Effectiveness of Advisor-Teller Money Manager

• Measures of psychiatric symptomatology
• Service utilization
• Cost

VA investigators have described greater substance use at the beginning of the month when disability and other monthly checks are received. The proposed research addresses an important VA priority�seeing that veterans� funds are spent to improve veterans� quality of life and are not misspent on substances of abuse.

Background:

VA investigators have described greater substance use at the beginning of the month when disability and other monthly checks are received. The proposed research addresses an important VA priority�seeing that veterans� funds are spent to improve veterans� quality of life and are not misspent on substances of abuse.

Objectives:

The objective was to determine the effectiveness of a money management-based therapy called ATM for veterans who abuse cocaine or alcohol compared to a financial advice control condition.

Methods:

Veterans were randomly assigned to 36-weeks of ATM or to the control condition, financial advice. ATM (Adviser-Teller Money Manager) involves meeting with a money manager at least weekly. The money manager performs three functions�limiting patients� access to funds by storing checkbooks and ATM cards, training patients to budget their funds, and linking spending to treatment goals. The control condition involved listing income and expenses in a workbook. Veterans were enrolled from each of two sites if they had spent at least $100 in the preceding 90 days on alcohol or cocaine, and had at least $300 per month income. Measures of treatment fidelity and participation included number of visits attended, whether funds were stored, monthly income and expenses and Likert-scaled ratings from 1-4 of money management-related outcomes. Outcome measures collected included urine toxicology tests and breathalyzers, self-reported substance use as assessed by the ASI follow-up, and secondary measures including quality of life and psychiatric symptomatology.

Status:

Data analysis is ongoing. Attempts are being made to (a) disseminate ATM and assess its effect among homeless women veterans (b) determine the reliability and validity of money management-based assessments used to determine which veterans are capable of managing their funds (c) optimize funds management by disabled veterans.

• Substance Abuse
• Dual Diagnosis

• Rosen MI, Bailey M, Rosenheck RR. Alcohol & drug abuse: principles of money management as a therapy for addiction. Psychiatr Serv. 2003 Feb;54(2):171-3. No abstract available.
• Rosen MI, Rosenheck R, Shaner A, Eckman T, Gamache G, Krebs C. Do patients who mismanage their funds use more health services? Adm Policy Ment Health. 2003 Nov;31(2):131-40.
• Black RA, Rounsaville BJ, Rosenheck RA, Conrad KJ, Ball SA, Rosen MI. Measuring money mismanagement among dually diagnosed clients. J Nerv Ment Dis. 2008 Jul;196(7):576-9.

Inclusion Criteria:

Age _>18. Meets DSM-II criteria for cocaine abuse or alcohol abuse. Self-reported use of at least $100 worth of alcohol or cocaine during 30 days within last 90 days. Income of at least $300 per month.

Exclusion Criteria:

Currently receives money management, physiological dependence on alcohol or opiates, has a conservator or other payee