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Kehle-Forbes SM, Nelson D, Norman SB, Schnurr PP, Shea MT, Ackland PE, Meis L, Possemato K, Polusny MA, Oslin D, Hamblen JL, Galovski T, Kenny M, Babajide N, Hagedorn H. Comparative effectiveness of trauma-focused and non-trauma-focused psychotherapy for PTSD among veterans with comorbid substance use disorders: Protocol & rationale for a randomized clinical trial. Contemp Clin Trials 2022; 120:106876. [PMID: 35987487 DOI: 10.1016/j.cct.2022.106876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) is common and concurrent treatment is recommended. Relatively little is known about which evidence-based psychotherapies for PTSD are most effective for patients with varying substance use profiles. We aim to examine the comparative effectiveness of trauma-focused therapy (TFT) and non-trauma-focused therapy (NTFT) among Veterans with PTSD and SUD. TFT has been found to be effective among those with PTSD/SUD, though effects are smaller and rates of treatment non-completion are higher than in those without SUD. NTFTs suggested for the treatment of PTSD, such as Present Centered Therapy, (PCT) have not been examined among those with co-occurring SUD, despite lower rates of treatment dropout. We will also examine the comparative effectiveness of TFT and NTFT for patients with varying SUD severity, type of substances used, and patient treatment preference. METHOD 420 Veterans with PTSD and SUD will be randomized in a prospective, pragmatic comparative effectiveness trial at 14 Veterans Health Administration facilities. Participants will receive either TFT (Prolonged Exposure or Cognitive Processing Therapy) or NTFT (PCT) after enrolling in concurrent SUD treatment-as-usual. Assessments will occur at baseline, posttreatment, 3- and 6 -months posttreatment. Main outcomes are PTSD symptom severity and PTSD treatment dropout. Clinician, patient, and leadership stakeholder panels advise study activities, and a process evaluation will identify strategies to enhance the implementation of evidence-based PTSD treatments in SUD care settings. CONCLUSIONS Results will provide critical information to guide clinicians when recommending PTSD treatments to patients with comorbid SUD. CLINICALTRIALS gov Identifier: NCT04581434.
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Affiliation(s)
- Shannon M Kehle-Forbes
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, United States of America; Women's Health Sciences Division at VA Boston, National Center for PTSD, 150 S. Huntington Ave, Boston, MA 02130, United States of America; Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, United States of America.
| | - David Nelson
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, United States of America; Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, United States of America
| | - Sonya B Norman
- National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, University of California San Diego, 3350 La Jolla Village Drive, La Jolla, CA 92161, United States of America
| | - Paula P Schnurr
- National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH 03577, United States of America
| | - M Tracie Shea
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, United States of America
| | - Princess E Ackland
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, United States of America; Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, United States of America
| | - Laura Meis
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, United States of America; Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, United States of America
| | - Kyle Possemato
- VA Center for Integrated Healthcare, 800 Irving Avenue, Syracuse, NY 13204, United States of America
| | - Melissa A Polusny
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, United States of America; Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417, United States of America; Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, 2312 South 6(th) Street, Minneapolis, MN 55454, United States of America
| | - David Oslin
- VISN 4 MIRECC, Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, United States of America; Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 1 191049, United States of America
| | - Jessica L Hamblen
- National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, United States of America; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH 03577, United States of America
| | - Tara Galovski
- Women's Health Sciences Division at VA Boston, National Center for PTSD, 150 S. Huntington Ave, Boston, MA 02130, United States of America; Department of Psychiatry, Boston University, Boston, MA 02118, United States of America
| | - Marie Kenny
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, United States of America
| | - Nofisat Babajide
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, United States of America
| | - Hildi Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417, United States of America; Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, 2312 South 6(th) Street, Minneapolis, MN 55454, United States of America
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McCabe CT, Watrous JR, Galarneau MR. Health Behaviors Among Service Members Injured on Deployment: A Study From the Wounded Warrior Recovery Project. Mil Med 2021; 186:67-74. [PMID: 33005930 DOI: 10.1093/milmed/usaa242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/06/2020] [Accepted: 08/03/2020] [Indexed: 01/12/2023] Open
Abstract
ABSTRACT
Introduction
Service members (SMs) who are injured on deployment are at risk for myriad long-term health problems that may be ancillary to their physical injury, including high rates of depression and posttraumatic stress disorder, and poor health behaviors (e.g., problem drinking, cigarette and tobacco use, poor sleep quality, and sedentary lifestyle). As the specific health behaviors injured SMs engage in have been largely ignored, the primary aim of this study was to compare health behavior patterns among those with and without mental health problems in a large, representative sample of SMs injured on combat deployment.
Materials and Methods
Participants (N = 3,303) completed behavioral health assessments between September 2018 and April 2019 as part of the Wounded Warrior Recovery Project. Multivariate linear regressions and binary logistic regressions were used to evaluate differences between mental health screening status and health behavior outcomes, adjusting for injury severity, age, and years since injury.
Results
Overall, about half of participants screened positive for posttraumatic stress disorder and/or depression (49%). Participants reported high rates of alcohol use and problems, cigarette and tobacco use, inadequate sleep and poor sleep quality, and low levels of physical activity. With the exception of number of drinking days and likelihood of current tobacco use, participants who screened positive for a mental health disorder evidenced significantly worse health behavior outcomes.
Conclusions
The results provide a preliminary glance into the mental health and health behaviors of SMs roughly a decade after injury, and underscore the importance of examining the interplay between mental, physical, and behavioral health outcomes among wounded warriors to promote health and wellness.
