Article

Association of Substance Use and VA Service-Connected Disability Benefits with Risk of Homelessness among Veterans

VA New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT 06516, USA.
American Journal on Addictions (Impact Factor: 1.74). 09/2011; 20(5):412-9. DOI: 10.1111/j.1521-0391.2011.00166.x
Source: PubMed

ABSTRACT Recent public attention on homelessness has shifted beyond emergency services and supportive housing to primary prevention. This study compares a national sample of homeless and nonhomeless Veterans Affairs (VA) mental health services users to determine risk and protective factors for homelessness. Using VA administrative data, veterans were identified as homeless (ie, used VA homeless services or received a diagnostic code for "lack of housing") or nonhomeless and compared using logistic regression. Additional analyses were conducted for two low-risk subgroups: veterans who served in current Middle East wars (Operation Enduring Freedom [OEF]/Operation Iraqi Freedom [OIF]) and veterans with ≥50% service-connected disability. Among all VA mental health users, OEF/OIF (odds ratio [OR]) = 0.4) and ≥50% service-connected (OR = .3) veterans were less likely to be homeless. In the overall and subgroup analyses, illicit drug use (OR = 3.3-4.7) was by far the strongest predictor of homelessness, followed by pathological gambling (PG) (OR = 2.0-2.4), alcohol use disorder (OR = 1.8-2.0), and having a personality disorder (OR = 1.6-2.2). In both low-risk groups, severe mental illness (schizophrenia or bipolar disorder), along with substance use disorders, PG, and personality disorders, increased homelessness risk. Substance use, PG, and personality disorders confer the greatest modifiable risk of homelessness among veterans using VA services, while service-connected disability conferred reduced risk. Clinical prevention efforts could focus on these factors. 

4 Followers
 · 
168 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: While there has been considerable concern about veterans dually diagnosed with both posttraumatic stress disorder (PTSD) and comorbid substance use disorders, a national study of clinical characteristics, service utilization and psychotropic medication use of such veterans in Veterans Affairs (VA) has yet to be conducted. We hypothesized that veterans having both PTSD and substance use disorder would have lower socioeconomic status, greater medical and psychiatric comorbidity, higher medical service utilization, and more psychotropic pharmacotherapy fills. Methods: National VA data from fiscal year 2012 were used to compare veterans dually diagnosed with PTSD and substance use disorder, to veterans with PTSD without substance use disorder on socio-demographic characteristics, psychiatric and medical comorbidities, mental health and medical service utilization and psychotropic pharmacotherapy. Comparisons were based on bivariate and Poisson regression analyses. Results: The sample included all 638,451 veterans who received the diagnosis of PTSD in the VA in fiscal year 2012: 498,720 (78.1%) with PTSD alone and 139,731 (21.9%) dually diagnosed with PTSD and a comorbid substance use disorder. Veterans with dual diagnoses were more likely to have been homeless and to have received a VA disability pension. Medical diagnoses that were more strongly associated with veterans who were dually diagnosed included seizure disorders, liver disease and human immunodeficiency virus (HIV). Psychiatric comorbidities that distinguished veterans with dual diagnoses included bipolar disorder and schizophrenia Veterans dually diagnosed with PTSD and substance use disorder also had a greater likelihood of having had mental health inpatient treatment. There were no substantial differences in other measures of service use or prescription fills for psychotropic medications. Conclusions: Several substantial differences were observed, each of which represented more severe medical and psychiatric illness among veterans dually diagnosed with PTSD and substance use disorder compared to those with PTSD alone. However, effective treatments are available for these disorders and special efforts should be made to ensure that veterans who are dually diagnosed receive them.
    Journal of Dual Diagnosis 12/2014; 11(1). DOI:10.1080/15504263.2014.989653 · 0.80 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Screening for acute stress is not part of routine trauma care owing in part to high variability of acute stress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study was to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a routine screening program in comparison to current ad hoc referral practice.
    Journal of Trauma Management & Outcomes 05/2014; 8:5. DOI:10.1186/1752-2897-8-5
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although the majority of combat veterans reintegrate into civilian life without long-lasting problems, a sizable minority return from deployment with psychiatric or physical injuries that warrant medical attention. Even in the absence of diagnosable disorders, many experience functional problems that impede full reintegration into civilian life. Considerable resources have been allocated to studying, diagnosing, treating, and compensating combat-related disorders. This important work has resulted in significant improvements in healthcare for those with deployment-related difficulties. Nevertheless, many service members and veterans with reintegration difficulty may not receive needed help. Based on our review, we argue that in addition to treatment and compensation for diagnosable postdeployment problems, a comprehensive approach to reintegration is needed that includes partnership between the government, private sector, and the public.
    Social Issues and Policy Review 01/2014; 8(1). DOI:10.1111/sipr.12001