Rachel Sayko Adams

• PhD, MPH
• Research Associate Professor at Boston University

Veterans with a history of military sexual trauma (MST+) are more likely to have substance use disorders (SUD) and may be at an elevated risk of premature death, driven in part by acute causes of death associated with SUD, such as suicide and overdose, as well as those associated with MST (e.g., suicide). However, the risks of veteran status, SUD,...

Importance Evidence-based, patient-centered treatment for alcohol use disorder (AUD) can include pharmacotherapy with naltrexone, acamprosate, or disulfiram; however, these medications are rarely used. Medicaid managed care plans (MCPs) manage health services for nearly 80% of Medicaid enrollees and are the largest payer for addiction treatment ser...

Objectives The association between traumatic brain injury (TBI) and alcohol use disorder (AUD) is known, but the extent of TBI’s role in developing AUD remains unclear. This study examines the association between TBI severity with subsequent AUD diagnosis, and hazard for death due to alcohol, drug overdose, or suicide. Methods Data from a national...

Objective To investigate the incidence of early/unplanned (E/U) separations following mild traumatic brain injury (mTBI) and assess whether sex impacts the hazard of separation. Setting Military Health System (MHS). Participants Active duty service members (N = 75,730) with an initial mTBI diagnosis in military records between January 2011 and Ja...

Background Traumatic brain injury (TBI) is common in people with substance use disorders (SUDs). TBI often results in cognitive deficits which can affect the clinical course of SUD. Case presentation Here we present the case of a 34-year-old Spanish-speaking man with severe opioid use disorder and two prior TBIs affecting his cognitive abilities....

Introduction US service members experience high rates of back pain. Guidelines prioritize nonpharmacologic treatment (NPT) as first-line pain treatments; however, NPT utilization patterns research is limited. This study examined NPT patterns of care within the first 10 weeks following an index back pain diagnosis. Materials and Methods Data were f...

Introduction To expand access to suicide prevention and support services, the Veteran Crisis Line (VCL) added text capabilities in 2011. It is unknown whether the likelihood of a contact being terminated by the user varies by contact type. We aimed to assess whether contact resolution varies by contact type after accounting for Veterans' sociodemog...

Background Treatment for alcohol use disorder (AUD) has the potential to improve health and quality of life. Little is known about disparities in AUD treatment utilization at the intersection of race and gender. We examined disparities in AUD treatment utilization among those diagnosed with AUD in a community sample, by race, ethnicity, and gender,...

Objective Extending prior research that has found that people with traumatic brain injury (TBI) experience worse substance use treatment outcomes, we examined whether history of TBI was associated with discontinuation of medication to treat opioid use disorder (MOUD), an indicator of receiving evidence-based treatment. Setting We used MarketScan c...

Introduction: Alcohol use (AU) and disorders (AUDs) have been increasing among women over the past decade, with the largest increases among women of child-bearing age. Unprecedented stressors during the COVID-19 pandemic may have impacted AU for women with and without children. Little is known about how these trends are impacting women in the milit...

Background Research examining at-risk substance use by disability status is limited, with little investigation into differences by disability type. We investigated binge drinking and prescription opioid misuse among adults with and without disabilities, and by type of disability, to inform need for assessment and intervention within these populatio...

Introduction: Early/unplanned military separation in Active Component U.S. service members can result in reduced readiness during periods of high-tempo combat and increased demand for health care services within the Military Health System and Veterans Administration. Although current assessment tools leverage prescription data to determine deploym...

Although alcohol use disorder (AUD) regularly co-occurs with other conditions, there has not been investigation of specific multimorbidity classes among military members with at-risk alcohol use. We used latent class analysis (LCA) to cluster 138,929 soldiers with post-deployment at-risk drinking based on their co-occurring psychological and physic...

Importance: Research to identify the direct and indirect associations of military-related traumatic brain injury (TBI) with suicide has been complicated by a range of data-related challenges. Objective: To identify differences in rates of new-onset mental health conditions (ie, anxiety, mood, posttraumatic stress, adjustment, alcohol use, and su...

Background and aims: Alcohol use is increasing among women in mid-life concurrently with societal changes in timing of parenthood and changing cultural norms, which may influence alcohol use. The aim of this study was to determine if age of first parenting was associated with excessive drinking [i.e. past 2-week binge drinking and past 5-year alco...

