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Datapoints: False Starts in Psychotherapy for Substance Use Disorders and PTSD in the VHA
Elizabeth M. Oliva, Ph.D.; Thomas Bowe, Ph.D.; Alex H. S. Harris, Ph.D.; Jodie A. Trafton, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201300145
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The authors are with the Program Evaluation and Resource Center, U.S. Department of Veterans Affairs Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA 94025 (e-mail: elizabeth.oliva@va.gov). Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column.

Copyright © 2013 by the American Psychiatric Association


As part of the push toward evidence-based mental health treatment, there is interest in increasing the proportion of patients who engage in evidence-based psychotherapy. However, attrition is a common phenomenon, especially at the beginning of psychotherapy. Using Veterans Health Administration (VHA) data, we examined psychotherapy utilization patterns among patients diagnosed as having a substance use disorder or posttraumatic stress disorder (PTSD) in fiscal year (FY) 2008. Start of a psychotherapy treatment episode was defined as the first psychotherapy visit after 60 days with no VHA psychotherapy visits within VHA. Thus psychotherapy visits more than 60 days apart were viewed as separate treatment episodes. This is consistent with a widely used definition of a treatment episode for a substance use disorder (1). Among patients who initiated psychotherapy, we also examined attrition—defined as attending only one or two psychotherapy visits.

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Figure 1 Percentage of patients with posttraumatic stress disorder (PTSD) or a substance use disorder in fiscal year 2008, by number of psychotherapy visits and by episode of care


 Healthcare Effectiveness Data and Information Set 2009: Technical Specifications , vol 2.  Washington, DC,  National Committee for Quality Assurance, 2008
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