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Substance Disorders Treatment Program

Substance Disorders Treatment Program (SDTP) is an outpatient program which helps Veterans overcome addictions to drugs and/or alcohol.

Introduction

SDTP is an outpatient program which helps Veterans overcome addictions to drugs and/or alcohol. 

Depending on need, Veterans in SDTP may also receive additional services from the Health Care for Homeless Veterans (HCHV) Program, Behavioral Health Interdisciplinary program (BHIP, formerly known as GMHC or the General Mental Health Clinic , Vocational Rehabilitation, Post Traumatic Stress Disorder Clinical Team, Whole Health or others.

The Mental Health Care Line strives to help Veterans maximize their chances for long-term success and offers treatments that work (also called “evidence-based treatments”) to help Veterans achieve their goals. 

While most Veterans participate in SDTP for 6 months or less, individuals who maintain specific recovery-oriented activities for a minimum of one year experience the best outcomes. We encourage Veterans to develop ongoing community based and/or whole health support to meet their particular needs and life situation now and for the future.

Philosophy

Veterans within SDTP developed a treatment philosophy to alert fellow Veterans that recovery involves much more than simply changing use of drugs and/or alcohol.  

“We fought for America with all of our heart, we’ll fight for ourselves to make a new start. We take responsibility for our actions and do not expect others to carry our load. 

To do the things we’ve never done, we’ll have to be someone we’ve never been. We each represent ourselves and gain hope and strength by working together. 

We stand in agreement to be set free, to become the people we were meant to be. We recognize the choices we make dictate the lives we live. 

Failure is not an option, we will not give up!”

While we hope other veterans will find these words helpful, we recognize that veterans may have different ideas. We encourage everyone to develop their own philosophy and modify it as they grow. 

Treatments that Work

The treatments we offer have helped many Veterans improve their lives. Change requires new ways of thinking, behaving, and relating to others and may feel awkward and overwhelming at times. SDTP offers the following specific treatments either directly or through referral:

Motivational Enhancement Therapy

This treatment involves learning and clarifying how one’s personal experiences with alcohol and drug use compares to others, risk factors for (and consequences of) substance use disorders, reasons and desires for change, confidence, values, and how to change. This treatment generally lasts about four sessions.

Cognitive Behavioral Therapy for Substance Use Disorders

This treatment helps patients identify and challenge thoughts which serve as triggers to substance use disorder. This treatment requires keeping track of thoughts, feelings and behavior outside of sessions and reviewing these homework sheets with a therapist through-out. The treatment lasts about 12-16 sessions.

Contingency Management for Stimulant & Cannabis Use Disorders

This treatment provides increasing financial rewards (e.g., Veterans Canteen Service coupons) for abstinence based on negative laboratory tests which occur twice a week, 3-4 days apart on a consistent basis for 12 weeks.

Medication Management

Medications for Alcohol Use and Tobacco Use Disorders are available throughout the MEDVAMC. Ask any prescribing provider in the MEDVAMC or SDTP.  Medications for Opioid Use Disorder are primarily available through a dedicated subgroup of BHIP  psychiatrists (ask any Mental Health provider for a referral).

Twelve Step Facilitation

This treatment explains the concepts and practices of the 12 step programs like Alcoholics Anonymous. SDTP offers components of Twelve Step Facilitation in different groups and one-on-one sessions.

Other approaches outside of SDTP outpatient care include self-help, spiritual, and/or short-stay inpatient and longer-stay residential programs. Individuals may choose to seek a combination of these treatments (which we often recommend) or no treatment. While treatment has been found to be superior to no treatment, many individuals with problematic use of alcohol and/or drugs have succeeded without professional help. 

Treatment Coordinator

Each Veteran in SDTP is assigned an SDTP Treatment Coordinator and a team. Treatment Coordinators may be a Psychologist, Social Worker, or Licensed Professional Mental Health Counselor. This person coordinates a Veteran’s care within SDTP and is the person Veterans should first communicate with about all of their questions, treatment needs, and appointments. Together with their Coordinator, Veterans will develop a plan for treatment including their overall goals, objectives to meet those goals, and methods to help achieve both.