Objective: To examine whether post-9/11 veterans who screened positive for mild traumatic brain injury (mTBI) but did not complete a Comprehensive TBI Evaluation (CTBIE) were at higher risk of subsequent adverse events compared with veterans who screened positive and completed a CTBIE. Upon CTBIE completion, information assessed by a trained TBI c...

Introduction: Over-prescription of opioids has diminished in recent years; however, certain populations remain at high risk. There is a dearth of research evaluating prescription rates using specific multimorbidity patterns. Objective: Identify distinct clinical profiles associated with opioid prescription and evaluate their relative odds of rec...

Traumatic brain injury (TBI) is a common neurological condition, defined as a disruption to brain functioning caused by a blow, bump, jolt to the head, or a penetrating head injury. The damage caused by the primary insult is exacerbated by the secondary injury (e.g., metabolic changes, cranial bleeding, swelling). Military members, including those...

Objective: To examine racial and ethnic differences in suicide and drug and opioid-related overdose deaths among a population-based cohort of military service members who were diagnosed with a mild traumatic brain injury (mTBI) during military service. Design: Retrospective cohort. Setting: Military personnel receiving care within the Military...

Importance: Adverse outcomes associated with opioid use disorder (OUD) are disproportionately high among people with disabilities (PWD) compared with those without disability. A gap remains in understanding the quality of OUD treatment for people with physical, sensory, cognitive, and developmental disabilities, specifically regarding medications...

Objective: To evaluate changes in healthcare utilization and cost following an index mild traumatic brain injury (mTBI) diagnosis among service members (SMs). We hypothesized that differences in utilization and cost will be observed by preexisting behavioral health (BH) diagnosis status. Setting: Direct care outpatient healthcare facilities with...

Background In the USA, deaths due to suicide, alcohol, or drug-related causes (e.g., alcohol-related liver disease, overdose) have doubled since 2002. Veterans appear disproportionately impacted by growing trends. Limited research has been conducted regarding the relationship between community-level factors (e.g., rurality, community distress resul...

Efforts were focused on identifying differences in suicide rates and time-dependent hazard rate trends, overall and within age groups, by race and ethnicity among United States Army members who returned from an index deployment (October 2007 to September 2014). This retrospective cohort study was conducted using an existing longitudinal database, t...

Objective: Among service members (SMs) with mild traumatic brain injury (mTBI) admitted to an Intensive Outpatient Program (IOP), we identified qualitatively distinct subgroups based on post-concussive symptoms (PCS) and characterized changes between subgroups from admission to discharge. Further, we examined whether co-morbid posttraumatic stress...

This article is linked to "Are We Undercounting the True Burden of Mortality Related to Suicide, Alcohol Use, or Drug Use? An Analysis Using Death Certificate Data From Colorado Veterans" and "Invited Commentary: Stop Analyzing Suicides, Drug-Related Deaths, and Alcohol-Related Deaths Together" (https://doi.org/10.1093/aje/kwac194 and https://doi.o...

Background To date, knowledge is limited regarding time-dependent suicide risk in the years following return from deployment and whether such rates vary by military rank (i.e., enlisted, officer) or component (i.e., active duty, National Guard, reserve). To address these gaps in knowledge, the objectives of this study were to determine and compare...

Research Objectives To examine whether Veterans who screened positive for mild traumatic brain injury (mTBI), but did not complete a Veterans Health Administration (VHA) Comprehensive TBI Evaluation (CTBIE), were at higher risk for adverse outcomes compared to Veterans who screened negative for TBI. Design Retrospective longitudinal study that inc...

Knowledge regarding deaths due to suicide, alcohol-related, or drug-related causes may be limited by inconsistent and/or restrictive case definitions, resulting in concerns regarding validity of findings and underestimates of burden. In this proof-of-concept study, we assessed varying case definitions (suicide, alcohol-related, drug-related mortali...

Objective: There have been no systematic studies of pregnancy outcomes among women with traumatic brain injury (TBI), potentially limiting informed clinical care for women with such injuries. The purpose of this exploratory study was to evaluate pregnancy and fetal/neonatal outcomes among women with a TBI diagnosis recorded during their delivery h...

Objective: Challenges associated with case ascertainment of traumatic brain injuries (TBIs) sustained during the Afghanistan/Iraq military operations have been widespread. This study was designed to examine how the prevalence and severity of TBI among military members who served during the conflicts were impacted when a more precise classification...

