Health-related quality of life among veterans in addictions treatment: identifying behavioral targets for future intervention

Implications of Physical Activity in Reducing Alcohol Use for Women Veterans: A Narrative Review

Women veterans (WV) are a fast-growing population in the United States with concerning health disparities. Reports of increased risks of cardiovascular disease (CVD) and poorer health are evident in WV compared with their civilian counterparts. The transition from active duty to veteran poses additional life stressors, causing changes in health behaviors such as unhealthy alcohol consumption and decreased physical activity, which may explain health disparities in WV. The changes in these two health risk behaviors may be influenced by each other, and emerging evidence suggests that physical activity aids in managing alcohol consumption during alcohol use treatment. In this general narrative review, we summarized findings from studies involving WV on (1) the associations between alcohol consumption and physical activity and (2) the effect of physical activity on reducing alcohol use. We also discussed the clinical consideration of adding physical activity to alcohol use interventions for WV. Most of the literature included in this review has been based on predominantly veteran men populations. This knowledge gap highlights the importance of continued efforts and research studies targeting WV to eliminate health disparities among them.

The examination of sleep hygiene, quality of life, and schizotypy in young adults

The co-occurrence of sleep disruption and schizophrenia-spectrum symptomology is common, with current research supporting the use of interventions, such as cognitive behavioral therapy for insomnia (CBTi), which include sleep hygiene education. Sleep hygiene refers to patterns of pre-sleep behaviors that can promote or impair sleep. These behaviors are easily identified and modifiable, potentially holding promise as targets of research and clinical practice. However, there is little research examining sleep hygiene in those at-risk for schizophrenia, measured through clusters of sub-clinical symptoms known as schizotypy. Given the likelihood poor sleep exacerbates negative emotions, thus serving as an etiologically relevant stressor, the study of sleep hygiene in at-risk populations appears warranted. Additionally, quality of life (QOL) has previously been shown to be negatively associated with sleep hygiene and schizophrenia-spectrum risk. As such, QOL domains were included to quantify the extent pre-sleep habits and dimensional schizotypy impact individuals' wellbeing. Data was collected from a non-clinical sample of 385 young adults (M = 20.83, SD = 3.61). As anticipated, higher schizotypy was correlated with poorer sleep hygiene and reduced QOL, although only negative schizotypy predicted QOL in the final regression model controlling for sex differences. Sex differences were present for all variables of interest except disorganized schizotypy. Post-hoc item-level analyses suggested that higher levels of schizotypy were correlated with emotional rumination prior to sleep, while increased negative schizotypy was associated with reduced QOL. Future research should further evaluate sleep hygiene as a potentially relevant risk variable in the development of schizophrenia-spectrum symptomology and associated decline in QOL.

Do Sex Differences Among Adults With Opioid Use Disorder Reflect Sex-specific Vulnerabilities? A Study of Behavioral Health Comorbidities, Pain, and Quality of Life

OBJECTIVES

Studies suggest that men and women have different vulnerabilities to a number of substance use disorders (SUDs). We examined whether differences between women and men with opioid use disorder (OUD) are significantly different from those without OUD for selected sociodemographic and health outcomes.

METHODS

We used a cross-sectional survey design using data from 2012 to 2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III, which surveyed nationally representative samples of non-institutionalized adults (n = 36,309 unweighted). Past-year OUD and other behavioral co-morbidities were defined using DSM-5 criteria. In bivariate analyses, we investigated sex differences in socio-demographic factors, behavioral co-morbidities, pain, and health-related quality of life (HRQOL) between women and men with past-year OUD, and then those without past-year OUD. We further used logistic regression analyses to evaluate interactions between effect of sex and past-year OUD status on behavioral co-morbidities, pain, and HRQOL.

RESULTS

When extrapolated, about 2.1 million US adults met diagnostic criteria for past-year OUD. Women with OUD had a higher likelihood of having several past-year psychiatric disorders, and a lower likelihood of having any past-year SUDs compared to male counterparts. However, similar relationships were observed among those without OUD and significant interaction effects were not found on behavioral co-morbidities, pain, and HRQOL, indicating that general sex differences are not specific to OUD.

CONCLUSIONS

Although sex differences are not specific to OUD, concurrent disorders are not uncommon among women, as well as men, with OUD. There is a need to treat concurrent behavioral health conditions from a multimorbidity perspective in the treatment of OUD in both sexes.

Natural American Spirit Brand Preference among Smokers with Mental Illness

INTRODUCTION

Despite a steady decline in the US smoking prevalence over the past 50 years, Natural American Spirit cigarettes (NAS), marketed as ‘natural’ and ‘organic’, have seen a 400% rise in sales. In a sample of smokers with mental illness, based on previous research, we hypothesized that preference for NAS would be associated with younger age, higher education, and a stronger health-orientation.

METHODS

Adult smokers were interviewed during acute psychiatric hospitalization in California between 2009–2013, reporting their preferred top three brands of cigarettes, smoking behaviors, self-rated health, and dietary and physical activity behaviors. The sample (N=956; Mean age=38.7 years, SD=13.5; 48.7% women) identified as 14.5% Hispanic ethnicity, 49.6% White, 23.7% African American, and 23.8% other.