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Affiliation(s)
- Cameron T McCabe
- Operational Readiness Directorate, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, San Diego, CA 92106, USA
| | - Jessica R Watrous
- Operational Readiness Directorate, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, San Diego, CA 92106, USA
| | - Michael R Galarneau
- Operational Readiness Directorate, Naval Health Research Center, San Diego, CA 92106, USA
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3
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Robjant K, Schmitt S, Chibashimba A, Carleial S, Elbert T, Koebach A. Trauma, Aggression, and Post Conflict Perpetration of Community Violence in Female Former Child Soldiers-A Study in Eastern DR Congo. Front Psychiatry 2020; 11:533357. [PMID: 33132929 PMCID: PMC7574907 DOI: 10.3389/fpsyt.2020.533357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Former combatants are exposed to multiple traumatic stressors during conflict situations and usually participate in perpetration of violence. Ongoing perpetration of violence in post conflict areas, linked to mental health problems and appetitive aggression, destabilises peace keeping efforts. The aim of this study is to investigate lifetime exposure to violence and the relationship between this exposure and mental health and current violent behaviour in a sample of female former child soldiers with a history of perpetration of violence in Eastern DR Congo. METHODS 98 female former child soldiers who had been abducted and forcibly recruited during the M23 insurgency (2012-2014) were assessed for lifetime exposure to trauma including perpetration of violence, clinical outcomes (PTSD and appetitive aggression), and current violent behaviour. RESULTS Female former child soldiers had been exposed to extremely high levels of trauma including perpetration of violence and presented with high levels of mental health problems. Linear regression models showed that current violent behaviour was predicted by both PTSD and appetitive aggression. CONCLUSIONS Trauma exposure predicts ongoing perpetration of violence post conflict via the resulting mental health problems. The findings imply that if PTSD and appetitive aggression symptoms are successfully treated, ongoing violent behaviour in the community post conflict will also decrease.
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Affiliation(s)
- Katy Robjant
- Department of Psychology, University of Konstanz, Konstanz, Germany
- vivo international e.V., Konstanz, Germany
| | - Sabine Schmitt
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Amani Chibashimba
- Department of Psychology, University of Konstanz, Konstanz, Germany
- vivo international e.V., Konstanz, Germany
| | - Samuel Carleial
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
- vivo international e.V., Konstanz, Germany
| | - Anke Koebach
- Department of Psychology, University of Konstanz, Konstanz, Germany
- vivo international e.V., Konstanz, Germany
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O'Toole BI, Gorman P, Catts SV. Military Combat, Posttraumatic Stress Disorder, and the Course of Alcohol Use Disorders in a Cohort of Australian Vietnam War Veterans. J Trauma Stress 2020; 33:709-719. [PMID: 32939901 DOI: 10.1002/jts.22588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 01/19/2023]
Abstract
The present study examined the course of diagnosed alcohol use disorders (AUDs) in a cohort of Australian veterans of the Vietnam War (N = 388) who were assessed 22 and 36 years after returning home. Standardized interviews provided data on AUDs, posttraumatic stress disorder (PTSD), other psychiatric diagnoses, and combat exposure. Overall, 148 veterans (38.1%) had no history of alcohol-related diagnoses, 151 veterans (38.9%) had a past AUD diagnosis that was not current at the second assessment point, and 89 veterans (22.9%) had a current AUD diagnosis at the second assessment. Less education, lower intelligence test scores, and misconduct were individual risk factors for AUDs, as were first-interview diagnoses of PTSD, antisocial personality disorder, generalized anxiety, and dysthymia, but not depression; these variables were all nonsignificant after controlling for combat exposure and PTSD. Multinomial regression was used to assess the relative contributions of combat exposure and PTSD to the course of AUDs. Combat exposure and PTSD had different patterns of association with AUDs whereby combat exposure, but not PTSD, was associated with a history of AUDs, odds ratio (OR) = 1.02, but not with current AUDs, whereas PTSD, but not combat exposure, was associated with current AUDs, OR = 3.37. Current numbing and avoidance symptoms were associated with current AUDs, OR = 4.48. The results do not support a mutual maintenance model of PTSD and AUDs but are consistent with a self-medication model, which suggests treatment for PTSD may have beneficial effects on AUDs.
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Affiliation(s)
- Brian I O'Toole
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Patrick Gorman
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Stanley V Catts
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Department of Psychiatry, University of Queensland, Brisbane, Australia
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5
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Mahoney CT, Iverson KM. The Roles of Alcohol Use Severity and Posttraumatic Stress Disorder Symptoms as Risk Factors for Women's Intimate Partner Violence Experiences. J Womens Health (Larchmt) 2020; 29:827-836. [PMID: 31905315 PMCID: PMC7307688 DOI: 10.1089/jwh.2019.7944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: To reduce women's risk for intimate partner violence (IPV), it is critical to elucidate malleable psychiatric and behavioral health risk factors. We aimed to identify if alcohol use problems moderate the associations between posttraumatic stress disorder (PTSD) symptoms and past-year IPV victimization experiences among female veterans, a population at high risk for IPV. Methods: Female veterans (N = 198) completed mail surveys assessing PTSD symptoms, alcohol use, and IPV at two time points between 2012 and 2013. Regression analyses were used to examine the associations between PTSD symptoms and alcohol use at Time 1 with past-year IPV at Time 2. Results: More than a third of women (36.9%) reported past-year IPV. Alcohol use severity significantly moderated the association between PTSD symptoms and past-year physical IPV. Specifically, there was a significant positive association between PTSD symptoms and past-year IPV at high levels of alcohol use severity, but not at low or average levels of alcohol use. Although both PTSD symptoms and alcohol use were independent risk factors for past-year sexual and psychological IPV, no moderating effect was found for these IPV types. Conclusions: Findings can inform tailored IPV, psychiatric, and behavioral health screening and counseling. Such practices may reduce psychiatric distress and IPV risk.