Objective To evaluate the impact of COVID-19 pandemic exposure on changes in alcohol use and mood from years 1 to 2 after traumatic brain injury (TBI). Methods We used a difference-in-difference (DiD) study design to analyze data from 1,059 individuals with moderate-to-severe TBI enrolled in the TBI Model Systems (TBIMS) National Database. We defi...

Introduction Research in soldiers who had been deployed to Iraq or Afghanistan suggests that nonpharmacological treatments may be protective against adverse outcomes. However, the degree to which exercise therapy received in the U.S. Military Health System (MHS) among soldiers with chronic pain is associated with adverse outcomes after soldiers tra...

Background Evidence about substance use and misuse among adults with disabilities is still emerging, despite increased risk of chronic pain and mental health problems, which are in turn risk factors for substance use and misuse. Objective We examined substance use and misuse among adults with selected self-reported disability (versus without), con...

Background Opioid misuse is a significant public health problem in the United States; however, there is a gap in knowledge regarding the experiences of individuals who have experienced both opioid misuse/opioid use disorder (OUD) and another disability. This gap in knowledge is particularly problematic because people with disabilities are more like...

Background Despite the devastating consequences of the opioid epidemic, little is known about its impact on the deaf and hard of hearing (DHH) community. Objective To determine risk of OUD-related ED visits, ED visits involving a prescription or non-prescription opioid overdose, and mortality during OUD-related ED visits among DHH adults, compared...

Research Objectives To address gaps in knowledge, we examined differences in prescription opioid use and alcohol related behaviors among adults with and without disabilities. Design Secondary analyses of a statewide population-based cross-sectional survey. Setting The 2018 Ohio Behavioral Risk Factor Surveillance System survey. Participants The...

Objective: To summarize the current literature to identify what research has been conducted, examine the approaches used, and determine what is presently known about prescription and nonprescription opioid receipts and use among individuals with traumatic brain injury (TBI). Data sources: The search strategy included the following: opioid; opiat...

Objective: To investigate associations of lifetime history of traumatic brain injury (TBI) with prescription opioid use and misuse among noninstitutionalized adults. Participants: Ohio Behavioral Risk Factor Surveillance System (BRFSS) participants in the 2018 cohort who completed the prescription opioid and lifetime history of TBI modules (n =...

We aimed to identify differences in prescription opioid-related behaviors between adults with and without disabilities in the U.S. We analyzed data from the 2015-2017 National Survey on Drug Use and Health (128,740 individuals; weighted N of 244,831,740) to examine disability-based differences in (1) reasons and sources of last prescription opioid...

Background Chronic pain presents a significant burden for both federal health care systems designed to serve combat Veterans in the United States (i.e., the Military Health System [MHS] and Veterans Health Administration [VHA]), yet there have been few studies of Veterans with chronic pain that have integrated data from both systems of care. This s...

Objective To examine the relationships between nonpharmacological treatment (NPT) utilization and opioid prescriptions and doses and whether these relationships vary according to the type of NPT service received. Data Source Secondary data from the US Military Health System, nationwide. Study Design Patterns of NPT utilization and opioid prescrip...

The objective of this retrospective, longitudinal study was to investigate the prevalence of drinking within the recommended limits (i.e., low-risk drinking) following moderate/severe traumatic brain injury (TBI). Data were drawn from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Model Systems National Da...

Pain is common among adults with traumatic brain injury (TBI), yet little data exists regarding prevalence of opioid use in this population. The objective of this retrospective cohort study was to evaluate the association between lifetime TBI exposure, opioid use, and pain in a nationally-representative sample of 1,022 adults aged 50+ who participa...

Background Alcohol use disorder (AUD) reduces the health of soldiers and the readiness of the Armed Forces. It remains unknown if engagement in substance use treatment in the Military Health System improves retention in the military. Methods The sample consisted of active duty soldiers returning from an Afghanistan/Iraq deployment in fiscal years...

Background and Aims Persons with substance use disorders (SUDs) are at elevated risk of suicide death. We identified novel risk factors and interactions that predict suicide among men and women with SUD using machine learning. Design Case‐cohort study. Setting Denmark. Participants The sample was restricted to persons with their first SUD diagno...

