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: 3.42). 07/2011; 116(1-3):93-101. DOI: 10.1016/j.drugalcdep.2010.11.027
Source: PubMed


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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    • "Rates of posttraumatic stress disorder (PTSD; 22% to 26%) are high among Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans using Veterans Affairs (VA) care (BurnettZeigler et al., 2011;McDevitt-Murphy et al., 2010;Seal et al., 2009Seal et al., , 2011). Research has demonstrated that PTSD symptoms have significant implications for veteran's postdeployment social readjustment. "

    Full-text · Article · Jan 2015 · Traumatology
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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.
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    • "Of the 25% percent of Iraq/Afghanistan veterans who received a psychiatric diagnosis in the VHA prior to 2005, Seal and colleagues [28] also found that 56% suffered from multiple mental health conditions that may demand clinical attention. Other research has also documented high rates of substance-related problems with combat-exposed samples [29], [30], which represents another significant concern for this population. "
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    ABSTRACT: Combat-related posttraumatic stress disorder (PTSD) can be a difficult condition to treat and has been associated with serious medical and economic issues among U.S. military veterans. Distinguishing between treatment responders vs. non-responders in this population has become an important public health priority. This study was conducted to identify pre-treatment characteristics of U.S. veterans with combat-related PTSD that might contribute to favorable and unfavorable responses to high value treatments for this condition.
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