Veterans and their Coordinator discuss how often and under what circumstances the two of them will meet individually (in person, by telephone or over video-teleconferencing). During active treatment, all Veterans meet with their Coordinator at least monthly, when their treatment groups change or end, as needed  , and as they transition their recovery efforts into the community. 

Coordinators will also have Veterans complete a questionnaire (verbally or on your own device)  called the “Brief Addictions Monitor-Revised” (BAM-R) covering the last 30 days at the beginning of treatment, monthly, when levels of care change, and at the end of treatment.

The results of this questionnaire will give Veterans an idea of their progress and opportunities for improvement. Veterans and their Coordinator decide when a Veteran is ready to transition from active treatment and are ready to receive a “commendation” for participation in treatment. 

The Coordinator will discharge the Veteran from SDTP when they finish a course of treatment, if the Veteran stops attending appointments or does not follow up. Specifically, for standard outpatient services, if a Veteran “no shows” for two appointments or two full days of group appointments back-to-back without any notice or follow up, future individual and group appointments may be cancelled and the Veteran will likely be discharged.

Also, if a Veteran no shows to the individual appointments, their future group appointments may be cancelled. It is not sufficient to attend groups only. If the Veteran wishes to appeal their discharge due to extenuating circumstances, he/she/they should reach out directly to their Coordinator. 

After discharge, Veterans may initiate return to SDTP by asking any MEDVAMC provider to submit a consult.

Groups and Levels of Care

SDTP offers a variety of group-based treatment options. Participation in these groups is recommended for individuals who could benefit from more intensive and/or frequent treatment and/or the comradery of other Veterans.  Most groups will have a written curriculum or workbook.

If groups are online, Veterans will receive links for those groups on the day of the appointment. These links will come to the Veteran’s listed phone and email address from “Video.Appointment@va.gov” (as with any individual video appointments). If these platforms are challenging for a Veteran related to equipment or there is a need or preference for in person visits, Veterans should develop a plan with their Coordinator.

There is also help available for technical issues through the Help Desk at . The video links should not be shared with individuals other than the Veteran with the appointment. These sessions are not for family or friends unless specifically arranged in advance.

Intensive Outpatient Program (4 Weeks)

The initial phase of treatment for many Veterans is known as “Intensive Outpatient Program” or “IOP” and involves attending three hours of group per day for three days per week, weekly individual sessions and contingency management sessions as explained above (if appropriate) . Before starting IOP, Veterans attend an orientation session to learn about the Program and decide if it is a good fit. If enrolled, Veterans are assigned a temporary IOP Coordinator who takes over the duties of the standard outpatient SDTP Coordinator during the time the Veterans are in the IOP. IOP participation can range from 10 hours to 12 hours total per week.

Veterans are encouraged to have their workbook and a writing implement with them for each group. Laboratory testing for alcohol and drugs of misuse is available and strongly recommended during IOP. Given the level of intensity in IOP, the “no show” policy is stricter and is reviewed at the IOP Orientation. 

Veterans are expected to complete a Brief Addictions Monitor – IOP weekly during their participation in the IOP. Towards the end of a Veteran’s stay in IOP, their IOP Coordinator may help them plan what is next to avoid any break in group support or may defer this to the Veteran and the standard outpatient SDTP Coordinator to plan. Follow up after IOP may include individual therapy, engagement in other outpatient group(s), referral to other mental health clinics, and/or other interventions to help Veterans achieve their goals.

Standard Outpatient

For Veterans who need or desire less intensive care from the outset or are ready to reduce the frequency and intensity of treatment or support, there are more than a dozen options including:

Commitment to Sobriety

This group meets in-person at the MEDVAMC once or twice a week for an hour and a half each for 4 to 8 weeks and uses a workbook by the same name.

Relapse Prevention

This group has multiple offerings in terms of days and times and length of commitment, though all of them meet once week and use the “Matrix Model” which was developed by the Substance Abuse & Mental Health Services Administration (SAMSHA).

Transcending Self Therapy

This is a 2-group per week package offered back-to-back on Tuesday nights from 6 – 8 pm and uses a workbook with the same name. The material is based on Cognitive Behavioral Therapy (described above). Veterans will develop coping skills to manage urges/cravings, learn how to respond to unhelpful thoughts and uncomfortable emotions, and develop new healthy behaviors. This therapy is designed to be completed in 10 weeks.