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Affiliation(s)
- Colin T. Mahoney
- Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
| | - Katherine M. Iverson
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
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6
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Poznanski P, Lesniak A, Korostynski M, Sacharczuk M. Ethanol consumption following mild traumatic brain injury is related to blood-brain barrier permeability. Addict Biol 2020; 25:e12683. [PMID: 30334599 DOI: 10.1111/adb.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022]
Abstract
Several preclinical and clinical studies that deal with the neuropathological consequences of mild traumatic brain injury (mTBI) have focused on unraveling its effect on ethanol drinking behavior. Previous reports describe changes in ethanol consumption, both in animal models of mTBI as well as in patients, after concussive brain injury. However, the neurobiological mechanisms underlying this phenomenon are still poorly understood. In the present study, we used a unique model of mouse lines divergently selected for high (HA) or low (LA) swim stress-induced analgesia to examine the effect of mTBI on ethanol drinking behavior. In comparison with LA mice, their HA counterparts exhibited increased blood-brain barrier (BBB) permeability, lower basal alcohol preference, and lower level of stress-induced ethanol intake. Here, we showed that mTBI attenuates voluntary ethanol intake in LA, but not in HA mice. Interestingly, BBB disruption after mannitol infusion also decreases the level of ethanol drinking behavior in this line. We conclude that in alcohol-preferring LA mice, BBB disruption as a consequence of mTBI attenuates ethanol consumption. Our results suggest that the innate level of BBB integrity plays a pivotal role in regulation of ethanol consumption in mice showing differential endogenous opioid system activity.
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Affiliation(s)
- Piotr Poznanski
- Laboratory of NeurogenomicsInstitute of Genetics and Animal Breeding, Polish Academy of Sciences Magdalenka Poland
| | - Anna Lesniak
- Department of Pharmacodynamics, Centre for Preclinical Research and TechnologyMedical University of Warsaw Warsaw Poland
| | - Michal Korostynski
- Department of Molecular NeuropharmacologyInstitute of Pharmacology Krakow Poland
| | - Mariusz Sacharczuk
- Laboratory of NeurogenomicsInstitute of Genetics and Animal Breeding, Polish Academy of Sciences Magdalenka Poland
- Department of Pharmacodynamics, Centre for Preclinical Research and TechnologyMedical University of Warsaw Warsaw Poland
- Department of Internal Medicine, Hypertension and Vascular DiseasesMedical University of Warsaw Warsaw Poland
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7
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London AS, Wilmoth JM, Oliver WJ, Hausauer JA. The Influence of Military Service Experiences on Current and Daily Drinking. Subst Use Misuse 2020; 55:1288-1299. [PMID: 32167849 DOI: 10.1080/10826084.2020.1735438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: An extensive public health literature associates military service with increased alcohol consumption and problematic drinking. However, few well-controlled population-based studies compare alcohol use among nonveterans and veterans with diverse military service experiences, and no such study examines everyday drinking. Methods: We use population-representative data from the 2010 and 2011 Behavioral Risk Factor Surveillance System and distinguish four groups of men: nonveterans; non-combat veterans without a psychiatric disorder (PD) or traumatic brain injury (TBI); combat veterans without a PD or TBI; and veterans (non-combat and combat combined) with a PD and/or TBI. We estimate hierarchical multivariate logistic regression models of current drinking (N = 21,947) and daily drinking (among current drinkers; N = 11,491). Results from supplemental analyses are discussed. Results: Relative to nonveterans, non-combat veterans with no PD or TBI and veterans with a PD and/or TBI, respectively, but not combat veterans with no PD or TBI, are more likely to be current drinkers. Among current drinkers, non-combat and combat veterans with no PD or TBI, respectively, are less likely than nonveterans to be daily drinkers. Conversely, among current drinkers, veterans with a PD and/or TBI are more likely to be daily drinkers than nonveterans, non-combat veterans with no PD or TBI, and combat veterans with no PD or TBI. Conclusion: We document heterogeneous and countervailing influences of military service experiences on current and daily drinking. Results indicate that harmful military service experience may be associated with an increased risk of current, moderate daily drinking, which may represent a form of self-medication.
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Affiliation(s)
- Andrew S London
- Aging Studies Institute, Syracuse University, Syracuse, NY, USA
| | - Janet M Wilmoth
- Aging Studies Institute, Syracuse University, Syracuse, NY, USA
| | - William J Oliver
- Department of Sociology, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
| | - Jessica A Hausauer
- Department of Sociology, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
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8
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Posttraumatic Stress Disorder Symptom Association With Subsequent Risky and Problem Drinking Initiation. J Addict Med 2019; 12:353-362. [PMID: 29870423 DOI: 10.1097/adm.0000000000000420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) and unhealthy alcohol use are commonly associated conditions. It is unknown whether specific symptoms of PTSD are associated with subsequent initiation of unhealthy alcohol use. METHODS Data from the first 3 enrollment panels (n = 151,567) of the longitudinal Millennium Cohort Study of military personnel were analyzed (2001-2012). Complementary log-log models were fit to estimate whether specific PTSD symptoms and symptom clusters were associated with subsequent initiation of 2 domains of unhealthy alcohol use: risky and problem drinking (experience of 1 or more alcohol-related consequences). Models were adjusted for other PTSD symptoms and demographic, service, and health-related characteristics. RESULTS Eligible study populations included those without risky (n = 31,026) and problem drinking (n = 67,087) at baseline. In adjusted analyses, only 1 PTSD symptom-irritability/anger-was associated with subsequent increased initiation of risky drinking (relative risk [RR] 1.05, 95% confidence interval [CI] 1.00-1.09) at least 3 years later. Two symptom clusters (dysphoric arousal [RR 1.17, 95% CI 1.11-1.23] and emotional numbing [RR 1.30, 95% CI 1.22-1.40]) and 5 symptoms (restricted affect [RR 1.13, 95% CI 1.08-1.19], sense of foreshortened future [RR 1.12, 95% CI 1.06-1.18], exaggerated startle response [RR 1.07, 95% CI 1.01-1.13], sleep disturbance [RR 1.11, 95% CI 1.07-1.15], and irritability/anger [RR 1.12, 95% CI 1.07-1.17]) were associated with subsequent initiation of problem drinking. CONCLUSIONS Findings suggest that specific PTSD symptoms and symptom clusters are associated with subsequent initiation of unhealthy alcohol use.
