Table 1.

Session Outline

Treatment Modules and Session Outline
Session Topic	Session Description
Module 1 - Motivational Enhancement via Assessment with Feedback (All patients)
Feedback	The patient and provider review the summary report of data from the first session. Feedback will be provided using MI’s Elicit-Provide-Elicit approach.
Change Planning	The provider and patient will discuss and complete the change plan. This discussion includes progress made and setbacks. The sessions also seek to evoke and affirm the patient’s motivations and commitment to make changes in substance use behaviors.
Change Planning	The provider and patient will discuss and complete the change plan. This discussion includes progress made and setbacks. The sessions also seek to evoke and affirm the patient’s motivations and commitment to make changes in substance use behaviors.
Finalize Change Plan	The provider and patient will identify and affirm progress. The change plan can be amended if data on anhedonia and/or substance use indicate the need for BA or CBT, respectively.
Module 2 - Behavioral Activation (Optional for patients with moderate to severe depression/anhedonia)
Introduction to Behavioral Activation	The provider will introduce BA, provide psychoeducation about connection between activity and mood, will gain an understanding of patients’ goals and valued behaviors, and teach the patient how to monitor activities and mood.
Activation and Engagement * 3 sessions	The provider will continue to explore values and set activation goals. The provider and patient will work together to plan activities for the coming week and identify strategies to help with activation.
Module 3 – CBT-Substance Use Disorder (Optional for patients with continued substance use)
Functional Analysis and Goal Setting	The provider will help the patient recognize connections between situations, thoughts/feelings, behavior, and results. The provider and patient will complete a functional analysis of the most recent episode and problem solve identified targets.
Progress Review and Goal Setting *3 sessions	The provider will review progress since the last session, review the risk assessment, identify high risk situations, and problem solve identified targets.
Module 4 - Brief CBT (Optional for patients with alcohol misuse, anxiety, or mild to moderate depression)
Depression & Anxiety Management	Oslin DW, Klaus J, Ingram E, et al. Foundations for Integrated Care: Volume 2, Depression and Anxiety Management. https://www.mirecc.va.gov/cih-visn2/Documents/Provider_Education_Handouts/Vol_2_Depression_and_Anxiety_Managment.pdf Accessed January 9, 2023.
Alcohol Misuse	Oslin DW, Klaus J, Ingram E, et al. Foundations for Integrated Care: Volume 3, At-Risk Drinking and Alcohol Dependence Management. https://www.mirecc.va.gov/cih-visn2/foundations.asp. Accessed January 9, 2023.

Abbreviations: motivational interviewing (MI); Behavioral Activation (BA); Cognitive Behavior Therapy (CBT)