Interdisciplinary Issues at the Intersection of Assessing and Treating Substance Use Disorders and Post Traumatic Stress Disorder: Clinical Social Work and Clinical Behavioral Analysis with Veterans
Veterans and military personnel may be at higher risk for developing addictions due to increased prevalence rates of co-occurring mental health disorders including posttraumatic stress and substance abuse disorders. However, clinicians may feel unprepared to assess and to treat these co-occurring disorders, especially when it includes a behavioral addiction such as gambling. Clinical social work and clinical behavior analysis are two fields with complementary interdisciplinary approaches that can lead to improved client-centered outcomes. Yet, limited evidence exists to guide interdisciplinary treatment teams in effective treatment of gambling addictions and Post Traumatic Stress Disorder (PTSD). The current article provides an interdisciplinary treatment model to assist clinicians in selecting appropriate evidence-based assessments and treatments. A case example focuses on the use of assessment tools and treatment approaches drawn from recommendations from best practice guidelines for veterans. Finally, resources related trauma and addictions are presented.
Association for Behavior Analysis International. (2017). What is Behavioral Analysis? Retrieved from: https://www.abainternational.org/about-us/behavior-analysis.aspx
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C.A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behavior Research and Therapy, 34, 669-673
Bolen, D. W, & Boyd, W. H. (1968). Gambling and the gambler: A review and preliminary findings. Archives of General Psychiatry, 18, 617-630. doi: https://doi.org/10.1001/archpsyc.1968.01740050105018
Bush K., Kivlahan, D. R., McDonell M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Archives of Internal Medicine, 158, 1789-1795. doi: https://doi.org/10.1001/archinte.158.16.1789
Casey, L. M., Oei, T. P., Raylu, N., Horrigan, K., Day, J., Ireland, M., & Clough, B. A. (2017). Internet-based delivery of cognitive behaviour therapy compared to monitoring, feedback and support for problem gambling: A randomised controlled trial. Journal of Gambling Studies [online], 1-18. doi: https://doi.org/10.1007/s10899-016-9666-y
Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. The Cochrane Database of Systematic Reviews, 11CD008937. doi: https://doi.org/10.1002/14651858.CD008937.pub2
Department of Veterans Affairs, Department of Defense [DVA/DoD]. (2015). DVA/DoD Clinical Practice Guideline for Management of Substance Use Disorder: Guideline Summary (ver.3.0). Office of Quality and Performance. Washington DC: Author.
Department of Veterans Affairs, Department of Defense [DVA/DoD]. (2017). DVA/DoD Clinical Practice Guideline for Post Traumatic Stress Disorder and Acute Stress Reaction. (ver. 3.0). Office of Quality and Performance. Washington DC: Author.
Dixon, M. R., & Johnson, T. E. (2007). The gambling functional assessment (GFA): An assessment device for identification of the maintaining variables of pathological gambling. Analysis of Gambling Behavior, 1(1), 44-49.
Dixon, M. R., Wilson, A. N., & Habib, R. (2016). Empirical research: Neurological evidence of acceptance and commitment therapy effectiveness in college-age gamblers. Journal of Contextual Behavioral Science, 5(2), 580-588. doi: https://doi.org/10.1016/j.jcbs.2016.04.004
Dixon, M. R., Wilson, A. N., Belisle, J., & Schreiber, J. (under review). Assessing the construct validity of the gambling functional assessment. The Psychological Record.
Edens, E., & Rosenheck, R. (2012). Rates and correlates of pathological gambling among VA mental health service users. Journal of Gambling Studies, 28(1), 1-11. doi: https://doi.org/10.1007/s10899-011-9239-z
Emshoff, J., Gilmore, D., & Zorland, J. (2010). Veterans and problem gambling: A review of the literature. Georgia State University. Retrieved from http://www2.gsu.edu/~psyjge/Rsrc/PG_IPV_Veterans.pdf
Gebauer, L., LaBrie, R. A., & Shaffer, H. J. (2010). Optimizing DSM-IV-TR classification accuracy: A brief bio-social screen for detecting current gambling disorders among gamblers in the general household population. Canadian Journal of Psychiatry, 55(2), 82-90. doi: https://doi.org/10.1177/070674371005500204
Gooding P.A. & Terrier. N., (2009). A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: Hedging our bets? Behaviour Research and Therapy, 47, 592-607 doi: https://doi.org/10.1016/j.brat.2009.04.002
Karlin, B. E., Ruzek., J. I., Chard, K. M., Eftekhari, A., Monson, C. M., Hembree, E. A., . . . Foa, E. B. (2010). Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23, 663-673. doi: https://doi.org/10.1002/jts.20588
Kessler, R. C., Hwang, I., Labrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., . . . (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38, 1-10. doi: https://doi.org/10.1017/S0033291708002900
Ledgerwood, D., & Milosevic, A. (2015). Clinical and personality characteristics associated with post-traumatic stress disorder in problem and pathological gamblers recruited from the community. Journal of Gambling Studies, 31(2), 501-512. doi: https://doi.org/10.1007/s10899-013-9426-1
Ledgerwood, D. M., & Petry, N. M. (2006). Posttraumatic stress disorder symptoms in treatment-seeking pathological gamblers. Journal of Traumatic Stress, 19, 411-416. doi:https://doi.org/10.1002/jts.20123
Lesieur, R., & Blume, S. (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 144, 1184-1188. doi: https://doi.org/10.1176/ajp.144.9.1184
Lopez-Viets, V. C., & Miller, W. R. (1997). Treatment approaches for pathological gamblers. Clinical Psychology Review, 17, 689-702
Maynard, B. R., Wilson, A. N., Labuzienski, E., & Whiting, S. W. (2015). Mindfulness-based approaches in the treatment of disordered gambling: A systematic review and meta-analysis. Research on Social Work Practice [online]. doi: https://doi.org/10.1177/1049731515606977
National Association of Social Workers [NASW]. (1989). NASW Standards for the Practice of Clinical Social Work. Washington, DC: NASW Press.