Objective: This study examined the prevalence of chronic pain alone, posttraumatic stress disorder (PTSD) alone, and both chronic pain and PTSD among U.S. Army soldiers during the postdeployment year. Methods: The sample was 576,425 active duty soldiers returning from deployment in Afghanistan or Iraq between October 1, 2008, and September 30, 2...

Introduction Concussions are one of the most common causes for emergency room use in the United States (US) among youth and adolescents; however, prevalence data on concussion in this population are inconsistent. A growing body of literature has explored associations of a range of variables with pediatric concussion, but they have not been explored...

Little is known about the rates and predictors of substance use treatment received in the Military Health System among Army soldiers diagnosed with a postdeployment substance use disorder (SUD). We used data from the Substance Use and Psychological Injury Combat study to determine the proportion of active duty (n = 338,708) and National Guard/Reser...

Individuals with a history of concussion report a notable rate of psychiatric symptoms. Some of these are best described as postconcussive and remit within days to weeks. However, other symptoms are more persistent and may require intervention. Within this chapter we will discuss psychiatric symptoms frequently noted among those with mild traumatic...

Background Potential protective effects of nonpharmacological treatments (NPT) against long-term pain-related adverse outcomes have not been examined. Objective To compare active duty U.S. Army service members with chronic pain who did/did not receive NPT in the Military Health System (MHS) and describe the association between receiving NPT and ad...

Background Pain and its consequences remain of concern, particularly in high-risk occupations such as the military. Alcohol is a legal and accessible means of self-medication, and risky alcohol use is associated with potentially serious consequences. This exploratory analysis aimed to better understand the association of selected pain diagnoses wit...

Objective: To describe and characterize the lifetime history of traumatic brain injury (TBI) among active duty soldiers returning from deployment to Afghanistan or Iraq. Method: Data were extracted from a larger parent study that was conducted at two large United States Army bases between 2009 and 2014 during Post-Deployment Health Assessment. T...

Unhealthy alcohol use in the military remains a serious threat to health and military readiness and raises the question of how to improve detection that facilitates diagnosis and treatment. Army active duty soldiers are routinely screened for possible alcohol use disorder in pre- and post-deployment health surveillance surveys. We examined the like...

Objective: To investigate associations of lifetime traumatic brain injury (LT-TBI) prior to an index deployment, and/or deployment-acquired TBI (DA-TBI), with postdeployment binge and heavy drinking. Setting: Soldiers from 3 Brigade Combat Teams deployed to Afghanistan in 2012. Participants: A total of 4645 soldiers who participated in the Arm...

Objective: Examine associations between traumatic brain injury (TBI) and (1) suicide and (2) suicide method among individuals receiving Veterans Health Administration (VHA) care. Setting: VHA, Fiscal Years 2006-2015. Participants: Veterans with a TBI diagnosis during/prior to the study window (n = 215 610), compared with a 20% random sample of...

Objectives: To determine the proportion of Army soldiers who utilized care in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC) within the postdeployment year and to describe prevalence of polytrauma diagnoses, and receipt of opioids, nonpharmacologic treatments (NPTs), and mental health treatments in the VHA during the year...

Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) can negatively affect quality of life and social functioning. This study examined the relationship between PTSD and social participation in a cohort of veterans and service members (V/SM). Participants included 242 adults enrolled in the Veterans Affairs Traumatic Brain Injury Mo...

Background: In the Veterans Health Administration (VHA) there is growing interest in the use of nonpharmacologic treatment (NPT) for low back pain (LBP) as pain intensity and interference do not decrease with opioid use. Objectives: To describe overall and facility-level variation in the extent to which specific NPT modalities are used in VHA fo...

Introduction Little is known about long-term prescription opioid utilization in the Military Health System. The objectives of this study were to examine predictors of any prescription opioid receipt, and predictors of long-term opioid utilization among active duty soldiers in the year following deployment. Materials and Methods The analytic sample...

Background: Studies have examined utilization of health care services by civilian children with chronic conditions but not utilization among child dependents of military personnel. Objective: To identify children with chronic conditions among military members and retirees and examine their health care utilization and its association with type of...

Background This study evaluated an educational intervention intended to increase physicians’ use of patient prescription history information from the state prescription monitoring program (PMP) and their adoption of clinical behaviors consistent with opioid prescription guidelines to reduce patient risk. Methods Physician volunteers (n = 87) in com...

