Veterans are far more likely to suffer from chronic pain than people in the general population, with more than half of all veterans receiving care from the Veterans Health Administration (VHA) being affected by chronic pain.
In 2014 alone, the VA reported issuing 1.7 million prescriptions for opioids to nearly half a million vets, and opioid addiction rates among vets rose by around 55 percent between 2010 and 2015. Sadly, opioid abuse is a leading cause of homelessness among veterans.
At the same time, this large population gives researchers scope for studying opioid addiction at scale and perhaps arriving at conclusions about addiction treatment that may not be evident from smaller, more localized studies. A new study by RAND and the VA is elucidating what works and what does not in terms of opioid addiction treatment.
The New RAND / VA Study
The study, published in the journal Drug and Alcohol Dependence, attempts to develop quality measures for medical care for people with opioid addictions. The overarching conclusion from the study is that medical treatment is associated with lower mortality in veterans with this type of substance abuse disorder. In other words, addiction is an illness, and mortality rates are lower when it is treated as such. Other conclusions drawn from the study include:
- Health systems should be able to reduce excess mortality by improving healthcare quality.
- Avoiding unnecessary opioid and benzodiazepine prescriptions improves mortality.
- Psychosocial counseling and regular medical follow-up are associated with better outcomes.
Medication-Managed Treatment Not Always Necessary
Medication-managed treatment with prescription opioids like methadone or prescription benzodiazepines surprisingly did not correlate with lower mortality in this study, and researchers are not sure why that is the case. One possibility is that the study did not distinguish between people who adhered to medication-managed treatment long term, and those who went on and off medication management inconsistently. It could be that consistent medication-managed treatment does improve outcomes, and this is likely to be a primary focus of further research.
The Importance of Psychosocial Counseling
Psychosocial counseling considers individuals within the context of the many psychological and social influences in which they live and strives to improve their mental wellness and ability to function. The RAND / VA study found that psychosocial counseling was associated with lower death rates among opioid-addicted veterans. Researchers postulate that making a connection with a caregiver is a critical part of addiction treatment, because it helps patients’ and counselors’ ability to identify changes in wellbeing early, before a relapse can occur. This aspect of addiction treatment was associated with a 24 percent drop in mortality.
Quarterly Follow-Up with a Physician
Lower death rates were also associated with quarterly visits with a VA physician. Again, researchers propose that these lower death rates had to do with a physician’s ability to help the patient identify co-occurring mental health conditions early on, before they can lead to desperation and relapse. For example, if clinical depression is diagnosed before it can become severe, a patient may be able to receive treatment with antidepressants and reduce the chances of abusing opioids again. The regular connection with a caregiver appears to be a key aspect of this component of addiction treatment, just as it is with psychosocial counseling.
Ultimately, the RAND / VA study shows that addiction treatment works. Programs that cover substance abuse treatment as an essential health benefit result in lower mortality rates among veterans with opioid addictions. The VA healthcare system is unique, and differs in key ways from the healthcare system outside the VA. Therefore, researchers say that evaluating these quality measures in other addiction treatment settings is also critical to determine whether the benefits are unique to the VA system. This study reconfirms that addiction treatment lowers mortality from opioid addiction. If you have any questions about addiction treatment, we encourage you to contact us at any time.
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