Marc Rosen, MD

We develop and test the efficacy of behavioral interventions for clients with comorbid psychiatric and substance abuse.

One line of research considers whether interventions targeting spending decisions by dually diagnosed clients might reduce their 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 considers interventions targeting medication non-adherence. A difficulty in counseling clients concerning the need to take prescribed medication is the difficulty in knowing when the medications were taken. In a series of studies, our group has tested the efficacy of counseling in which clients are provided electronically-generated feedback and review the dates and times medications were taken as prescribed and when they were missed. In clinical trials, we have found this counseling to be effective among clients prescribed medication for diabetes but ineffective among clients prescribed antiretroviral medication. However, review of feedback has been effective when coupled with material reinforcement, contingent on on-time bottle openings.

A third line of research examines the processes involved in applying for Compensation and Pension examinations. One multi-site study involves comparing a semi-structured method of conducting the Compensation and Pension evaluation of veterans being evaluated for PTSD to assessment as usual. A second study is comparing the effect of four sessions of Benefits Counseling to a control condition on engagement in work among veterans presenting for evaluation of psychiatric disabilities.

• Clinical trial of abstinence-linked money management in people with comorbid psychiatric disorders and cocaine use.
• Clinical trial of benefits counseling for veterans presenting for Compensation and Pension evaluations.
• E3 study comparing two methods of conducting Compensation and Pension evaluations of veterans presenting for psychiatric evaluations.
• Multisite Adherence evaluation of pooled data concerning adherence, viral loads and substance use among people with HIV