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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    ABSTRACT: The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies. Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles. Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans. Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis.
    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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    ABSTRACT: Veterans (N = 133) who were seeking treatment in either the Posttraumatic Stress Program or Substance Use Disorders Program at a Veterans Affairs Medical Center (VAMC) and, based on self-report of symptoms, met clinical norms for posttraumatic stress disorder (PTSD) or hazardous substance use (HSU) completed a survey related to relationship conflict behaviors, attachment styles, and depression severity. Participants were grouped into one of three categories on the basis of clinical norm criteria: PTSD only, HSU only, and PTSD + HSU. Participants completed the PTSD Checklist-Military, Experiences in Close Relationships Scale-Short Form, Center for Epidemiologic Studies-Depression scale, Alcohol Use Disorders Identification Test, Drug Use Disorders Identification Test, and Psychological Aggression and Physical Violence subscales of the Conflict Tactics Scale. Most participants were male and Caucasian. Significant differences were found between groups on depression, avoidant attachment, psychological aggression perpetration and victimization, and physical violence perpetration and victimization. Post hoc analyses revealed that the PTSD + HSU group had significantly higher levels of depression, avoidant attachment, and psychological aggression than the HSU only group. The PTSD + HSU group had significantly higher levels of physical violence than did the PTSD only group, but both groups had similar mean scores on all other variables. Potential treatment implications are discussed.
    Journal of Interpersonal Violence 11/2013; 29(7). DOI:10.1177/0886260513506274 · 1.64 Impact Factor
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