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Tran BR, Glass N, Tripathi O, Kalombo O, Ibata P, Mpassi RB. Alcohol use and its association with sexual risk behaviors in the Armed Forces of the Republic of the Congo. PLoS One 2019; 14:e0223322. [PMID: 31577815 PMCID: PMC6774508 DOI: 10.1371/journal.pone.0223322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/18/2019] [Indexed: 11/18/2022] Open
Abstract
Background Previous research has shown alcohol misuse amplifies the risk of acquiring sexually transmitted infections [STIs], including HIV, by increasing high risk sexual behaviors. Military populations are particularly vulnerable to both alcohol misuse and STIs due to the unique conditions of military service. This study estimated the prevalence of probable hazardous and harmful alcohol use and examined associations with transactional sex, sex with a sex worker, and multiple sexual partners among military personnel in the Armed Forces of the Republic of the Congo (FAC). Methods A secondary analysis of data collected from a 2014 seroprevalence and behavioral epidemiology risk survey was performed. Participants included 703 active duty male service members 18 years of age or older who reported ever having sex. Patterns of harmful and hazardous drinking were measured with the Alcohol Use Disorders Identification Test (AUDIT). Participants with an AUDIT score ≥ 8 (indicative of probable hazardous and harmful alcohol use, and possible alcohol dependence) were compared to those with an AUDIT score ≤ 7. Results A total of 15.8% received a score of 8 or higher on the AUDIT. These participants were more likely to be lower educated and of lower military rank. In separate multivariable models, an AUDIT score ≥ 8 was significantly associated with higher odds of sex with a commercial sex worker and having multiple sexual partners. Conclusions Study results emphasize the need to address patterns of harmful and hazardous alcohol use in the FAC and integrate alcohol misuse education into the HIV prevention program. The development of military-specific interventions to reduce alcohol-related risky sexual behaviors are also needed. Lastly, implementing policies such as restricting alcohol availability and sales on military bases, and adding warning labels to advertisements and containers may provide a more comprehensive response to reduce problematic alcohol use.
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Affiliation(s)
- Bonnie Robin Tran
- Department of Defense HIV/AIDS Prevention Program, San Diego, California, United States of America
- Leidos Inc., Reston, Virginia, United States of America
- * E-mail:
| | - Nicole Glass
- Department of Defense HIV/AIDS Prevention Program, San Diego, California, United States of America
- Leidos Inc., Reston, Virginia, United States of America
| | - Osika Tripathi
- Department of Defense HIV/AIDS Prevention Program, San Diego, California, United States of America
- Leidos Inc., Reston, Virginia, United States of America
| | | | - Pascal Ibata
- Armed Forces of the Republic of the Congo, Brazzaville, Republic of the Congo
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Simpson TL, Rise P, Browne KC, Lehavot K, Kaysen D. Clinical presentations, social functioning, and treatment receipt among individuals with comorbid life-time PTSD and alcohol use disorders versus drug use disorders: findings from NESARC-III. Addiction 2019; 114:983-993. [PMID: 30694592 PMCID: PMC6719550 DOI: 10.1111/add.14565] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/18/2018] [Accepted: 01/23/2019] [Indexed: 12/22/2022]
Abstract
AIMS To compare individuals with comorbid life-time post-traumatic stress disorder (PTSD) and alcohol use disorders [AUD; i.e. no drug use disorders (DUD)] with those with comorbid PTSD and DUD on past-year prevalence of these disorders, social functioning, life-time psychiatric comorbidities, and treatment receipt. The comorbid groups were also compared with their single diagnosis counterparts. DESIGN AND SETTING Cross-sectional cohort study using data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC-III). PARTICIPANTS The total sample size was 36 309. Six groups were established: PTSD/AUD, PTSD/DUD, AUD, DUD, PTSD, and neither PTSD nor AUD/DUD. Life-time prevalence of AUD among those with PTSD/DUD was 80.2% and among those with DUD was 73.8%. MEASUREMENTS The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 version assessed life-time and past-year psychiatric disorders and treatment receipt. Demographics and social stability indicators were queried. Group characteristics were summarized using weighted means. Prevalences and estimates for adjusted differences in means and adjusted odds ratios (aORs) were derived from multiple linear regression and logistic regression models, respectively. Analyses were conducted in R and accounted for the NESARC-III's complex survey design, clustering, and non-response. FINDINGS Compared with those with life-time PTSD/AUD, those with life-time PTSD/DUD were significantly less likely to have neither disorder in the past year (PTSD/AUD = 16.1%; PTSD/DUD = 8.5%; aOR = 0.54), and were more likely to report worse social and psychiatric functioning, and to have received both addiction and mental health treatment (PTSD/AUD = 18.4%; PTSD/DUD = 43.2%; aOR = 3.88). Compared with their single disorder counterparts, those with PTSD/DUD reported greater impairment than both groups, whereas the comorbid PTSD/AUD group differed more from the AUD than the PTSD group. CONCLUSIONS People with comorbid PTSD and drug use disorder have greater social and psychiatric impairment and may require different types and intensity of intervention than people with comorbid post-traumatic stress disorder and alcohol use disorder.
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Affiliation(s)
- Tracy L. Simpson
- Center of Excellence in Substance Abuse and Treatment (CESATE), VA Puget Sound Health Care System, Seattle, WA, USA,,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Peter Rise
- Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Kendall C. Browne
- Center of Excellence in Substance Abuse and Treatment (CESATE), VA Puget Sound Health Care System, Seattle, WA, USA,,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA,,Center of Excellence in Substance Abuse and Treatment (CESATE), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Keren Lehavot
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA,,Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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11
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Shaffer SE, Shaffer KJ, Perryman KD, Patterson JK, Hartos JL. Does Mental Health Differ by Alcohol Use in Elderly Male Veterans? Gerontol Geriatr Med 2019; 5:2333721419837803. [PMID: 30993150 PMCID: PMC6449810 DOI: 10.1177/2333721419837803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction: With limited research for mental health and alcohol use among veterans in the general population and none for elderly male veterans only, the purpose is to assess whether mental health differs by alcohol use in elderly male veterans in the general population. Method: This cross-sectional analysis uses 2017 Behavioral Risk Factor Surveillance System data for male veterans aged 65 and older in general population samples from Florida (n = 1,700), Maryland (n = 1,060), New York (n = 552), and Washington (n = 1,031). Multiple logistic regression by state assessed the relationship between mental health and alcohol use, after controlling for health-related, demographic, and socioeconomic factors. Results: Across states, most participants reported good mental health (80%-84%) and more than half reported drinking (53%-63%). Adjusted results indicated that mental health did not differ by alcohol use in any state; however, it was related to physical health and activity limitations across states. Conclusion: Overall, alcohol use was not related to mental health in elderly male veterans in the general population; however, physical health status and activity limitations were. Practitioners should always screen for alcohol use and should automatically screen for mental health, physical health, and activity limitations when symptoms present for any and assess concurrent treatment and management strategies.
