Marc Rosen, MD

We develop and test the efficacy of behavioral interventions for clients with substance use and comorbid conditions.

One line of research considers whether interventions targeting spending decisions impact substance use. This question has been approached with surveys, analysis of data from quasi-experimental designs, and clinical trials. Our research has demonstrated that a high proportion of VA inpatients need money management assistance, and that expenditures for illicit drugs are not increased after benefits have been awarded. In several surveys, we have described generally high client ratings of satisfaction with a variety of involuntary payee arrangements.

In clinical trials, we have tested the efficacy of a money management-based intervention called ATM (Advisor Teller Money Manager). ATM involves a positive conception of the power of money to help clients achieve their goals and their ability to learn to manage their own affairs, as well as dampening the temptation to spend loose cash on illicit drugs and alcohol. In a recently-completed 36-week clinical trial of ATM, ATM participants had less cocaine use, reduced preference for immediate rewards (as measured by the Delayed Discounting Questionnaire), and greater likelihood of being assigned a payee compared to participants assigned to the Control intervention.

A second line of research examines the processes involved in applying for service-connection (a kind of Veterans' disability-like compensation). These studies examined the process of applying for service-connection, attitudes about service-connection, and the impact of receiving service-connection on utilizing treatment.

Following up on the service-connection work, we have developed and evaluated a counseling approach called SBIRT-PM (Screening, Brief Evaluation, and Referral to TReatment for Pain Management). We evaluated this intervention in a pilot RCT published in Pain Medicine, and in a recently-completed 1101 Veteran, 8-site RCT. We are conducting a Hybrid Type 2 Implementation-Effectiveness Trial at 28 sites testing the effects of Implementation Facilitation on adoption and health outcomes.