Effectiveness of Advisor-Teller Money Manager

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.

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

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. doi: 10.1176/appi.ps.54.2.171. 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. doi: 10.1023/b:apih.0000003018.16515.32.

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. doi: 10.1097/NMD.0b013e31817d0535.