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Affiliation(s)
- Sarah E. Shaffer
- University of North Texas Health Science
Center, Fort Worth, USA
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12
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Gass JC, Morris DH, Winters J, VanderVeen JW, Chermack S. Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic. J Subst Abuse Treat 2018; 84:1-8. [PMID: 29195588 DOI: 10.1016/j.jsat.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking. One rationale is that patients may not be motivated to quit smoking. In the current study, data from veterans enrolled in outpatient treatment for a SUD were examined to assess for general characteristics of smokers as compared to non-smokers as well as to examine motivation to quit smoking. Baseline (i.e., pre-treatment) data from 277 Veterans were used. Charts of smokers in the SUD clinic (SUDC) were reviewed to assess how smoking is handled by SUDC providers, and if smokers attempt cessation. Of 277, 163 (59%) SUDC patients reported that they currently smoke cigarettes (M=16.3 cigarettes per day, SD=11.1). Smokers in the clinic reported greater general impairment than nonsmokers on the Short Index of Problems, F(1248)=8.9, p=0.003, as well as greater specific impairment: Physical Problems, F(1258)=13.5, p=0.000; Interpersonal Problems, F(1262)=5.6, p=0.019; Intrapersonal Problems, F(1260)=6.5, p=0.011, and Social Responsibility, F(1262)=14.7, p=0.000. Smokers in the sample were marginally more anxious than their non-smoking counterparts as measured by the GAD-7, F(1254)=4.6, p=0.053, though they were not significantly more depressed (p=0.19). On a 1-10 scale, smokers reported moderate levels of importance (M=5.4, SD=3.1), readiness (M=5.6, SD=3.2), and confidence (M=5.0, SD=3.0) regarding quitting smoking. Review of smokers' medical records reveal that while SUDC providers assess tobacco use at intake (90%) and offer treatment (86.5%), a substantially small portion of smokers attempt cessation (41.1%) while enrolled in SUDC. Moreover, no patients were enrolled in smoking-specific behavioral interventions while in SUDC, though 78 patients did obtain nicotine replacement or another smoking cessation medication (41% were prescribed by a SUDC provider). Contrary to the belief that treatment-seeking substance users are not motivated to quit smoking, these preliminary analyses demonstrate that Veterans were at least contemplating quitting smoking while they were enrolled in substance use treatment. Further, there is evidence that cigarette smokers have greater impairment caused by substance use, suggesting that this subgroup is of particular high need. Specific treatment recommendations are discussed, including how behavioral health providers in SUD clinics may be better able to capitalize on patients' moderate motivation to quit at intake.
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Affiliation(s)
- Julie C Gass
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States.
| | - David H Morris
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jamie Winters
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Joseph W VanderVeen
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Stephen Chermack
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
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Cadigan JM, Klanecky AK, Martens MP. An examination of alcohol risk profiles and co-occurring mental health symptoms among OEF/OIF veterans. Addict Behav 2017; 70:54-60. [PMID: 28214434 DOI: 10.1016/j.addbeh.2017.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Compared to the general population, veterans of the wars in Afghanistan and Iraq (OEF/OIF) are more likely to engage in hazardous alcohol use and meet criteria for mental health disorders including Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder. Less is known how distinct profiles of alcohol use behavior relate to mental health symptoms. METHOD The current study examined the extent that indicators of alcohol use (i.e., drinks per week, peak blood alcohol concentration, and alcohol-related problems) are categorized into different alcohol risk profiles utilizing a person-centered approach. We also examined how mental health symptoms (i.e., PTSD, depression, and anxiety-related symptoms) were associated with the alcohol risk profiles. Participants were 252 Veterans who reported consuming alcohol within the past month. RESULTS Latent profile analysis indicated a four-class solution yielded the best-fitting model, and profiles were named based on their respective levels and patterns of alcohol use. Mental health symptoms were significantly different among the four profiles. Profiles of veterans who endorsed more alcohol-related problems (i.e., the "Severe alcohol behavior" and "Steady drinkers with functional impairment") also reported comorbid clinical symptoms of PTSD, depression, and anxiety. The "Binge drinkers with no functional impairment" and "Mild alcohol behavior" profiles reported the lowest levels of mental health symptoms. DISCUSSION Findings highlight the unique relationship between distinct alcohol risk profiles and mental health outcomes. Targeted interventions and treatment options based on unique alcohol risk profiles may be helpful in tailoring prevention and intervention efforts in detecting co-occurring mental health symptoms among OEF/OIF veterans.
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Köbach A, Schaal S, Hecker T, Elbert T. Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat-related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage. Clin Psychol Psychother 2017; 24:807-825. [PMID: 26676201 PMCID: PMC5573918 DOI: 10.1002/cpp.1986] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 08/10/2015] [Accepted: 09/21/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depending on the exposure to traumatic stressors and combat, 20% to 50% of ex-combatants present with trauma-related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma-related suffering and the lowered threshold for aggressive behaviour. OBJECTIVE Supporting the demobilization process of ex-combatants in the eastern DR-Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET). METHOD In two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3-week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment-as-usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success. RESULTS Six months post-intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months. CONCLUSIONS Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd. KEY PRACTITIONER MESSAGE Posttraumatic stress symptoms, depression and clinically relevant levels of drug dependence can effectively be reduced with a version of Narrative Exposure Therapy (NET) adapted for Forensic Offender Rehabilitation (FORNET). The intervention is effective in the context of ongoing conflict. Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET. It is possible to pass down psychotherapeutic techniques like FORNET over generations of counsellors. Psychotherapeutic interventions like FORNET may facilitate the transition to peace in war-torn regions.
