(PS6-C57) Response to Evidence Based Psychotherapy via Telehealth in a Diverse Population of Veterans with Dual Diagnoses During a Time of Prolonged Crisis

Introduction: Numerous studies have demonstrated the detrimental effect of COVID-19 on mental health, including higher levels of substance use in patients with preexisting psychiatric disorders. Despite the increased need for mental health services, there has also been a significant disruption in the delivery of treatment for individuals with dual diagnoses (DD). Although psychotherapy via telehealth can be a useful tool for removing barriers for treatment, it can also pose unique challenges in this population if access to equipment and privacy is limited. Furthermore, some components of treatment such as urine drug screening are difficult to replicate virtually. The current study seeks to investigate differences in treatment outcomes for veterans and family members enrolled in the DD outpatient program prior to the pandemic (2019) and seen for treatment in person vs. those treated during the pandemic (2021) and seen via telehealth. We hypothesized that the cohort receiving treatment during the pandemic would have less robust response to treatment compared to the pre-pandemic cohort.

Methods: Patients selected for this study were enrolled in the DD program in 2019 and 2021, diagnosed with a substance use disorder and an additional psychiatric diagnosis. Patients, provided with Cognitive Behavioral Therapy (CBT) and medication management, were administered self-report measures at the beginning of treatment and at each session. The PCL-5 (PTSD), PHQ-9 (depression), and GAD-7 (anxiety) were administered.

Results: Participants were 152 veterans and family members obtaining treatment. Of 84 patients enrolled in care in 2019, 95.2% were veterans, 89.29% male identified, mean age of 39.38 years, and 34.5% identify as White, 22.6% as Black, 10.7% as LatinX, 2.4% as Asian, 9.5% are unknown, and 20.2% as other. Of 68 patients enrolled in 2021, 94.1% were veterans, 92.65% identified as male, mean age was 39.46 years, 41.2% identify as White, 19.1% as Black, 22.1% as LatinX, 1.5% as Asian, 5.9% are unknown, and 10.3% as other or more than one race. For patients who completed treatment in 2019, significant decreases were found from pre to post treatment in PTSD symptoms (M=8.83 points, SD=17.62, p< .001), depressive symptoms (M=4.72, SD=5.77, p< .001), anxious symptoms (M=4.31, SD=7.85, p< .001). For patients who completed treatment in 2021, significant decreases were found from pre to post treatment in PTSD symptoms (M=11.56 points, SD=13.48, p< .001), depressive symptoms (M=4.9, SD=5.79, p< .001), anxious symptoms (M=4.08, SD=6.97, p< .001). Further analyses will be presented comparing the 2019 and 2021 cohorts and predictors of engagement and response.

Conclusion: Preliminary results indicate telehealth can be a successful treatment delivery mechanism to leverage in emergency/disaster situations with dually diagnosed veterans and family members. This poster will consider aspects of tele mental health that may have facilitated greater treatment engagement and decreased barriers to access despite an increase in psychosocial stressors during the COVID 19 pandemic. Lastly, clinical considerations specific to veterans and their family members will be discussed.