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Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment

University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
Drug and alcohol dependence (Impact Factor: 3.28). 07/2011; 116(1-3):93-101. DOI: 10.1016/j.drugalcdep.2010.11.027
Source: PubMed

ABSTRACT The prevalence and correlates of alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses in Iraq and Afghanistan veterans who are new users of Department of Veterans Affairs (VA) healthcare nationwide has not been evaluated.
VA administrative data were used in retrospective cross-sectional descriptive and multivariable analyses to determine the prevalence and independent correlates of AUD and DUD in 456,502 Iraq and Afghanistan veterans who were first-time users of VA healthcare between October 15, 2001 and September 30, 2009 and followed through January 1, 2010.
Over 11% received substance use disorder diagnoses: AUD, DUD or both; 10% received AUD diagnoses, 5% received DUD diagnoses and 3% received both. Male sex, age < 25 years, being never married or divorced, and proxies for greater combat exposure were independently associated with AUD and DUD diagnoses. Of those with AUD, DUD or both diagnoses, 55-75% also received PTSD or depression diagnoses. AUD, DUD or both diagnoses were 3-4.5 times more likely in veterans with PTSD and depression (p < 0.001).
Post-deployment AUD and DUD diagnoses were more prevalent in subgroups of Iraq and Afghanistan veterans and were highly comorbid with PTSD and depression. Stigma and lack of universal screening may have reduced the number of DUD diagnoses reported. There is a need for improved screening and diagnosis of substance use disorders and increased availability of integrated treatments that simultaneously address AUD and DUD in the context of PTSD and other deployment-related mental health disorders.

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    • "Veterans are at particularly high risk for SUD-PTSD comorbidity (e.g., Carter, Capone, & Short, 2011). For example, among a sample of nearly half a million Iraq and Afghanistan veterans, 63–76% of those with an alcohol or drug use disorder also met criteria for PTSD (Seal et al., 2011). Further, meta-analytic studies indicate that PTSD symptom severity is strongly associated with aggressive behavior and that this association is stronger among veterans as compared to civilians (Orth & Wieland, 2006; Taft et al., 2011). "
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    ABSTRACT: This study examined posttraumatic stress disorder (PTSD) symptom severity and impulsivity as predictors of aggressive behavior among 133 male military veterans entering substance abuse treatment who endorsed difficulty controlling anger in the past year. At treatment intake, participants completed measures assessing PTSD symptom severity, impulsivity and aggressive behavior. Perpetration of aggressive behavior was reassessed 4 months later. Results from multivariate models indicated that PTSD symptom severity and impulsivity explained unique variance in aggressive behavior at intake but not follow-up. Mediation models indicated that the association between PTSD symptom severity and aggressive behavior was accounted for by impulsivity. The identification of impulsivity as a key mediator between trauma symptoms and aggressive behavior has significant clinical and research implications. Based on these findings, clinicians are encouraged to consider a standard assessment of impulsivity and the selection of interventions that target impulsivity as a trans-diagnostic process among at-risk client populations.
    Journal of Substance Abuse Treatment 11/2014; 50. DOI:10.1016/j.jsat.2014.10.014 · 3.14 Impact Factor
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    • "Additionally, SUD often goes undiagnosed among Iraq and Afghanistan veterans (Seal et al., 2011), which may be especially true of women who were historically often missed by traditional screening measures (Davis et al., 2003). Better screening is needed to identify those needing services (Seal et al., 2011), as engagement in substance abuse treatment may decrease odds of suicide attempt (Ilgen et al., 2007). "
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    Drug and alcohol dependence 11/2013; 136. DOI:10.1016/j.drugalcdep.2013.11.009 · 3.28 Impact Factor
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    • "Studies have found prevalence of PTSD among individuals who are in SUD treatment to range from 36% to 50% (Brady et al., 2004; Brown, Stout, & Mueller, 1996). Similarly, research with the veteran population indicates that comorbid PTSD and SUDs are frequently seen in treatment settings (Ouimette, Ahrens, Moos, & Finney, 1997; Seal et al., 2011). Individuals with comorbid PTSD and SUD tend to have more severe psychological symptom presentations than do individuals with PTSD or SUDs alone (Najavits et al., 1998). "
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