June 2023

In This Issue: HSR&D Research on Telehealth

Addressing Loneliness and Substance Use with Telehealth Cognitive-Behavioral Therapy

Feature Article

Takeaway: Loneliness is associated with increased mortality, substance use, and relapse among individuals with substance use disorder. This ongoing study is testing cognitive-behavioral therapy for loneliness and substance use disorder via telehealth, which might improve engagement with social support and reduce substance use. Researchers will make efforts to recruit participants from outside VA, possibly increasing access to care among Veterans who are especially isolated.

Loneliness is associated with increased mortality, substance use, and relapse among individuals with substance use disorder (SUD) and is more common among individuals with SUD. Without effective intervention, Veterans with SUD and loneliness are at high risk of relapse and will continue to have problems engaging with social support, including healthcare providers—factors critical for recovery.

Cognitive-behavioral therapy (CBT) has shown the strongest effects on loneliness, but there are no interventions specifically designed for substance-using populations who are lonely. This ongoing study (April 2022–September 2023) seeks to test CBT for Loneliness (CBT-L) among individuals with SUD via telehealth to improve engagement with social support and reduce substance use. Researchers will recruit participants from outside VA in hopes of increasing access to care among Veterans who are especially isolated. The study aims to:

• Refine a CBT-L manual focused on Veterans with SUD by eliciting feedback from content experts on a draft of the manual, followed by a trial among Veterans with SUD who report loneliness (n=6).
• Randomize participants to receive either CBT-L/SUD (n=15) or CBT for just SUD (n=15) to assess feasibility and acceptability among Veterans with SUD who report loneliness.

Methods

Researchers will use feedback on the draft manual from SUD treatment providers and Veterans with SUD to finalize the manual for the small, randomized trial. The trial will provide data on treatment delivery, acceptability, participant adherence to treatment, and therapist fidelity. Results can be used to further refine the manual and to conduct a larger trial that assesses the effects of CBT-L among Veterans with SUD.

Findings are not yet available.

Anticipated Impact

Testing CBT-L among Veterans with SUD has the potential to address a critical, unmet need that commonly affects Veterans with SUD, and will inform future trials. The research team will work with VA’s Office of Mental Health and Suicide Prevention and the National Mental Health Program’s Substance Use Disorder office to identify implementation and dissemination efforts, with findings translated into applied practice across various settings, such as primary care mental health and rehabilitation treatment programs. Additionally, this telehealth intervention might be particularly useful for rural and other Veterans who have difficulty accessing VA care.

Principal Investigator

Lisham Ashrafioun, PhD, is an investigator with VA’s VISN 2 Center of Excellence for Suicide Prevention in Canandaigua, NY.

Related research by this investigator

Ashrafioun L, Allan NP, Stecker TA. Opioid use disorder and its association with self-reported difficulties participating in social activities. The American Journal on Addictions. January 2022;31(1):46–52.

View study abstract.