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Affiliation(s)
- Anke Köbach
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- vivo internationalKonstanzGermany
| | - Susanne Schaal
- vivo internationalKonstanzGermany
- Department of PsychologyUniversity of UlmUlmGermany
| | - Tobias Hecker
- vivo internationalKonstanzGermany
- Department of PsychologyUniversity of ZürichZürichSwitzerland
| | - Thomas Elbert
- Department of PsychologyUniversity of KonstanzKonstanzGermany
- vivo internationalKonstanzGermany
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Buzzetta M, Hayden SCW, Ledwith K. Creating hope: Assisting Veterans with Job Search Strategies using Cognitive Information Processing Theory. JOURNAL OF EMPLOYMENT COUNSELING 2017. [DOI: 10.1002/joec.12054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Kehle-Forbes SM, Drapkin ML, Foa EB, Koffel E, Lynch KG, Polusny MA, Van Horn DHA, Yusko DA, Charlesworth M, Blasco M, Oslin DW. Study design, interventions, and baseline characteristics for the Substance use and TRauma Intervention for VEterans (STRIVE) trial. Contemp Clin Trials 2016; 50:45-53. [PMID: 27444425 PMCID: PMC9873310 DOI: 10.1016/j.cct.2016.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/09/2016] [Accepted: 07/17/2016] [Indexed: 01/26/2023]
Abstract
While comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is common among veterans, there is debate regarding how to best treat individuals suffering from both conditions. Despite data supporting the effectiveness of integrated treatments that simultaneously address both disorders, due to concerns that an early focus on trauma may increase dropout and reduce the likelihood of achieving SUD-related goals, providers continue to prefer a sequential approach, where the addiction is treated first and PTSD treatment is instituted following sustained abstinence or reduced use. This project is designed to directly examine these provider concerns by evaluating the benefits and harms of an integrated versus a sequential approach to treating comorbid PTSD and SUD. This paper reviews the study's methodology, treatment approaches, and baseline participant characteristics. In this randomized clinical trial, one hundred eighty-three veterans with co-occurring PTSD and SUD have been randomized to one of two psychotherapies that include the same treatment components for SUD and PTSD (Motivational Enhancement Therapy and Prolonged Exposure respectively), but differ by whether the components are delivered sequentially or are integrated such that PTSD and SUD symptoms are addressed concurrently. We hypothesize that veterans assigned to integrated treatment will show greater improvement in PTSD and SUD symptoms than veterans assigned to sequential treatment. If this hypothesis is supported, the findings have the potential to change clinicians' beliefs and challenge long-standing practice patterns that require participation in SUD treatment prior to initiating trauma-focused therapies for PTSD.
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Affiliation(s)
- Shannon M Kehle-Forbes
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA 02130, United States; Minneapolis VA Healthcare System, Minneapolis, MN 55417, United States; Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States.
| | - Michelle L Drapkin
- Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, United States; Mental Illness Research, Education, and Clinical Center, at the Corporal Michael J. Crescenz VA Medical Center, and Center of Excellence for Substance Abuse Treatment and Evaluation, Philadelphia, PA 19104, United States
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Erin Koffel
- Minneapolis VA Healthcare System, Minneapolis, MN 55417, United States; Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, United States
| | - Kevin G Lynch
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Melissa A Polusny
- Minneapolis VA Healthcare System, Minneapolis, MN 55417, United States; Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, United States
| | - Deborah H A Van Horn
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - David A Yusko
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | | | - Molly Blasco
- Mental Illness Research, Education, and Clinical Center, at the Corporal Michael J. Crescenz VA Medical Center, and Center of Excellence for Substance Abuse Treatment and Evaluation, Philadelphia, PA 19104, United States
| | - David W Oslin
- Mental Illness Research, Education, and Clinical Center, at the Corporal Michael J. Crescenz VA Medical Center, and Center of Excellence for Substance Abuse Treatment and Evaluation, Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
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Gilmore AK, Brignone E, Painter JM, Lehavot K, Fargo J, Suo Y, Simpson T, Carter ME, Blais RK, Gundlapalli AV. Military Sexual Trauma and Co-occurring Posttraumatic Stress Disorder, Depressive Disorders, and Substance Use Disorders among Returning Afghanistan and Iraq Veterans. Womens Health Issues 2016; 26:546-54. [PMID: 27528358 DOI: 10.1016/j.whi.2016.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 06/23/2016] [Accepted: 06/29/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Posttraumatic stress disorder (PTSD), depressive disorders (DD), and substance use disorders (SUD) are prevalent among veterans. A positive military sexual trauma (MST) screen is associated with higher likelihood of each of these disorders. The current study examined the associations between MST, gender, and co-occurring PTSD, DD, and SUD among veterans receiving services at the Department of Veterans Affairs to inform assessment and treatment. We were specifically interested in the interactions between MST and gender on co-occurring disorders. METHODS The sample included 494,822 Department of Veterans Affairs service-seeking veterans (12.5% women) deployed to Iraq and Afghanistan who recently separated from the military and were screened for MST between 2004 and 2013. MAIN FINDINGS Veterans with positive MST screens had higher odds than those with negative screens of individual and co-occurring PTSD, DD, and SUD. The association between positive MST screens and diagnostic outcomes, including PTSD, was stronger for women than for men, and the association between positive MST screens and some diagnostic outcomes, including DD, was stronger for men than for women. CONCLUSIONS These results highlight the importance of assessing for and recognizing the potential MST and gender interactions in the clinical context among veterans with co-occurring PTSD, DD, and/or SUD.
