Clinical Considerations in the Treatment of Substance Use Disorders with Veterans (original) (raw)
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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
Military Medicine, 2012
Substance use disorders (SUDs) are among the most common and costly conditions in veterans and active duty military personnel, adversely affecting their health and occupational and personal functioning. The pervasive burden of SUD has been a continuing concern for the Department of Veterans Affairs (VA) and Department of Defense (DoD), particularly as large numbers of service members return from Operations Enduring and Iraqi Freedom. The VA and DoD have prioritized implementation of evidence-based practices and treatment services to enhance the recognition and management of SUD in general medical and SUD specialty-care settings. This article summarizes the clinical practice guidelines for identifying, diagnosing, and treating SUD in VA and DoD general medical and SUD specialty-care settings, highlights evidence-based pharmacotherapy and psychosocial interventions for managing SUD, and describes barriers to successful treatment of veterans and service members at risk for SUD in VA and DoD health care systems.
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.
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.
Psychological trauma : theory, research, practice and policy, 2015
Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linki...
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...
PTSD Care Among Veterans With and Without Co-Occurring Substance Use Disorders
Psychiatric services (Washington, D.C.), 2017
This study examined whether a co-occurring substance use disorder contributed to disparities in receipt of Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) specialty care or psychotherapy. Logistic regression, controlling for sociodemographic characteristics, was used to examine predictors of PTSD care among 424,211 veterans with confirmed PTSD (two or more PTSD diagnosis encounters) who accessed care in a VHA facility between fiscal years 2009 and 2010. Overall, 16% of veterans had PTSD and a co-occurring substance use disorder diagnosis. In adjusted analyses, veterans with a co-occurring substance use disorder were more likely than veterans with PTSD alone to receive any outpatient PTSD specialty care and complete eight or more sessions of outpatient psychotherapy within 14 weeks, but they were less likely to be treated in inpatient PTSD specialty units. Co-occurring substance use disorders did not appear to hinder receipt of outpatient specialty PTSD trea...
Advances in Social Work
Veterans and military personnel may be at higher risk for developing addictions due to increased prevalence rates of co-occurring mental health disorders including posttraumatic stress and substance abuse disorders. However, clinicians may feel unprepared to assess and to treat these co-occurring disorders, especially when it includes a behavioral addiction such as gambling. Clinical social work and clinical behavior analysis are two fields with complementary interdisciplinary approaches that can lead to improved client-centered outcomes. Yet, limited evidence exists to guide interdisciplinary treatment teams in effective treatment of gambling addictions and Post Traumatic Stress Disorder (PTSD). The current article provides an interdisciplinary treatment model to assist clinicians in selecting appropriate evidence-based assessments and treatments. A case example focuses on the use of assessment tools and treatment approaches drawn from recommendations from best practice guidelines for veterans. Finally, resources related trauma and addictions are presented.
Journal of Traumatic Stress, 2013
This study examined the relative influences of posttraumatic stress disorder (PTSD), other psychopathology, and intimate partner alcohol and drug use on substance-related problems in U.S. veterans (242 couples, N = 484). Hierarchical regression analyses revealed that partner alcohol and drug use severity explained more variance in veteran alcohol use and drug use (20% and 13%, respectively) than did veteran PTSD, adult antisocial behavior, or depression symptoms combined (6% for veteran alcohol use; 7% for veteran drug use). Findings shed new light on the influence of relationship factors on veteran alcohol and drug use and underscore the importance of couples-oriented approaches to treating veterans with comorbid PTSD and substance abuse.