Recovery Dynamics

This is a once weekly, 50 minute group led by Peer Support Specialists that helps individuals understand what recovery is really all about and demystifies the 12 Steps, 12 Traditions, and sponsorship. Individuals who attend at least 30 Twelve Step meetings in their first year of recovery double their chances for long-term success.

Other Groups

We also provide many population- and topic-specific groups (e.g., Sober Seniors, Women, Spirituality, and Harm Reduction). We are also happy to make referrals to “Seeking Safety” for trauma and addictions as well as group-based Grief and Smoking Cessation programs. Veterans are encouraged to discuss their particular concerns with their treatment Coordinator and develop a custom plan to address them.  

Telehealth/Group Guidelines

We strive to create a treatment experience that maximizes chances for creating and sustaining a successful recovery. Toward that end, we have learned that following these quality and comfort statements in video-telehealth groups produce better results:

  1. Group members are expected to have their camera on so that group members can see and be seen by others.  This increases engagement and personal connection. Veterans are expected to speak up and be ready to answer if called upon. A Veteran’s particular preferences, challenges, or concerns should be discussed with the individual Coordinator versus the group or group therapist.
     
  2. When sessions take place online in a virtual setting, we cannot guarantee privacy. Therefore, it is the responsibility of all participants to establish and maintain as much privacy and confidentiality as possible by joining the meeting in a quiet, private space where no one else is within ear shot or able to view the screen and abide by the “What’s said in group stays in group” rule.  
     
  3. Active participation during sessions is strongly encouraged, not only for each member’s  individual benefit but also for the benefit of any other participant who might learn from other’s experiences. 
     
  4. We ask that while in group each member  give the person that’s talking their undivided attention and maintain a respectful manner by not cross-talking, leaving the group unnecessarily or repeatedly, or taking any other actions that could disrupt the meeting.
     
  5. We conduct these groups the same way we would as if we were physically in attendance in a classroom. All other activities should be restricted once the class is in session, such as:  using cell phones , reading, listening to music, cooking, cleaning, working, providing childcare, or any other activity that could cause distraction. Members should also dress as they would for an in-person hospital visit. 
     
  6. No use of any substances during session. No smoking, vaping, eating or using any substances that could be triggering to any participants is condoned . Drinking something such as coffee or refreshments is allowed.
     
  7. It is important to be on time. These sessions open at 10 minutes before the hour and start promptly on the hour. Technical difficulties and individual exemptions are taken into consideration; if a member is late to a group or gets locked out of the meeting - which normally occurs at 10 minutes past the hour – members should follow up with their Coordinator. 
     
  8. Group members are encouraged to use ‘I STATEMENTS’ while participating in class, relate comments or concerns to personal experiences and only give suggestions when invited by the speaker. 
     
  9. Members can use their vehicle as a secure location as long as the member is alone in the vehicle and it is not moving. 

General Guidelines and Other Resources

  1. While in SDTP, a Veteran’s best resource for any non-urgent questions or concerns regarding the substance use disorder or treatment is a Veteran’s SDTP Treatment Coordinator. While this person may be working remotely, he or she will check her voicemail messages and return calls within 24 hours during regular Monday-Friday business hours in keeping with their tour of duty.
     
  2. For urgent mental health services Veterans may report to the Emergency Room or 6B-100 during business hours (before 4:30 pm) Monday through Friday.  
     
  3. To schedule an appointment with Mental Health call .
     
  4. VA Telecare is available 24 hours a day, 7 days a week at or toll free 1-. Telecare is available to help Veterans cancel group or individual appointments or speak to a Nurse, Pharmacist or clerk. 
     
  5. The Crisis Hotline is available 24/7 by dialing 988, and then press #1 for Veterans’ line. To text, send a message to 838255.  
     
  6. Help with housing is available by calling or 877-4AID-VET, visiting Primary Care Clinic #4 at the MEDVAMC, or via Consult (Veterans may request a consult from their provider or Treatment Coordinator). The Health Care for Homeless Veterans Program also operates a Community Resource Referral Center which accepts walk-ins at 1700 Webster Street, Houston, TX 77003 Monday - Friday 8 a.m. – 3:30 p.m.
     
