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Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment.
Drug Alcohol Depend. 2011 Jul 01; 116(1-3):93-101.DA

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.

Authors+Show Affiliations

University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. Karen.Seal@va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

21277712

Citation

Seal, Karen H., et al. "Substance Use Disorders in Iraq and Afghanistan Veterans in VA Healthcare, 2001-2010: Implications for Screening, Diagnosis and Treatment." Drug and Alcohol Dependence, vol. 116, no. 1-3, 2011, pp. 93-101.
Seal KH, Cohen G, Waldrop A, et al. Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment. Drug Alcohol Depend. 2011;116(1-3):93-101.
Seal, K. H., Cohen, G., Waldrop, A., Cohen, B. E., Maguen, S., & Ren, L. (2011). Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment. Drug and Alcohol Dependence, 116(1-3), 93-101. https://doi.org/10.1016/j.drugalcdep.2010.11.027
Seal KH, et al. Substance Use Disorders in Iraq and Afghanistan Veterans in VA Healthcare, 2001-2010: Implications for Screening, Diagnosis and Treatment. Drug Alcohol Depend. 2011 Jul 1;116(1-3):93-101. PubMed PMID: 21277712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment. AU - Seal,Karen H, AU - Cohen,Greg, AU - Waldrop,Angela, AU - Cohen,Beth E, AU - Maguen,Shira, AU - Ren,Li, Y1 - 2011/01/31/ PY - 2010/06/18/received PY - 2010/11/24/revised PY - 2010/11/27/accepted PY - 2011/2/1/entrez PY - 2011/2/1/pubmed PY - 2012/1/14/medline SP - 93 EP - 101 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 116 IS - 1-3 N2 - 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. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/21277712/Substance_use_disorders_in_Iraq_and_Afghanistan_veterans_in_VA_healthcare_2001_2010:_Implications_for_screening_diagnosis_and_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(11)00026-3 DB - PRIME DP - Unbound Medicine ER -