Publication year
2011
Citation Title
Substance use disorders in Iraq and Afghanistan Veterans in VA healthcare, 2001–2010: Implications for screening, diagnosis, and treatment.
Journal Name
Drug and Alcohol Dependence
Journal Volume
116
Issue Number
1
Page Numbers
93–101
DOI
10.1016/j.drugalcdep.2010.11.027
Summary
Researchers used Department of Veterans Affairs administrative data to determine the prevalence of alcohol use disorders and drug use disorders among Iraq and Afghanistan Veterans (N = 456,502). Researchers also explored the comorbidity of substance use disorders and other mental health issues including posttraumatic stress disorder (PTSD), depression, anxiety, and adjustment disorders. Ten percent of Veterans received an alcohol use disorder diagnosis, 5% received a drug use disorder diagnosis, and 3% received both alcohol use disorder and drug use disorder diagnoses.
Key Findings
Of those with an alcohol use disorder diagnosis, 63% received a comorbid diagnosis of PTSD, 54% of depression, 30% of an anxiety disorder, and 27% of an adjustment disorder.
Of those with a drug use disorder diagnosis, 63% received a comorbid diagnosis of PTSD, 58% of depression, 38% of an anxiety disorder, and 28% of an adjustment disorder.
Of those with both an alcohol use disorder and drug use disorder, 76% received a comorbid diagnosis of PTSD, 72% of depression, 44% of an anxiety disorder, and 34% of an adjustment disorder.
Alcohol use disorder and drug use disorder diagnoses were more likely among Active Duty Veterans, Veterans under age 25, males, unmarried Veterans, and Veterans with a greater probability of combat exposure.
Implications for Program Leaders
Host workshops for professionals who work with military families in practices designed to reduce the stigma associated with seeking treatment for mental health issues, including drug and alcohol misuse
Create systematic referral systems and establish collaborations with community-based mental health centers to help Service members who experience substance abuse
Disseminate information regarding possible symptoms of mental health problems Service members may face after deployment and where individuals and families can find help for those problems
Implications for Policy Makers
Recommend routine screening schedules for hazardous drinking among Service members at specified intervals and locations during the deployment cycle
Encourage media campaigns designed to reduce the stigma associated with seeking treatment for mental health and substance abuse issues
Disseminate information regarding possible symptoms of mental health problems Service members may face after deployment
Methods
Participants were first-time users of Veterans Affairs healthcare between October 15, 2001 and September 30, 2009 who were followed for at least 90 days until the study end date of January 1, 2010.
Results are based on the entire population of OEF/OIF Veterans nationwide who sought treatment at Veterans Affairs healthcare facilities and received International Classification of Diseases, Ninth Revision (ICD-9) diagnoses associated with clinical visits.
Data were anaylzed to determine if there were any relationships among the prevalence of substance abuse and other mental health diagnoses.
Participants
Study population consisted of 456,502 OEF/OIF Veterans.
Participants were mostly male (88%), with an average age of 28 years old.
Race/ethnicity of the sample is as follows: 64% White, 13% Black, 14% Latino/Latina, 9% other. Participants represented the following service branches: 60% Army, 15% Marines, 13% Navy, and 12% Air Force.
Fifty-nine percent of the sample was Active Duty, while 41% was National Guard and Reserve; most were enlisted (93%).
Limitations
Results are based on a sample of treatment-seeking OEF/ OIF Veterans, which may limit generalizability.
Data were cross-sectional; hence, causation cannot be inferred.
Only one source of data (administrative records) was used to determine rates, which increases likelihood of measurement errors.
Avenues for Future Research
Apply longitudinal designs to studies to investigate potential factors that lead to substance abuse among Service members
Conduct randomized controlled trials to identify the most effective interventions designed to address comorbid diagnoses
Examine the impact of family histories of substance and mental health have on Service members' prevalence of substance abuse and mental health
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Background: 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. Methods: 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. Results: 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). Conclusions; 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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