Improving PTSD/Substance Abuse Treatment in the VA: A Survey of Providers (original) (raw)

2010, American Journal on Addictions

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,