Newhouse, J. (2013). Vets vulnerable to gambling addictions. Psychology Today. Retrieved from: ww.psychologytoday.com/blog/invisible-wounds/201305/vets-vulnerable-gambling-addictions.
Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B., & Molde, H. (2005). Outcome of psychological treatments of pathological gambling: a review and meta-analysis. Addiction, 100, 1412-1422. doi: https://doi.org/10.1111/j.1360-0443.2005.01204.x
Petry, N. M. (2009). Disordered gambling and its treatment. Cognitive and Behavioral Practice, 16(4), 457-446. doi: https://doi.org/10.1016/j.cbpra.2009.02.005
Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66, 564-574. doi: https://doi.org/10.4088/JCP.v66n0504
Petry, N. M., & Steinberg, K. L. (2005). Childhood maltreatment in male and female treatment-seeking pathological gamblers. Psychology of Addictive Behaviors, 19, 226-229. doi: https://doi.org/10.1037/0893-164X.19.2.226
Prins, A., Ouimette, P., Kimerling, R., Cameron, R. P., Hugelshofer, D. S., Shaw-Hegwer, J…Sheikh, J. I. (2003). The Primary Care PTSD Screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9, 9-14. doi: https://doi.org/10.1185/135525703125002360
Prins, A., Bovin, M.J., Smolenski, D.J., Marx, B. P., Kimerling, R., Jenkins-Guarnieri, M. A. . . . Tiet, Q. Q. (2016). The primary care PTSD screen for DSM-5 (PC-PTSD-5): Development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206-1211. doi: https://doi.org/10.1007/s11606-016-3703-5
Raylu, N., & Oei, T. P. (2002). Pathological gambling. A comprehensive review. Clinical Psychology Review, 22, 1009-1061. doi: https://doi.org/10.1016/S0272-7358(02)00101-0
Substance Abuse and Mental Health Services Administration [SAMHSA]. (2016). SBIRT: Screening, brief intervention, and referral to treatment. Retrieved from http://www.samhsa.gov/sbirt
SAMHSA-HRSA Center for Integrated Health Solutions. (n.d.). AUDIT-C – Overview. Retrieved from: http://www.integration.samhsa.gov/images/res/tool_auditc.pdf
SAMHSA-HRSA Center for Integrated Health Solutions. (n.d.). Screening tools: DAST-10. Retrieved from: http://www.integration.samhsa.gov/clinical-practice/screening-tools
Skinner H. (1982). The Drug Abuse Screening Test. Addictive Behaviors, 7, 363-371. doi: https://doi.org/10.1016/0306-4603(82)90005-3
Taber, J. I., McCormick, R. A., & Ramirez, L. F. (1987). The prevalence and impact of major life stressors among pathological gamblers. International Journal of the Addictions, 22, 71-79. doi: https://doi.org/10.3109/10826088709027414
U.S. Department of Veterans Affairs [DVA]. (2008). VHA Handbook 1160.01 Uniform Mental Health Services in VA Medical Centers and Clinics. Washington, D.C.: Author.
U.S. Department of Veteran Affairs: National Center for PTSD [NC-PTSD]. (2016). Primary care PTSD screen (PC-PTSD). Retrieved from http://www.ptsd.va.gov/professional/assessment/screens/pc-ptsd.asp
Volberg, R. A., & Williams, R. J. (2011). Developing a brief problem gambling screen using clinically validated samples of at-risk, problem and pathological gamblers. Report to the Alberta Gaming Research Institute. Retrieved from: https://www.uleth.ca/dspace/bitstream/handle/10133/2561/2011-Brief%20Screen-AGRI.pdf?sequence=1&isAllowed=y
Whiting, S. W., Potenza, M. N., Park, C. L., McKee, S. A., Mazure, C. M., & Hoff, R. A. (2016). Investigating veterans’ pre-, peri-, and post-deployment experiences as potential risk factors for problem gambling. Journal of Behavioral Addictions 5(2), 213-220. doi: https://doi.org/10.1556/2006.5.2016.027
Wilson, A. N., & Matthieu, M. M. (2015). Clinical application of behavior analytic social work practice. In H. S. Roane, J. L. Ringdahl, & T. S. Falcomata (Eds.), Clinical and organizational applications for applied behavior analysis (pp. 501-522). London: Elsevier.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright to works published in Advances in Social Work is retained by the author(s).
Beginning with Volume 17 Number 2, all articles published in this journal are licensed under a Creative Commons Attribution 4.0 International License.