Evidence-Based Screening, Diagnosis, and Treatment of Substance Use Disorders Among Veterans and Military Service Personnel (original) (raw)
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Clinical Considerations in the Treatment of Substance Use Disorders with Veterans
Journal of Contemporary Psychotherapy, 2011
This article addresses issues associated with the treatment of substance use disorders (SUD) in the U.S. veteran population. First, we examine special considerations regarding the assessment of alcohol and drug use in veterans. Second, we discuss current treatment approaches that have demonstrated efficacy in this population, with special consideration the issue of co-morbidity (especially SUD and Posttraumatic Stress Disorder). Third, we discuss two strategies to coordinate treatment of SUD: stepped care as a way to implement these treatments for SUD alone, and integrated treatment for SUD and co-morbid disorders. Finally, we discuss promising future directions for the treatment of SUD in the veteran population, including examination of mechanisms of behavior change, formal involvement of the veteran's family in treatment, and use of existing datasets.
The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 2016
Substance use disorders (SUDs), which encompass alcohol and drug use disorders (AUDs, DUDs), constitute a major public health challenge among US veterans. SUDs are among the most common and costly of all health conditions among veterans. This study sought to examine the epidemiology of SUDs among US veterans, compare the prevalence of SUDs in studies using diagnostic and administrative criteria assessment methods, and summarize trends in the prevalence of SUDs reported in studies sampling US veterans over time. Comprehensive electronic database searches were conducted. A total of 3,490 studies were identified. We analyzed studies sampling US veterans and reporting prevalence, distribution, and examining AUDs and DUDs. Of the studies identified, 72 met inclusion criteria. The studies were published between 1995 and 2013. Studies using diagnostic criteria reported higher prevalence of AUDs (32% vs. 10%) and DUDs (20% vs. 5%) than administrative criteria, respectively. Regardless of as...
Management of Substance use Disorder in Military Services: A Comprehensive Approach
Advanced Biomedical Research
Background: Historically, substance misuse has been a serious problem faced by worldwide military personnel. Some research showed that military personnel have higher rates of unhealthy substance use than their age peers in the general population. These problems have serious consequences and may lead to significant military difficulties in the field of readiness, discipline, and mental or physical health. In this review, we gathered various methods for prevention, diagnosis, and treatment of substance use disorders and suggested a comprehensive plan for Iran Armed Forces to improve existing services. Materials and Methods: This article is a narrative review study, which was carried out on 2016. A careful literature review was performed between January 1970 and April 2016 on several national and international databases. Articles were screened according to the following inclusion criteria: (1) review articles about prevention and treatment protocols, (2) executive guidance, (3) cohort articles about risk factors of addiction, and (4) randomized controlled trials about prevention or treatment of substance use disorders in army service members. After screening by title and abstract, 130 articles selected of 832 founded articles, and after quality assessment, finally, 63 articles included in the review. Results: There is a necessity to manage substance use disorder through prevention, screening, and then referral to proper services for diagnosis and treatment. Urinalysis programs for screening are cost-effective and should be considered as a main method. Effective treatment includes both behavioral and pharmacological methods. Conclusions: The ideal prevention program will include multiple and mutually reinforcing evidence-based universal, selective, and indicated attempts at both the individual and environmental levels. The implementation of screening and treatment strategies needs strict rules and national guideline for the comprehensive management of substance use disorders in army.
Untreated Substance Use Disorders in Veterans
There is a gap in treating substance use disorders in veterans in the United States. Links between PTSD, TBI and substance use disorders are not fully understood, but these battle injuries have already stressed the overloaded Veterans Administration health care system, and are bound to dramatically increase over the next 5 to 10 years. Advances in battlefield medicine and military protective equipment and clothing have resulted in many troops returning home with injuries. The physical injuries are apparent and treated by the active duty medical system while the military men and women are on active and by the Veterans Administration after they are discharged from the military. The mental and behavioral health injuries are nebulous and remain untreated for many veterans. This study uses surveys of active duty military men and women (N-43) and veterans (N-42) to determine some of the potential causes of or contributors to substance use disorders in veterans. Separate surveys civilian health care facilities (N-18) surrounding a major Veterans Administration medical center in
Psychological Services, 2007
Affairs (VA) operates over 200 substance abuse treatment programs. Historically, planning for these services has not been informed by population-level prevalence data. Accordingly, the authors analyzed the National Survey on Drug Use and Health data from 2000 to 2003 to estimate substance use and substance use disorder prevalence among all veterans. The authors present the data in comparison to comparable nonveterans. Data show notable rates of substance use among veterans; 22.6% and 4.4% of veterans reported binge drinking and any illicit drug use in the past month, respectively. In addition, prevalence varied by geographic location. Monitoring substance use prevalence is needed to ensure the VA and other substance use providers can plan appropriate substance use disorder services for current and future enrollees, including veterans of the current military operations in Iraq and Afghanistan.