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Affiliation(s)
- Amanda K Gilmore
- Department of Psychiatry, National Crime Victims Research & Treatment Center, Medical University of South Carolina, Charleston, South Carolina; VA Puget Sound Health Care System, Seattle Division, Seattle, Washington.
| | - Emily Brignone
- Department of Psychology, Utah State University, Logan, Utah; VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Janelle M Painter
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
| | - Keren Lehavot
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
| | - Jamison Fargo
- Department of Psychology, Utah State University, Logan, Utah; VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Ying Suo
- VA Salt Lake City Health Care System, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Tracy Simpson
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
| | | | - Rebecca K Blais
- Department of Psychology, Utah State University, Logan, Utah
| | - Adi V Gundlapalli
- VA Salt Lake City Health Care System, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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Vazan P, Golub A, Bennett AS. PTSD, Depression, Daily Stressors, and Treatment Pathways Among Urban Veterans. MILITARY BEHAVIORAL HEALTH 2015; 3:108-115. [PMID: 26052475 PMCID: PMC4452201 DOI: 10.1080/21635781.2014.995255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many veterans face various mental health challenges after separation. This study examines change over 14 months in mental health and related factors among 242 veterans returning to low-income predominately minority sections of New York City. Mental health treatment provided more than reductions in symptoms of PTSD and depression. It also resulted in reductions in substance use disorders and daily stresses. However, many veterans not in treatment are experiencing combat-related concerns at subsyndromal levels. The findings highlight the need for low threshold community-based outreach programs for this population.
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Affiliation(s)
- Peter Vazan
- National Development and Research Institutes, Inc., New York
| | - Andrew Golub
- National Development and Research Institutes, Inc., Burlington
| | - Alex S Bennett
- National Development and Research Institutes, Inc., New York
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Yoon G, Petrakis IL, Rosenheck RA. Correlates of major depressive disorder with and without comorbid alcohol use disorder nationally in the veterans health administration. Am J Addict 2015; 24:419-26. [PMID: 25950244 DOI: 10.1111/ajad.12219] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/15/2015] [Accepted: 03/21/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study assesses medical and psychiatric comorbidities, service utilization, and psychotropic medication prescriptions in veterans with comorbid major depressive disorder (MDD) and alcohol use disorder (AUD) relative to veterans with MDD alone. METHODS Using cross-sectional administrative data (fiscal year [FY]2012: October 1, 2011-September 30, 2012) from the Veterans Health Administration (VHA), we identified veterans with a diagnosis of current (12-month) MDD nationally (N = 309,374), 18.8% of whom were also diagnosed with current (12-month) AUD. Veterans with both MDD and AUD were compared to those with MDD alone on sociodemographic characteristics, current (12-month) medical and psychiatric disorders, service utilization, and psychotropic prescriptions. We then used logistic regression analyses to calculate odds ratio and 95% confidence interval of characteristics that were independently different between the groups. RESULTS Dually diagnosed veterans with MDD and AUD, relative to veterans with MDD alone, had a greater number of comorbid health conditions, such as liver disease, drug use disorders, and bipolar disorder as well as greater likelihood of homelessness and higher service utilization. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Dually diagnosed veterans with MDD and AUD had more frequent medical and psychiatric comorbidities and more frequently had been homeless. These data suggest the importance of assessing the presence of comorbid medical/psychiatric disorders and potential homelessness in order to provide appropriately comprehensive treatment to dually diagnosed veterans with MDD and AUD and indicate a need to develop more effective treatments for combined disorders.
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Affiliation(s)
- Gihyun Yoon
- VA New England Mental Illness, Research, Education, and Clinical Center, West Haven, Connecticut.,VA Connecticut Healthcare System, Yale University School of Medicine, West Haven, Connecticut
| | - Ismene L Petrakis
- VA New England Mental Illness, Research, Education, and Clinical Center, West Haven, Connecticut.,VA Connecticut Healthcare System, Yale University School of Medicine, West Haven, Connecticut
| | - Robert A Rosenheck
- VA New England Mental Illness, Research, Education, and Clinical Center, West Haven, Connecticut.,VA Connecticut Healthcare System, Yale University School of Medicine, West Haven, Connecticut
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20
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Williams EC, Frasco MA, Jacobson IG, Maynard C, Littman AJ, Seelig AD, Crum-Cianflone NF, Nagel A, Boyko EJ. Risk factors for relapse to problem drinking among current and former US military personnel: a prospective study of the Millennium Cohort. Drug Alcohol Depend 2015; 148:93-101. [PMID: 25599962 DOI: 10.1016/j.drugalcdep.2014.12.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/17/2014] [Accepted: 12/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Military service members may be prone to relapse to problem drinking after remission, given a culture of alcohol use as a coping mechanism for stressful or traumatic events associated with military duties or exposures. However, the prevalence and correlates of relapse are unknown. We sought to identify socio-demographic, military, behavioral, and health characteristics associated with relapse among current and former military members with remittent problem drinking. METHODS Participants in the longitudinal Millennium Cohort Study who reported problem drinking at baseline (2001-2003) and were remittent at first follow-up (2004-2006) were included (n=6909). Logistic regression models identified demographic, military service, behavioral, and health characteristics that predicted relapse (report of ≥1 past-year alcohol-related problem on the validated Patient Health Questionnaire) at the second follow-up (2007-2008). RESULTS Sixteen percent of those with remittent problem drinking relapsed. Reserve/National Guard members compared with active-duty members (odds ratio [OR]=1.71, 95% confidence interval [CI]: 1.45-2.01), members separated from the military during follow-up (OR=1.46, 95% CI: 1.16-1.83), and deployers who reported combat exposure (OR=1.32, 95% CI: 1.07-1.62, relative to non-deployers) were significantly more likely to relapse. Those with multiple deployments were significantly less likely to relapse (OR=0.73, 95% CI: 0.58-0.92). Behavioral factors and mental health conditions also predicted relapse. CONCLUSION Relapse was common and associated with military and non-military factors. Targeted intervention to prevent relapse may be indicated for military personnel in particular subgroups, such as Reservists, veterans, and those who deploy with combat exposure.
