2023 HSR&D/QUERI National Conference

4019 — Alcohol treatment preferences among VA women primary care patients

Lead/Presenter: Katherine Buckheit,  Center for Integrated Healthcare
All Authors: Buckheit KA (Center for Integrated Healthcare, Syracuse VA Medical Center), Possemato, K (Center for Integrated Healthcare, Syracuse VA Medical Center) Mastroleo, N (Binghamton University Department of Psychology) Simpson, T (VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education) Scharer, J (Center for Integrated Healthcare, Syracuse VA Medical Center) Maisto, SA (Center for Integrated Healthcare, Syracuse VA Medical Center; Syracuse University, Department of Psychology)

Women Veterans are the fastest-growing demographic seeking VA healthcare, and have historically been underrepresented in health services research (HSR), particularly regarding alcohol use. VA has identified HSR priorities in women’s health and substance use to ensure Veterans’ future needs can be met. Hazardous alcohol use is common among women Veterans (31-33%), and gender differences in treatment engagement exist. Primary Care-Mental Health Integration (PCMHI) is well-situated to fill the gap in alcohol treatment for women Veterans; women are more likely to seek alcohol treatment in primary care than specialty care. Incorporating patient preferences is associated with better treatment outcomes in PCMHI, however, alcohol treatment preferences among VA women primary care patients are currently unknown. Preliminary results are presented from an ongoing study that fills an important gap by assessing treatment preferences among women Veterans with hazardous alcohol use.

Participants are women Veterans with hazardous alcohol use and enrolled in VA primary care (current n = 72, expected n = 200). Eligible participants were identified via medical record and sent a letter with a link to an online survey of demographics, alcohol use, mental health symptoms, and alcohol treatment preferences. Descriptive statistics were computed to characterize the sample, as were frequencies for alcohol treatment preferences.

Thirty-six percent of the sample reported hazardous alcohol use (AUDIT > = 7). Nineteen percent reported clinically significant PTSD symptoms, and 19% reported at least moderate depression symptoms. Participants preferred individual treatment (38.9%), followed by self-help resources (25.7%), group (11.3%), one-time workshop (11.3%), and family (5.7%). Participants preferred face-to-face treatment (25.5%), followed by video telehealth (18%), paper resources (16.3%), mobile applications (12%), online course/resources (12%), and telephone (10%). Participants preferred a treatment goal of improving overall health (45.8%), followed by reducing consumption (24.5%), managing other problems without alcohol (10.2%), total abstinence (8.2%), and reducing alcohol-related problems (4.1%). Participants preferred to receive information about alcohol/women’s health (57.1%), followed by alcohol/addiction (16.3%), alcohol feedback (12.2%), and alcohol recommendations (8.2%). Participants preferred skills/strategies for identifying drinking triggers (27.1%), followed by discussing pros/cons of alcohol use (20.8%), managing cravings (16.7%), setting an alcohol goal (12.5%), and managing social pressure to drink (12.5%). Participants’ top preferences for co-occurring concerns to be addressed within alcohol treatment were: sleep (22.7%), trauma (20.9%), mood (20%), pain (17.4%), and stress (15.2%). Participants preferred to make treatment decisions on their own (77.4%), or in collaboration with a healthcare professional (20.8%).

Women Veterans’ preferences for alcohol treatment in primary care were consistent with effective and feasible PCMHI models. Participants identified key preferences for information (alcohol/women’s health), skills (identifying triggers) and co-occurring concerns (sleep, mood, trauma) that are not typically addressed in primary care alcohol interventions. Follow up analyses will test for differences in treatment preferences based on clinically relevant indicators (e.g., severity of alcohol use).

Results directly impact future HSR and clinical care by identifying intervention targets that may be beneficial and acceptable to women Veterans with hazardous alcohol use and inform future HSR to adapt and refine behavioral health interventions for women Veterans’ needs and preferences.