoses and patterns of health care utilization among high-cost patients in the Department of Veterans Affairs (VA) health care system.

Methods: The costliest 5% of patients who received care in the VA in fiscal year 2010 were assigned to five mutually exclusive hierarchical groups on the basis of diagnosis codes: no mental health condition, serious mental illness, substance use disorder, posttraumatic stress disorder (PTSD), and depression. Multivariable linear regression was used to examine associations between diagnostic groups and use of mental health and non-mental health care and costs of care, with adjustment for sociodemographic characteristics. The proportion of costs generated by mental health care was estimated for each group.

Results: Among 261,515 high-cost VA patients, rates of depression, substance use disorder, PTSD, and serious mental illness were 29%, 20%, 17%, and 13%, respectively. Individuals in the serious mental illness and substance use disorder groups were younger and had fewer chronic general medical conditions and higher adjusted rates of mental health care utilization; they also had a greater proportion of costs generated by mental health care (41% and 31%, respectively) compared with individuals in the PTSD and depression groups (18% and 11%, respectively).

Conclusions: Optimal management of high-risk, high-cost patients may require stratification by psychiatric diagnoses, with integrated care models for patients with multiple chronic conditions and comorbid mental health conditions and intensive mental health services for patients whose primary needs stem from mental health conditions.
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http://dx.doi.org/10.1176/appi.ps.201400286DOI Listing
September 2015

Patient-centered feedback on the results of personality testing increases early engagement in residential substance use disorder treatment: a pilot randomized controlled trial.

Addict Sci Clin Pract 2015 Mar 14;10. Epub 2015 Mar 14.

Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.

Background: Patient-centered models of assessment have shown considerable promise for increasing patients' readiness for mental health treatment in general, but have not been used to facilitate patients' engagement in substance use disorder (SUD) treatment. We developed a brief patient-centered intervention using assessment and feedback of personality data and examined its acceptability and efficacy to increase early engagement in residential SUD treatment.

Methods: Thirty patients entering a 90-day residential SUD treatment program were randomly assigned to a feedback (n = 17) or control (n = 13; assessment-only) condition. Normal-range personality was assessed with the NEO Personality Inventory-Revised (NEO PI-R). Patients were re-interviewed one month after treatment entry to obtain information on their satisfaction with the intervention, as well as their adjustment to the residential milieu. Electronic medical records were reviewed to obtain information on patients' length of stay in the program and discharge status. Univariate ANOVAs and chi-square tests were conducted to examine group differences on outcomes.

Results: Patients' ratings indicated strong satisfaction with the feedback intervention and expectations that it would have a positive impact on their treatment experiences. Among patients who had not previously been treated in the residential program, the feedback intervention was associated with more positive relationships with other residents in treatment and a stronger alliance with the treatment program one month after treatment entry. The feedback intervention was also associated with a longer length of stay in treatment, although this effect did not reach statistical significance.

Conclusions: The findings highlight the clinical utility of providing SUD patients with patient-centered feedback based on the results of personality testing, and provide preliminary support for the acceptability and efficacy of this intervention to facilitate early engagement in residential SUD treatment.
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http://dx.doi.org/10.1186/s13722-015-0030-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421926PMC
March 2015

Socio-contextual factors are linked to differences in the course of problem drinking in midlife: A discordant-twin study.

Am J Addict 2015 Apr 24;24(3):193-196. Epub 2015 Mar 24.

Family Research Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.

Background: Course of alcohol use disorders (AUD) during midlife is understudied, and most research designs are unable to attribute an unambiguous environmental explanation to observed findings.

Objectives & Methods: Test whether socio-contextual factors are linked to differences in the course of problem drinking during midlife. Participants were 163 monozygotic and dizygotic twin pairs concordant for a history of AUD but discordant on problem drinking in the past 10 years.

Results: Frequency of drinking with spouse, and peer and emotional problems were associated with discordance.

Conclusions And Scientific Significance: Socio-contextual factors are linked to differences in course of problem drinking in midlife and are not confounded by genetic effects. (Am J Addict 2015;24:193-196).
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http://dx.doi.org/10.1111/ajad.12205DOI Listing
April 2015

Distinct facets of impulsivity exhibit differential associations with substance use disorder treatment processes: a cross-sectional and prospective investigation among military veterans.

J Subst Abuse Treat 2015 Aug 5;55:21-8. Epub 2015 Mar 5.

Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.

Impulsivity, a multi-faceted construct characterized by rash, unplanned actions and a disregard for long-term consequences, is associated with poor substance use disorder (SUD) treatment outcomes. Little is known though about the influence of impulsivity on treatment process variables critical for initiating and maintaining behavioral change. This knowledge gap is important as different aspects of impulsivity may be susceptible to diverse cognitive, behavioral and pharmacological influences. The present study examined two distinct facets of impulsivity (lack of planning and immoderation--a proxy of urgency) as predictors of processes that impact SUD treatment success (active coping, avoidant coping, self-efficacy, and interpersonal problems). Participants were 200 Veterans who completed impulsivity and treatment process assessments upon entering an SUD treatment program and treatment process assessments at treatment discharge. Results from multivariate models revealed that lack of planning was associated with lower active coping and higher avoidant coping and interpersonal problems at intake, though not with lower self-efficacy to abstain from substances. Immoderation was associated with higher avoidant coping and lower self-efficacy to abstain from substances at intake, but not with lower active coping or higher interpersonal problems. Higher immoderation, but not lack of planning, predicted lower self-efficacy to abstain from substances at treatment discharge. These findings suggest that different facets of impulsivity confer risk for different SUD treatment process indicators and that clinicians should consider the behavioral expression of patients' impulse control problems in treatment planning and delivery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623565PMC
http://dx.doi.org/10.1016/j.jsat.2015.02.005DOI Listing
August 2015