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Affiliation(s)
- Emily C Williams
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research Development, Department of Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA; Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St., Magnuson Health Sciences Center, Room H-664, Box 357660, Seattle, WA 98195-7660, USA.
| | - Melissa A Frasco
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA.
| | - Isabel G Jacobson
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA.
| | - Charles Maynard
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research Development, Department of Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA; Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St., Magnuson Health Sciences Center, Room H-664, Box 357660, Seattle, WA 98195-7660, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA.
| | - Alyson J Littman
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA 98195-7236, USA.
| | - Amber D Seelig
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA.
| | - Nancy F Crum-Cianflone
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA; Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
| | - Anna Nagel
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA.
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA 98195-7236, USA; Department of Medicine, University of Washington School of Medicine, RR-512 Health Sciences Building, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA.
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Crane CA, Schlauch RC, Easton CJ. Dual diagnosis among veterans in the United States. ADVANCES IN DUAL DIAGNOSIS 2015. [DOI: 10.1108/add-09-2014-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Over the course of their service, veterans are exposed to elevated levels of chronic stress that contribute to a greater prevalence of mental illness than observed in the general population. When mental illness is present, comorbidity is normative. Convergent evidence suggests that co-occurring substance use and mental illness is among the most prevalent forms of comorbidity within veteran samples. The purpose of this paper is to explore issues associated with dual diagnoses among veterans in the USA.
Design/methodology/approach
– Research on dual diagnoses among veterans was reviewed and consolidated for presentation into three substantive content areas consisting of prevalence, associated conditions, and treatment of dual diagnoses.
Findings
– Dually diagnosed veterans represent a group at particularly high risk for myriad adverse biopsychosocial and treatment outcomes, including poor health, suicidality, violence or aggressive behavior, arrest, homelessness, and unemployment. A comprehensive strategy has been implemented within the Veterans Health Administration to address dual diagnosis and related problems. Additional research is required to more readily identify co-occurring substance use and mental illness and to refine integrated intervention approaches to minimize burden while improving treatment outcomes for veterans and their families.
Originality/value
– The current review includes a wide range of research spanning more than two decades and describing dual diagnosis among combat veterans of all modern eras. Areas in need of further research (e.g. dual diagnosis among female veterans; early detection of psychopathology and fully integrated care among returning veterans) are identified and discussed.
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Köbach A, Schaal S, Elbert T. Combat high or traumatic stress: violent offending is associated with appetitive aggression but not with symptoms of traumatic stress. Front Psychol 2015; 5:1518. [PMID: 25709586 PMCID: PMC4285743 DOI: 10.3389/fpsyg.2014.01518] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/09/2014] [Indexed: 11/13/2022] Open
Abstract
Former members of armed groups in eastern DR Congo had typically witnessed, experienced, and perpetrated extreme forms of violence. Enhanced trauma-related symptoms had been shown in prior research. But also lashing out in self-defense is a familiar response to threat defined as reactive aggression. Another potential response is appetitive aggression, in which the perpetration of excessive violence is perceived as pleasurable (combat high). What roles do these forms of aggressive behavior play in modern warfare and how are they related to posttraumatic stress symptoms? To answer the question, we sought to determine predictors for appetitive aggressive and trauma-related mental illness, and investigated the frequency of psychopathological symptoms for high- and low-intensity conflict demobilization settings. To this end, we interviewed 213 former members of (para)military groups in the eastern Democratic Republic of Congo in regard to their combat exposure, posttraumatic stress, appetitive aggression, depression, suicidality, and drug dependence. Random forest regression embedded in a conditional inference framework revealed that perpetrated violent acts are not necessarily stressful. In fact, the experience of violent acts that typically implicated salient cues of hunting (e.g., blood, suffering of the victim, etc.) had the strongest association with an appetite for aggression. Furthermore, the number of lifetime perpetrated violent acts was the most important predictor of appetitive aggression. However, the number of perpetrated violent acts did not significantly affect the posttraumatic stress. Greater intensity of conflict was associated with more severe posttraumatic stress symptoms and depression. Psychotherapeutic interventions that address appetitive aggression in addition to trauma-related mental illness, including drug dependence, therefore seem indispensible for a successful reintegration of those who fought in the current civil wars.
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Affiliation(s)
- Anke Köbach
- Department of Psychology, University of Konstanz Konstanz, Germany ; Vivo International ( www.vivo.org )
| | - Susanne Schaal
- Vivo International ( www.vivo.org ) ; Department of Psychology, University of Ulm Ulm, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz Konstanz, Germany ; Vivo International ( www.vivo.org )
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Giebel CM, Clarkson P, Challis D. Demographic and clinical characteristics of UK military veterans attending a psychological therapies service. PSYCHIATRIC BULLETIN 2014; 38:270-5. [PMID: 25505626 PMCID: PMC4248162 DOI: 10.1192/pb.bp.113.046474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/07/2014] [Accepted: 03/31/2014] [Indexed: 11/26/2022]
Abstract
Aims and method To investigate the demographic and clinical characteristics of subgroups of UK veterans attending a dedicated psychological therapies service following the Improving Access to Psychological Therapies (IAPT) treatment model. Veterans accessing a newly established service in the north-west were categorised into three groups: early service leavers, those with a physical disability, and substance and/or alcohol misusers. Anxiety, depression and social functioning were measured pre- and post-treatment. Results Veterans vary in their demographic and clinical characteristics as well as in treatment efficacy, as measured by the post-treatment scores on probable depression and anxiety. Therapy appears to be most effective in early service leavers, whereas veterans with a physical disability or a substance or alcohol misuse problem tend not to do as well in terms of symptoms of depression or anxiety. Clinical implications This study highlights the importance of targeting different veteran subgroups for dedicated psychological therapy.
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