MIRECC / CoE

Substance Use Disorder Consultation Available from the National Telemental Health Center

By Ellen L. Edens, MD, NTMHC-SUD Program Director

Do you treat Veterans with at-risk substance use or complex Substance Use Disorder needs? Perhaps you are treating a Veteran with PTSD and co-occurring alcohol use that is interfering with successful recovery? Or, you are managing a Veteran on high dose opioids who is having difficulty with a taper? Or, a Veteran is hearing voices or experiencing paranoia in the context of stimulant or cannabis use?

The National Telemental Health Center (NTMHC) Substance Use Disorder (SUD) Consultation Service links VA primary care and mental health providers and Veterans to subject matter experts in SUD treatment. We provide three types of consultation:

1. Ask the Expert – allows providers to ask any non-PHI question which is then triaged to subject matter experts nationally. Email your questions to AskTheExpert-SubstanceUseDisorder@va.gov (do not include PHI/PII).
2. Direct Telehealth Videoconferencing – provides videoconferencing with Veterans for diagnostic clarification and treatment recommendations. Please note: The NTMHC does NOT assume the care of Veterans and does not provide direct treatment.
3. E-consults – When real-time video teleconferencing is not an option because the Veteran is unable or unwilling to be scheduled for video consultation, NTMHC expert clinicians will review the Veteran’s medical record to complete an E-consult with recommendations for care.

Veterans who might benefit include those with:

• Unclear SUD diagnosis—for example Veterans on long-term opioid therapy for chronic pain
• Co-occurring psychiatric illness:
• PTSD, depression, or serious mental illnesses
• Multiple addictive disorders, including behavioral disorders
• Differential diagnoses
• Challenging treatment cases
• Complex medical problems

Core components of teleconferencing evaluation include:

• Extensive and thorough evaluation
• Assessment – in-depth review of Veterans’ medical records
• Secure clinical video-teleconference interview addressing:
• Differential diagnosis
• Prior treatment
• Common medical-psychiatric comorbidities
• Evidence-based psychopharmacologic consultation:
• VA/Department of Defense Guidelines for Substance Use Disorders
• Medical comorbidity monitoring and management
• Recommendations are provided to the referring clinician
• Additional on-going consultative sessions to collaboratively monitor Veterans’ responses to treatment recommendations and manage psychotherapeutic options

Request a consultation by contacting the National Telemental Health Center at VHANTMHCAdminStaff@va.gov or 203-479-8181. For more information about this program, contact Dr. Ellen Edens at 203-985-9569 or Ellen.Edens@va.gov.

Last updated: October 29, 2020