RESULTS

NAS was identified as a top preferred brand by 15.2% of the participants and was the fourth most popular brand for the sample overall. In a multivariate logistic regression, preference for NAS was significantly greater among participants who were younger (OR=0.97), had some college education or more (OR=2.64 to 4.31), ate a low-fat diet (OR=1.56) and reported better overall health (OR=1.26), with p<0.05. Identifying as Hispanic (OR=1.80) or White (OR=3.00) also predicted NAS preference, p<0.05. NAS preference did not differ by gender or psychiatric diagnosis.

CONCLUSIONS

Study findings indicate greater NAS brand appeal among smokers living with mental illness who are younger, more highly educated, and have a stronger orientation to health, perhaps because they perceive NAS to be a ‘healthier’ cigarette to smoke. Marketing language that obscures the harms of smoking ought to be prohibited.

The effect of exercise as adjunctive treatment on quality of life for individuals with alcohol use disorders: a randomized controlled trial

Background

A physically active lifestyle contributes to the prevention of lifestyle diseases, promotion of physical health, and reduction of pain, among other benefits. Being physically active also promotes mental health for many individuals, in the form of improved mood, increased self-efficacy and reduced risk of depression. Alcohol-dependent individuals may experience a better quality of life when supplementing their treatment with physical exercise. This study aimed to evaluate the effect of exercise on Quality of Life among patients with alcohol use disorder in a large randomized controlled trial.

Methods

The study had three arms: Patients were allocated to (A) treatment as usual, (B) treatment as usual and supervised group exercise two days a week of one hour each, (C) treatment as usual and individual physical exercise minimum two days a week. Duration of the intervention was six months. Data on values of Quality of Life were collected at baseline (before treatment start and at time of enrollment in the study), and at follow-up (at six months after enrollment in the study) using the EQ-5D questionnaire and the EQ-VAS. The sample consisted of 117 consecutive patients, and the follow-up rate was 66.6%. Intention-to-treat analyses were conducted to evaluate the effect of exercise on quality of life.

Results

Although not statistically significant, a substantial portion of the participants in the individual exercise condition reported that they had no pain or discomfort (one of the five quality of life dimensions measured by EQ-5D questionnaire) compared to the controls at follow-up. No difference was found between the groups regarding the EQ-VAS.

Conclusion

The exercise intervention had no effect on quality of life for patients with alcohol use disorder, nor was quality of life improved across the total sample. More research in how to improve quality of life for patients with alcohol use disorder is needed.

Trial registration

ISRCTN74889852 (retrospectively registered, date: 16/05/2013).

Comparison of opioid use disorder among male veterans and non-veterans: Disorder rates, socio-demographics, co-morbidities, and quality of life

BACKGROUND AND OBJECTIVES

Amidst a surging national crisis of opioid use, concern has been expressed about its impact on veterans, but no study has presented a population-based comparison of opioid use disorder (OUD) among veterans and non-veterans. We analyzed national epidemiologic data to compare rates, correlates and impacts of the opioid crisis on male veterans and non-veterans.

METHODS

Restricted data from 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) were used to compare veteran and non-veteran men on rates of OUD, as well as correlates of OUD including socio-demographic characteristics, psychiatric and substance use co-morbidities, and reductions in health-related quality of life (HRQOL).

RESULTS

About 2.0% of veterans and 2.7% of non-veterans, estimated at 418,000 and 2.5 million men, respectively, met criteria for life-time OUD. In both groups, OUD was associated with younger age, lower income levels, and fewer years of education. OUD was associated minority race among veterans, but with non-Hispanic white race among non-veterans. Both veteran and non-veteran adults with OUD were at least five times more likely than their peers to have both psychiatric and substance use co-morbidities (p < .001) and they experienced strongly reduced HRQOL scores (Cohen's d = -.50 to -.93).

DISCUSSION AND CONCLUSION

Veterans and non-veterans experience similar risk of OUD, similar correlates and adverse HRQOL impacts suggesting that similar treatment approaches may be effective for both groups.

SCIENTIFIC SIGNIFICANCE

Our findings highlight comparable vulnerability of veterans to non-veterans in both the risk of OUD and adverse effects on HRQOL. (Am J Addict 2018;XX:1-9).

Relationship between Tobacco Use and Health-Related Quality of Life (HRQoL) among Clients in Substance Use Disorders Treatment

We examined relationships of smoking status and tobacco-related variables with health-related quality of life (HRQoL), a metric of disease burden, among clients in substance use disorders (SUDs) treatment. Participants (N = 2,068; 46.6% female) completed surveys reporting demographics, smoking status, and past-month days they experienced physical and/or mental health distress. Smokers (n = 1,596; 77.2% of sample) answered questions on tobacco-related variables. Multinomial regression models assessed relationships between tobacco-related variables (smoking status, nicotine dependence, menthol smoking, electronic-cigarette use, health concerns, and cost as reasons affecting reducing/quitting smoking, past and future quit attempts) with HRQol in four categories (good health, physical health distress, mental health distress, or both physical and mental health distress). Current smokers were more likely than former smokers to report frequent physical and mental health distress than good health (OR = 1.97, 95% CI = 1.16, 3.34), as were smokers with higher nicotine dependence (OR = 1.18, 95% CI = 1.03, 1.35). Smokers reporting both frequent physical and mental health distress were more sensitive to cigarettes' cost (OR = 1.56, 95% CI = 1.06, 2.29), and less likely to use e-cigarettes (OR = 0.59, 95% CI = 0.38, 0.94). Findings of poor HRQoL among nicotine-dependent smokers with additional SUDs strengthen the imperative to provide smoking cessation interventions in addictions treatment.