"When I got back, especially at first, it was impossible to turn my brain off and fall asleep at night. Drinking was a quick and easy way to combat that, but also one that caused a lot more problems later on." (Source: Make the Connection website)
See the Make the Connection website to learn more about the signs of problematic drug or alcohol use and
related problems. You may also want to visit the website to listen to Veteran stories
regarding their experiences with substance use and related difficulties.
Assessing for a Substance Use Problem
There are many screening tools to assess drug and alcohol misuse. This section provides information about some widely used screening tools for alcohol, nicotine, and other drug misuse. Positive screening serves as a very valuable early warning sign that can identify potential substance use problems before they get worse. See the Online Resources section to learn about additional tools.
Alcohol Use Identification Test - Alcohol Consumption (AUDIT-C)
A screening tool that is widely used to assess alcohol misuse is the AUDIT-C. The AUDIT-C is a 3 item
validated screening questionnaire. The AUDIT-C asks questions like "How often did you have a drink containing
alcohol in the past year?" and "How many drinks did you have on a typical day when you were drinking in the
Download the AUDIT-C and learn more about screening and providing feedback to Veterans
using this measure.
Veterans can also self-administer the Audit-C at the My HealtheVet website.
Brief scoring information for the AUDIT-C:
A score of 4 or higher on the AUDIT-C may indicate misuse. A score of greater than 7 may indicate dependence.
If a client scores greater than 4, further evaluation, referral and brief intervention may be warranted.
Additional information about and assessment tools for alcohol misuse can be found at the VA QUERI website.
Useful Tool for Veterans
Also, the Drinker's Check-up can be a
useful tool for clients at risk of substance misuse.
Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)
Veterans can self-administer a brief screen about alcohol, tobacco products, and other drugs at the VA My
HealtheVet website. The ASSIST will ask questions about the Veterans experience of using substances across the
lifetime and in the past three months. Based on the Veteran's answers, feedback will be given about potential
risk of health and other problems related to problems with alcohol, tobacco or drugs. The results are not
stored or sent anywhere.
The ASSIST and scoring information can also be found at the After Deployment website.
Screening for Nicotine Dependence
The After Deployment website provides a downloadable brief screening tool with
scoring information for nicotine use.
Screening for frequently co-occurring problems
Some conditions that commonly co-occur with substance abuse and dependence include PTSD and Depression.
The Brief Addiction Monitor (BAM) is a 17-item measure of addiction problem severity that is designed to support individualized, measurement-based care (MBC) to patients with substance use disorders by providing reliable symptom monitoring in a format that yields clinically-actionable data that are not a burden to collect. The BAM may be administered as a clinical interview (in-person or telephonically) or via patient self-report; and, it typically takes about 5 minutes to complete. The BAM retrospectively examines the patient's past 30-days and includes items that assess Risk factors for substance use (items 1, 2, 3, 8, 11, & 15), Protective factors that support recovery (items 9, 10, 12, 13, 14, & 16), and drug and alcohol Use (items 4-7G). Furthermore, the BAM produces composite scores for the three domains (Risk, Protective, & Use). A patient's clinical status may be assessed by examining individual BAM items and/or composite scores. Initial psychometric evaluation of the BAM reveals good test-retest reliability. End users are strongly encouraged to attend to the item-level data because they have direct implications for treatment planning. That is, they identify specific areas of need or resources the patient brings to bear in his/her recovery.
Please contact the Philadelphia CESATE for more information: (215) 823-5800, x6181; Dominick.DePhilippis@va.gov.
Brochures, Booklets, and Handouts on Substance Misuse:
Download a brochure to encourage Veterans to discuss and self-assess for substance
Take a look at the handouts for clients on alcohol and other drug use on the AfterDeployment website.
These include information on topics such as:
Tips for drinking moderately
How to know if there is a problem
Substance use and combat stress
NIDA provides a selection of booklets and fact sheets for both clients and providers.
Free Online Program to Help Veterans Cut Back or Stop Drinking:
VetChange.org is a free and confidential online program created for Veterans and active duty military who are concerned about their drinking.
