Substance use consequences, mental health problems, and readiness to change among Veterans seeking substance use treatment

• Published in: Journal of substance abuse treatment Vol. 94; pp. 113 - 121
• Main Authors: Morris, David H., Davis, Alan K., Lauritsen, Kirstin J., Rieth, C. Martin, Silvestri, Mark M., Winters, Jamie J., Chermack, Stephen T.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2018; Elsevier Limited
• Subjects: Alcohol use; Anxiety; Attrition; Behavior change; Clinical outcomes; Comorbidity; Confidence; Correlation analysis; Drug use; Health problems; Help seeking behavior; Insomnia; Marijuana; Medical treatment; Mental depression; Mental disorders; Mental health; Mental health problems; Nicotine; Opioids; Outpatient treatment; Psychiatric symptoms; Readiness to change; Recovery; Self report; Stages of change; Substance abuse; Substance abuse treatment; Substance use treatment; Symptoms; Veterans; Women; Veterans; Mental health problems; Readiness to change; Substance use treatment
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2018.08.005

Individuals seeking substance use treatment who have one or more co-occurring mental health problems tend to have lower treatment engagement, higher rates of attrition, and poorer treatment outcomes. Readiness to change (RTC) is an integral construct in the recovery process, with higher RTC associated with improved treatment outcomes. However, the impact of psychiatric symptoms on RTC is not fully understood, especially among specialty subpopulations, such as military Veterans. Therefore, the aim of the present study was to examine the associations of mental health problems with RTC in a sample of Veterans initiating outpatient substance use treatment. The present sample was comprised of 278 Veterans (12% women, Mage = 48.22, SD = 14.06) who completed self-report intake measures assessing past month substance use frequency, substance-related consequences, symptoms of insomnia, depression, and anxiety, and importance and confidence to change one's substance use. Four separate canonical correlation analyses focusing on RTC alcohol, opioid, cannabis, and nicotine use were conducted. Veterans' inclusion in each analysis was not mutually exclusive. Results indicated that greater depression, anxiety, consequences, and frequency of alcohol use corresponded with greater importance to change alcohol use. Likewise, greater depression, anxiety, and insomnia symptoms along with frequency of use and consequences related to greater importance and confidence to change one's opioid use. In contrast, greater anxiety, depression, insomnia, and frequency of use were associated with less confidence in one's ability to change cannabis use. None of these variables were related to one's RTC nicotine use. Findings highlight the importance of assessing mental health problems at outset of substance use treatment, as they may be an indication of RTC and could be used as a catalyst to advance Veterans forward in the process of behavior change. •Probable depression and anxiety correspond with greater importance for alcohol change•Veterans with comorbid psychiatric symptoms are more ready to change opioid use•Substance use problems relate to level of readiness for alcohol and opioid cessation•Cannabis-using Veterans with mental health problems issues report lower self-efficacy•Comorbid psychiatric symptoms unrelated to Veteran's readiness to change tobacco use