Substance abuse and mental health treatment in the military: Lessons learned and a way forward
Military Psychology, 2011
Articles in this issue, "Stigma as a Barrier to Treatment," provide an excellent overview of the challenges associated with the treatment of substance abuse and mental health disorders in military settings. The issue serves to document substance abuse rates in the military; identify factors that influence and impede entry and participation in treatment, negative beliefs about treatment, and factors influencing perceived stigma; and examine the acceptability and feasibility of new substance abuse treatment models being employed at three Army installations. Two overarching conclusions can be made from the articles in this issue. First, the problems, barriers, and stigma associated with substance abuse and mental health disorders are not unique to military settings. Second, the military setting has unique characteristics that may help to destigmatize substance abuse and mental health problems, remove barriers to treatment, and facilitate access to military members to deal with substance abuse and mental health problems. In this article, we review similarities among military and civilian populations with respect to substance abuse and mental health problems; highlight strategies to reduce substance abuse among individuals in military service; and identify unique opportunities to improve substance abuse and mental health services within the military settings. In the introductory article for this issue, McFarling, D'Angelo, Drain, Gibbs, and Rae Olmsted (2011/this issue) note that the articles provide an overview of stigma toward substance abuse and mental health problems in the military and identify
Journal of Dual …, 2011
Co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders have become increasingly prevalent in military populations. Over the past decade, PTSD has emerged as one of the most common forms of psychopathology among the 1.7 million American military personnel deployed to Iraq and Afghanistan in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND). Among veterans from all eras, symptoms of PTSD have been highly correlated with hazardous drinking, leading to greater decreases in overall health and greater difficulties readjusting to civilian life. In fact, a diagnosis of co-occurring PTSD and alcohol use disorder has proven more detrimental than a diagnosis of PTSD or alcohol use disorder alone. In order to effectively address co-occurring PTSD and alcohol use disorder, both the clinical and research communities have focused on better understanding this comorbidity, as well as increasing treatment outcomes among the veteran population. The purpose of the present article is threefold: (1) present a case study that highlights the manner in which PTSD and alcohol use disorder co-develop after trauma exposure; (2) present scientific theories on co-occurrence of PTSD and alcohol use disorder; and (3) present current treatment options for addressing this common comorbidity. CASE PRESENTATION A 60 year-old, divorced, male Vietnam-era veteran was referred for substance use treatment following an alcohol-related arrest. He presented for outpatient treatment at a Veterans Affairs (VA) Medical Center with a chief complaint of longstanding anxiety symptoms and recent increase in heavy alcohol use after being laid off from his job. On the Alcohol Use Disorders Identification Test (AUDIT; Bush et al., 1998; WHO Brief Intervention Study Group, 1996), a brief screening tool for hazardous alcohol use, the veteran scored 10 out of 12 points, indicating that he was consuming alcohol at a level harmful to his health. The veteran scored a 50 on the PTSD Checklist for military populations (PCL-M; Weathers, Hushka, & Keane, 1991), indicating a positive screen and the need for a formal evaluation of PTSD.
Improving PTSD/Substance Abuse Treatment in the VA: A Survey of Providers
American Journal on Addictions, 2010
We surveyed 205 Veterans Affairs (VA) staff on treatment of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and the combination (PTSD/SUD). The survey was anonymous and VA-wide. PTSD/SUD was perceived as more difficult to treat than either disorder alone; gratification in the work was stronger than difficulty (for PTSD, SUD, and PTSD/SUD); and difficulty and gratification appeared separate constructs. Respondents endorsed views that represent expert treatment for the comorbidity; however, there was also endorsement of "myths." Thus, there is a need for more training, policy clarifications, service integration, and adaptations for veterans returning from Iraq and Afghanistan. Limitations are described. (Am J Addict 2010;19:257-263) Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur, and are more challenging to treat than either alone. 1-3 Clients with PTSD/SUD have worse treatment outcomes and more psychiatric, medical, legal, and social problems than those with just PTSD or SUD. High rates of PTSD/SUD comorbidity are documented in both community 2 and veteran samples. In 2008, 20% of Veterans Affairs (VA) patients with a diagnosis of PTSD also had SUD (Rosenheck, personal communication). Veterans from Iraq and Afghanistan are also demonstrating problems with PTSD and SUD: current PTSD is estimated at 20% in military troops 9 and 11% in veterans; 10 and current SUD is estimated at up to 21% in veterans seeking VA care. 11 Military deployment is a risk factor for both PTSD and SUD. 9,
Substance Use Among Women Veterans: Epidemiology to Evidence-Based Treatment
Journal of Addictive Diseases, 2013
An increasing percentage of women are U.S. Military Veterans. We review the substance misuse rates and comorbidities and the risk factors for and consequences of substance use among women Veterans. Women Veterans may have higher rates of substance misuse and comorbid psychiatric and medical disorders than male Veterans and women who are not Veterans. Studies support the AUDIT-C as a scaled marker of alcohol-related risk among female Veterans, but validated drug screening instruments are needed. We discuss evidencebased approaches in terms of treating women Veterans' substance misuse in primary and specialty care settings, along with knowledge gaps and potential research priorities to improve care in this special population.
Meta-analysis of risk factors for substance abuse in the US military
Military Psychology, 2019
This article describes the results from a meta-analytic review of 55 studies and 78 independent samples containing information about the demographic, contextual, and psychological factors associated with alcohol and drug abuse among United States military personnel. In terms of demographics, results from this analysis reveal higher levels of substance abuse among personnel who are male, younger, have less education, are unmarried, and who are of a lower military rank (E1-E3). In terms of the military context, rates of substance abuse are greater for personnel with combat exposure and a recent or lengthy deployment. Finally, rates of substance abuse are higher among personnel reporting specific psychological symptoms, including negative emotionality, impulsivity, and symptoms associated with depression, posttraumatic stress disorder (PTSD), and traumatic brain injuries (TBI). This study suggests that a number of sociodemographic, psychological, and contextual factors are related to the odds that a military service member engages in high levels of substance abuse. The results provide a strong foundation for the development of interventions aimed toward vulnerable populations in the US military.