  7. The Behavioral Health Integrated Program (AKA GMHC) has a Nurse Help Line to help Veterans navigate their non-urgent mental health treatment needs and helps with medication refills.  This number is .  Please leave a message and allow 24 hours for a return call.
     
  8. For Primary Care, call .
     
  9. To call Pharmacy, dial .
     
  10. To call MyHealthE Vet representatives, call .
     
  11. Veterans are encouraged to enroll in My HealtheVet (MHV) to enable secure email communication and also enable access to their medical chart, appointments, laboratory results, and more. For help with getting set up and using MyHealthE Vet, call .
     
  12. The Vocational Rehabilitation Service is available to Veterans seen in the Mental Health Care Line and helps Veterans with resumes, finding jobs in the community that fit with a Veteran’s experience and interest, making referrals to the DARS (Department of Assistive and Rehabilitative Services) and Texas WorkSource, and therapeutic work on-site. Mental Health Treatment Coordinator, Social Worker or SDTP Treatment Coordinator are able to initiate this consult. 
     
  13. If Veterans are interested in a specific type of therapy outside of SDTP, they are encouraged to discuss this with their Treatment Coordinator. After a provider submits a consult, a therapist or scheduler will call review them to discuss their needs and preferences and the options over the telephone.  
     
  14. The VA Mobile Solutions Technical Support can be accessed by calling . They will assist by doing a demonstration and trouble-shooting issues Veterans have with VVC. After a Veteran is set up for video appointments or groups, an email will be sent containing a link to click on at the time of the appointment. At each individual visit, the provider will need to know the Veteran’s location, other persons present, and review any safety concerns in case an urgent situation arises.
     
  15. Veterans are asked to please keep us informed of the best telephone number and email address for appointment reminders and general communication.   
     
  16. We encourage Veterans to be on time for all scheduled individual appointments and groups. Group links (or doors) are generally locked 10 minutes after the start time.
     
  17. If Veterans are not achieving their goals or participating appropriately, their Coordinator or treatment team may ask to meet with them and will make recommendations which may include a behavioral contract. If the treatment team is concerned about a Veteran’s safety, this will likely lead to a recommendation of more intensive treatments. SDTP will only provide treatment which the team deems appropriate and likely to be helpful.
     
  18. Information regarding Veterans is kept confidential within the VA, except in several specific situations. Information may be released without a Veteran’s consent if/when they make a serious threat toward someone else, make a disclosure about committing a violent crime, or provide information regarding possible child or elder abuse. Information about Veterans learned of in individual or group sessions is routinely shared between staff (including Peer Support Specialists) and the Veteran’s treatment team.
     
  19. No cursing at other Veterans, staff or visitors, stalking (in person or electronic), threats or sexual harassment is tolerated at the Michael E. DeBakey VA Medical Center and will prompt a Disruptive Behavior Report to the Violence Prevention Team and a review by the Veteran’s treatment team. Please keep in mind that a Veteran’s ease of access to future treatment at the VA can be restricted to maintain a safe and secure environment. 
     
  20. Veterans are encouraged to let their Treatment Coordinator know if they would like one or more gun locks to enhance the safety of Veterans, family members, and the community. 
     
  21. Veterans are encouraged to ask questions and familiarize themselves with their rights and responsibilities. Copies of “Patient’s Rights and Responsibilities” are posted through-out our facility. We strive to respect each Veteran’s values and beliefs. Veterans are invited to please discuss any conflicts experienced in this area with their SDTP Treatment Coordinator, Mental Health Treatment Coordinator, and/or treatment team. If a Veteran is unsure of the appropriate place to discuss the conflict, they are encouraged to start by reviewing it with their Coordinator. The next level of review is with the Veteran’s team or Team Coordinator, then the SDTP Director or staff member’s supervisor, and as a last resort, the Consumer Affairs Veteran Experience office.

Community Support

Veterans are strongly encouraged to consider utilizing self-help and community support to enhance treatment engagement for at least one year. Information about local self-help options are available by phone or online: 

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