Online Workshop for Clients:
The AfterDeployment website
offers an online client workshop and assessments to provide more information about assessing and treatment of
alcohol and other drug use.
A psychoeducational program for the client
to help them to better understand whether their alcohol use is problematic and potential steps to help.
Treatment & Training
Treatment and Training
The guideline describes the critical decision points in the Management of Substance Use
Disorder and provides clear and comprehensive evidence based recommendations incorporating current information
and practices for practitioners throughout the DoD and VA Health Care systems. The guideline is intended to
improve patient outcomes and local management of patients with substance use disorder. Go to the VA/DoD Clinical Practice Guidelines website for a
listing of all the Guidelines.
This Veterans Health Administration (VHA) Handbook specified the Mental Health Services that are to be
available to all enrolled Veterans and lays out minimum requirements for VHA Mental Health Services.
These recommendations are from a multidisciplinary workgroup. They are intended to provide
guidance to clinicians seeing clients with both Substance Use Disorders and Posttraumatic Stress Disorder.
This PDF file may be printed and used as a handout.
Clients who are unable or unwilling initially to consider abstinence as a goal might benefit from medications
for alcohol dependence. The NIAAA Clinician's Guide and the NIAAA COMBINE Medical
Management Treatment Manual list information and contraindications to FDA approved medications.
Medications for alcohol dependence approved by the US Food and Drug Administration (FDA) include:
The NIAAA Clinician's Guide has helpful information for use of these. All three of these
medications have been shown to be effective for some clients and can be managed in the primary care setting
with support from a primary care-mental health team. In addition, recent trials have shown other medications
to be associated with decreased drinking including:
If clients have other indications for these medications, they may also benefit from their potential effect on
Among the many behavioral health services available through VA is treatment for Substance Use
Disorders (SUD). VA also is an innovator in SUD treatment by supporting research and development of best
Learn More About VA Services for Veterans with Substance Use Disorders:
If your client screens positive for substance misuse, they may be referred to specialized SUD
treatment, behavioral medicine, or more general mental health services for further evaluation and possible
treatment. In addition to individual services, Veterans can also find SUD treatment groups where they can
connect with and receive support from other Veterans.
How Do I Refer?
Below are various ways to connect with VA to refer a client or to support the services your Veteran client is
Center for PTSD: A goldmine of materials and resources about PTSD for provider and client with resources
that address co-occurring PTSD and Substance Use Disorders as well.
VetChange.org: A free and confidential online program created for Veterans and active duty military who are concerned about their drinking.
AfterDeployment: Information and materials on SUD and other associated conditions for the Veteran and his/her family.
Make the Connection: Veteran stories and
educational information about a variety of signs, symptoms, and conditions for your client. This site also
provides direction for the Veteran about next steps to take to seek treatment or resources.
QUERI: The VA Quality
Enhancement Research Initiative (QUERI) Substance Use Disorders Website provides information for clinicians
Self-Help Toolkit: The 3-
step Referral Method: A Product Developed by SUD QUERI, this toolkit teaches a strategy for engaging SUD
clients in self-help care.
The 3-Step Referral Method is an empirically validated method for referring patients to self-help programs.
This step-by-step method augments standard referral practices with the addition of a few new components. The
method was found to improve patient attendance and engagement in self-help programs and abstinence rates at
one year. Protocol and handouts on this site.
The Rethinking Drinking Program: This is a NIAAA program addressing alcohol misuse.
Includes information on alcohol misuse and provides tools such as a booklet for client's that discusses
healthy drinking guidelines and self-assessment.
Anonymous: For meeting information, contact a local A.A. resource that provides meeting times and
locations. Use this link for a list of meeting resources by state and province in the U.S. and Canada.
PsychArmor: This national non-profit organization is dedicated to bridging the military-civilian divide through free online education. PsychArmor has an online course focused on substance use.
Cool Intervention and Technology
Veterans can self-administer a brief screen about alcohol, tobacco products, and other drugs at the VA My HealtheVet website. Enrollment in My HealtheVet can be done right on the website.
Veterans enrolled in VA can manage their health information - appointments, prescriptions, labs, blood tests
and even exchange messages with their health care team.