(PS10-59) Feasibility, Acceptability, and Preliminary Clinical Impact of a Computer Assisted Transdiagnostic CBT Intervention for Veterans with Co-occurring Anxiety and Substance Use Disorders

For Veterans with anxiety and substance use disorders (SUD), there is a need for innovative, feasible, and effective evidence-based transdiagnostic mental health interventions (TMHIs) that overcome barriers to care. Each year, 1.8 million Veterans are currently diagnosed with substance use disorder (SUD; SAMHSA, 2021) and nearly 300,000 Veterans are newly diagnosed with anxiety disorders (Barrera et al., 2014). Twenty seven percent  of Veterans with SUD also have an anxiety disorder (Petrakis et al., 2011). TMHIs are effective for treating co-occurring anxiety and SUD, (Buckner et al., 2019) and are often superior to single disorder treatments (Wolitzky-Taylor, 2023). TMHIs have the potential to fill an important gap given access challenges related to multiple treatment needs and a shortage of trained clinicians. To address this care gap, our team adapted VA Coordinated Anxiety Learning and Management (Cucciare et al., 2020) to treat co-occurring anxiety and SUD (including alcohol and drugs) using an integrated, transdiagnostic format (VA CALM-S). VA CALM-S was adapted in partnership with the VA treatment community, including feedback from Veterans, mental health providers, and clinical leadership. This study was a pilot randomized trial to evaluate the feasibility, acceptability, and preliminary clinical impact of VA CALM-S.

Method: Participants (N=19; Mage=48.8; 23% female) were randomized to receive VA CALM-S (N = 11) or Enhanced Usual Care (EUC; n = 8). Participants completed self-report measures at baseline and 3 month follow up, which included the Overall Anxiety Severity and Impairment Scale (OASIS; Norman et al., 2006), the Brief Addiction Monitor Revised Consumption Items (BAM-RC; Cacciola et al., 2013), and the Short Inventory of Problems (SIP-R; Kiluk et al. 2013), a measure of substance-related negative consequences.

Results: Participants who received VA-CALM-S reported that overall it was a helpful program. Further highlighting the feasibility and acceptability, 85% of participants in the VA CALM-S condition completed all 9 modules in 10-12 sessions. In the intervention group mean OASIS changed from 12.18 (SD=2.96) at pretreatment to 9.55 (SD=4.95) at posttreatment, Cohen’s d = 0.64. The EUC group reported mean OASIS of 12.38 (SD=4.03) at pretreatment and 11.50 (SD=3.16) at posttreatment, Cohen’s d = 0.24. On the BAM-R consumption items in the intervention group mean was 38.6 (SD=25.54) at pretreatment to 24.20 (SD=14.67) at posttreatment, Cohen’s d = 0.69. In contrast the EUC group reported mean OASIS of 46.37 (SD=22.45) at pretreatment and 43.63 (SD=24.26) at posttreatment, Cohen’s d = 0.64. In the intervention group, SIP-R mean at pretreatment was 20.30 (SD=12.17) and 16.90 (SD=9.21) at post treatment, Cohen’s D = 0.34. The EUC mean SIP-R was 17.43 (SD=12.51) at baseline and 19.71 (SD=15.00) at posttreatment, Cohen’s d = -0.14. Participants also provided qualitative feedback on their experiences in the prior three months related to treatment of co-occurring anxiety and SUD. Most participants in EUC reported not receiving any care for anxiety or SUD during the study timeframe, highlighting access gaps.

Discussion: VA CALM-S appears feasible, acceptable, and shows preliminary support for potential clinical impact.