1. Engaging Younger Veterans Struggling with Addictions Kellie Rollins, Psy.D. Psychologist, Substance Abuse Programs San Francisco VA Medical Center Assistant Clinical Professor University of California, San Francisco

2. Disclosures: No Commercial Interest No Financial relationships No Relevant financial relationships No Conflict of Interest

3. Overview Profile of OEF/OIF/OND Veterans – Addiction prevalence Best Practices Summary – For SUD w/in the VA Opioid Replacement Treatment Clinic (ORT) - San Francisco VA Medical Center Young Adults Recovery Group Q&A

4. “The 9/11 Generation” - Barack Obama OEF - Operation Enduring Freedom October 7, 2011 – present. OIF - Operation Iraqi Freedom March 30, 2003 - redesignated.   OND - Operation New Dawn September 1, 2010 - present.

5. OEF / OIF / OND Over 5 million American men and women served in the ranks of the US armed forces since 9/11/2001. Over 2 million US Troops deployed to Iraq & Afghanistan since 09/11. 1.6 million active duty.

6. OEF / OIF / OND 1/3 have mental health diagnoses or serious psychosocial problems 1/5 dx with SUD 15% unemployment 78% divorce rate Significant homelessness Elevated risk of suicide

7. Scope of the SUD problem Alcohol Dependence rate doubled in the last 5 years (US Army figure). 27% of Army active duty misuse alcohol (Santiago et al., 2010). Youngest service members at highest risk (Bray et al., 2009; Jacobson et al., 2008). High correlation between substance misuse and PTSD (Jacobson et al., 2008).

8. Veterans vs Non-Veterans – % of SUD by age

9. Serious Psychological Distress (SPD), SUD, and Co- Occurring SPD and SUD in the Past Year among Veterans, by Age: 2004 to 2006 SAMHSA, 2004, 2005 and 2006 NSDUHs

10. Prevalence of SPD, SUD, SPD/SUD past year among Veterans, by gender: 2004-2006 SAMHSA, 2004, 2005 and 2006 NSDUHs DisorderMalesFemales SPD6.5%14.5% SUD7.2%5.8% SPD/SUD1.5%2.0%

11. Rx Drug Use/Abuse Doubled from 2002-2005 Tripled from 2005-2008 Increasing rates of opioid use for pain among Veterans aged 18-30. NIDA Brief, April, 2011

12. PTSD TBIPAIN SUD Co-occurring Triad

13. VAMCs with Onsite OTP and/or Buprenorphine Treatment (BT)

14. San Francisco Veterans Affairs Medical Center Opioid Replacement Treatment Clinic (ORT) Methadone & Buprenorphine Interdisciplinary Treatment Team

15. Medical Psychological Systemic No Medication Restrictions HCV & HIV Screening Observed Toxicology Screens Blister Packing Phase Model (up to 27 TH) Integrated treatment Tobacco Cessation Groups & Individual Research Trainees Treatment on Demand Interdisciplinary Team Approach Computerized Medical Records AM Nursing Report + Weekly Team Mtg Good Old Fashioned Sense of Humor SFVAMC ORT Best Practices

16. Young Adults Recovery Group SFVAMC, Substance Abuse Programs

17. Group Themes Relationships Romantic Familial Collegial Recovery MAT Medical MJ? Social Drinking? Telling others Education Health Promotion Mental Health Issues Reinvention Safe(er) Sensation Seeking Self as Recovering Adjusting to home Roles Goals / dreams / aspirations

18. No Script for Treating Younger Veterans “Younger veterans are difficult to engage! They have life on their minds.” Dr. Sam Wan, 2010, 2011, 2012

19. Q & A