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A new free, self-guided online program is designed to help active-duty military and veterans reduce their drinking and symptoms of post-traumatic stress disorder (PTSD). VetChange allows veterans to build personalized action plans to handle real-world situations that trigger unhealthy drinking and track their progress over time.
Among veterans returning from Iraq and Afghanistan, between 25 to 30 percent – of an estimated 2.2 million people who have been deployed – may have problems with drinking, according to Dr. Deborah Brief, one of the clinical architects of VetChange. Veterans drink for a variety of reasons, including decreasing anxiety, feeling more comfortable around other people, decreasing unwanted thoughts about the war, or improving sleep.
“Many veterans use alcohol to self-medicate for PTSD-related issues, such as stress, anger and sleep problems,” said Dr. Brief, Director of Residential and Rehabilitation Services at the VA Boston Healthcare System, and Assistant Professor of Psychiatry and Psychology at Boston University. “Our program focuses on alcohol and its link to PTSD. It helps them learn to address these problems and other stressors in their lives without using alcohol.”
A study of a pilot version of the program found it helped many veterans reduce their drinking and PTSD symptoms. The pilot program was designed for returning veterans, but the new version is for all veterans, she notes. “We want people who have served in the military to know we appreciate the context of their drinking.”
VetChange allows users to decide whether they want to try to abstain from alcohol altogether, or to cut down on their drinking, although it does remind them of the National Institute on Alcohol Abuse and Alcoholism guidelines for safer drinking. “It was very clear to us from the outset that we needed to be as flexible as possible,” Dr. Brief said. “In our original study we found people go back and forth in their goal-setting. They may start with moderation as a goal and switch to abstinence, or vice versa.”
Veterans using the site begin by answering questions designed to determine if their drinking is putting them at risk. The questionnaire includes sections on combat experience and trauma experienced during deployment, as well as their responses to those experiences.
The site allows veterans to track their daily drinking, and encourages them to check in at the end of each week to see how much they drank each day and in total for the week. They can change their goals as they move through the program. “We continuously ask people how well they are doing in reaching their goals,” Dr. Brief said. “If they are not successful, we ask them if they want to set another goal for the following week.”
Three modules help veterans learn basic skills for controlling drinking: managing risky situations; managing thoughts and moods; and developing a support system. The program also includes units that help veterans manage sleep, stress and anger.
While the original program provided one module per week, veterans who use the new VetChange site can use any modules in any order, notes Eric Helmuth, VetChange’s Project Manager. “It’s helpful to space the modules out, with a week in between each one, so you have time to practice the skills in each module and evaluate whether they work,” adds Dr. Brief. The new site also includes videos that feature veterans and researchers, who talk about different aspects of the program.
VetChange can be used as a stand-alone program, or as a supplement to other types of treatment. “There has been some concern that many veterans with alcohol problems have not sought out treatment, either because of concerns about stigma or logistics,” she observed. The study of the pilot program suggested there did not seem to be a difference in effectiveness between those who used it as a stand-alone program and those who had recently been involved in treatment.
There is no time limit on VetChange. Veterans can use the site for as long as they think it will be helpful. They are encouraged to keep their action plans handy to review, and continue to track their drinking for a while just to keep track of how much alcohol they are consuming.
The researchers will be evaluating the effectiveness of VetChange. “We want to see who we are reaching, how they are using the website, and which modules they complete,” Dr. Brief says. “Ultimately, we want to see if people report the site helps reduce their drinking and PTSD symptoms.”
VetChange is being promoted through Facebook and other social media, the VA, and through military bases and hospitals. At least one veterans’ hotline is referring callers to the site.