Background: Chronic low-back pain (LBP) is a frequent cause of work absence and disability, and is frequently associated with long-term use of opioids. Objective: To describe military readiness-related outcomes at follow-up in soldiers with LBP grouped by the type of early treatment received for their LBP. Treatment groups were based on receipt...

Introduction Soldiers are at risk for acute and chronic pain due to the mental and physical challenges of military duties and ongoing training for force readiness. With the burden of pain on any individual attributable across pain sources, a broad perspective that goes beyond prior characterizations of pain is important. We aim to further the under...

We estimated the prevalence of select mental health diagnoses (MHDX) and mental health treatment (MHT), and identified characteristics associated with MHT during the pre-deployment year (365 days before deployment) in active duty Army women (N = 14,633) who returned from Iraq or Afghanistan deployments in FY2010. Pre-deployment year prevalence esti...

Objective: Within the same time frame, compare the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and VA Traumatic Brain Injury Model System (TBIMS) data sets to inform future research and generalizability of findings across cohorts. Setting: Inpatient comprehensive interdisciplinary rehabilitation fa...

Objective: Approximately three to six months after returning from deployment, military service members complete the Post-Deployment Health Reassessment (PDHRA), which includes screens for alcohol misuse, depression, and posttraumatic stress disorder (PTSD). To determine whether Army Reserve Component (RC) members (Army National Guard and Army Rese...

Introduction: South Carolina (SC) ranks 10th in opioid prescriptions per capita-33% higher than the national average. SC is also home to a large military and veteran population, and prescription opioid use for chronic pain is alarmingly common among veterans, especially those returning from Afghanistan and Iraq. This article describes the backgrou...

This study examines whether the relationship between traumatic brain injury (TBI) and post-deployment binge drinking is independent of screening positive for mental health problems among male and female service members. Data are from the Substance Use and Psychological Injury Combat Study of Army members returning from deployment to Afghanistan or...

An association between combat exposure and postdeployment behavioral health problems has been demonstrated among U.S. military service members returning from Afghanistan or Iraq in predominantly male samples, yet few studies have focused on the experiences of women. Using data from the longitudinal, observational Substance Use and Psychological Inj...

Objective: To identify characteristics associated with testing positive for illicit drugs postdeployment among Army enlisted members. Methods: Army active duty and National Guard/Reserve enlisted members returning from Operation Enduring Freedom/Operation Iraqi Freedom deployments in fiscal years 2008 to 2011, who submitted urine specimens for r...

This study described the rate and predictors of Operation Enduring Freedom/Operation Iraqi Freedom active duty Army members’ enrollment in and use of Veterans Health Administration (VHA) services (linkage), as well as variation in linkage rates by VHA facility. We used a multivariate mixed effect regression model to predict linkage to VHA, and also...

Objective: To identify characteristics associated with testing positive for illicit drugs postdeployment among Army enlisted members. Methods: Army active duty and National Guard/Reserve enlisted members returning from Operation Enduring Freedom/Operation Iraqi Freedom deployments in fiscal years 2008 to 2011, who submitted urine specimens for rand...

This study described rates and predictors of Army National Guard and Army Reserve members' enrollment in and utilization of Veteran Health Administration (VHA) services in the 365 days following demobilization from an index deployment. We also explored regional and VHA facility variation in serving eligible members in their catchment areas. The sam...

Objectives: We identified to what extent the Department of Defense postdeployment health surveillance program identifies at-risk drinking, alone or in conjunction with psychological comorbidities, and refers service members who screen positive for additional assessment or care. Methods: We completed a cross-sectional analysis of 333 803 US Army...

To the Editor Ms LeardMann and colleagues1 reported on 83 suicides among 151 560 participants of the MCS and found that suicide was not associated with deployment or combat. In particular, 58% of suicide deaths were among those without any deployments; the age- and sex-adjusted hazard ratio for number of deployments was not significant; and the cum...

Objective: To examine whether experiencing a traumatic brain injury (TBI) on a recent combat deployment was associated with postdeployment binge drinking, independent of posttraumatic stress disorder (PTSD). Methods: Using the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel, an anonymous survey...

Rationale: Combat-acquired traumatic brain injury (TBI) has occured among military service members serving in Afghanistan and Iraq with reported prevalence ranging from 12-23% of returning service members. In addition, studies suggest that TBI may be a risk factor for post-deployment unhealthy alcohol use. Research is needed to determine how routin...